شدت علائم اصلی در اولین اپیزود اسکیزوفرنی و بهبودی بلند مدت

A definable concept of symptomatic remission in schizophrenia has been proposed by the Remission in Schizophrenia Working Group (RSWG). Nevertheless no studies to date assessed eventual differences in core symptoms at onset between remitters and non-remitters. The present study evaluated whether the severity of core symptoms differed among 48 patients with first episode schizophrenia (FES), and whether it predicted long-term (16-years) remission. Particularly, the present study aimed to verify if RSWG remission criteria might identify a sub-group of patients with mild core symptoms at their first episode. In the present study the severity of core symptoms was significantly lower in remitted than in non-remitted patients; interestingly, five out of the eight core symptoms already satisfied the severity criteria for remission in most remitted patients. Among the core symptoms only the severity of social withdrawal predicted the long-term outcome, while age at onset, duration of untreated psychosis and employment status did not exert any effect. Concluding, patients with FES presenting, mild core symptoms, particularly low negative symptoms, were more likely to reach long-term remission. Therefore, RSWG remission criteria seem to identify a subgroup of FES patients with mild severe core symptoms so with a higher probability to reach remission.

Since the description of dementia praecox (Kraepelin, 1899, schizophrenia has been conceptualized as a chronic illness and remission has long been considered largely impossible, with the consequence that diagnosis and prognosis were viewed as essentially the same (McGlashan, 2008). However, in the recent years the Remission in Schizophrenia Working Group (RSWG) (Andreasen et al., 2005) posited that “symptomatic remission is a definable concept and an achievable stage in the treatment of schizophrenia” and proposed criteria for symptomatic remission. According to such criteria, remission is defined as: “a state in which patients have experienced an improvement in core symptoms, to the extent that these symptoms no longer interfere significantly with daily life”. Core symptoms are those perceived as diagnostically characteristics for the condition, and eight items of the Positive and Negative Syndrome Scale (PANSS) were proposed for their evaluation. Remission is achieved if all eight items are rated as mild (Andreasen et al., 2005). According to these criteria a substantial proportion of patients with schizophrenia (45–70%) (Lambert et al., 2010) can be defined as remitters at some point during the course of their illness. However, patients who eventually reach the RSWG remission condition may be highly heterogeneous. For instance, remitted patients could have shown, at illness onset, a different severity of the core symptoms when compared to patients who will not achieve remission, even though no studies have specifically investigated this topic. Therefore, the present study aimed to evaluate whether 1) patients with first episode schizophrenia (FES) who gained remission after several years of illness differed from non-remitters with respect to the severity of the core symptoms, and 2) which of the core symptoms predicted long-term remission. Particularly, we aimed to verify if RSWG remission criteria identified a sub-group of patients with mild core symptoms at their first episode.

During the period of recruitment, 75 patients with FES were consecutively admitted to the Psychiatric Clinic. Twenty-seven patients were not included in the study: eight were lost at follow-up; three refused to be revaluated; 16 were non-adherent to the monthly visits or treatment and therefore they were excluded from the study. The remaining 48 patients participated in the study and were re-evaluated in 2010. The SCID-IV re-administration confirmed the diagnosis of schizophrenia in all 48 patients. None of them was using illicit drugs. Eighteen patients (37.5%) satisfied the remission RSWG criteria (R), while the remaining 30 patients (62.5%) did not (NR). Among remitted patients, three of them (16.7%) were in complete symptomatic recovery, nine (50%) showed minimal symptom severity and six (33.3%) had mild symptom severity at follow-up. The socio-demographics and clinical features at baseline were reported in Table 1. Table 1. Socio-demographic and symptoms features at baseline in patients with first episode schizophrenia. Remission at follow-up Yes No n. 18 n. 30 n. % n. % F a p Gender Male 10 55.5 19 63.3 0.2 0.76 Marital status 3.6 0.19 Never married 13 72.2 22 73.3 Married 5 27.8 4 13.3 Divorced/Widowed 0 0.0 4 13.3 Working status 6.4 0.01 Never occupied 4 22.2 18 60.0 Occupied 14 77.8 12 40.0 Living status 0.5 0.54 Living alone 8 44.4 10 33.3 Living with someone 10 55.6 20 66.7 mean±S.D. mean±S.D. t p Age at onset years 22.2±3.8 21.6±5.8 0.3 0.70 DUP weeks 18.0±4.5 19.7±4.4 1.2 0.20 PANSS scores Positive score 24.8±3.7 28.1±4.0 2.7 0.008 Negative score 17.8±3.1 25.3±4.4 6.1 <0.001 General psychopathology score 46.0±4.1 55.8±5.4 6.6 <0.001 Total score 88.8±6.2 109.2±10.0 7.7 <0.001 PANSS core items score Delusions (P1) 4.7±0.7 5.3±0.8 2.4 0.02 Hallucinations (P3) 3.9±1.3 4.2±1.4 0.6 0.50 Unusual thought Content (G9) 3.5±0.7 4.4±0.9 3.2 0.002 Conceptual disorganization (P2) 3.5±1.3 3.8±0.9 0.9 0.32 Mannerisms/posturing (G5) 2.7±0.8 3.3±0.9 2.3 0.02 Blunted affect (N1) 3.0±0.6 3.6±0.8 2.8 0.007 Social withdrawal (N4) 2.7±0.6 4.1±0.8 5.5 <0.001 Lack of spontaneity (N6) 1.8±0.7 3.1±0.9 4.7 <0.001 PANSS score≤3 (yes) n. % n. % F a p Delusions (P1) 1 5.6 1 3.3 0.1 1.00 Hallucinations (P3) 6 33.3 8 26.7 0.2 0.74 Unusual thought content (G9) 9 50.0 5 16.7 6.0 0.02 Conceptual disorganization (P2) 9 50.0 8 26.7 2.6 0.12 Mannerisms/posturing (G5) 15 83.3 16 53.3 4.4 0.06 Blunted affect (N1) 14 77.8 11 36.7 7.6 0.008 Social withdrawal (N4) 16 88.9 7 23.3 19.3 <0.001 Lack of spontaneity (N6) 15 83.3 16 53.3 4.4 0.06 ≥5 Items with a score ≤3 11 61.1 3 10.0 17.4 <0.001 a Fischer׳s exact test. Table options At the follow-up R and NR patients showed similar age (R: 40.5±9.8 yrs; NR: 44.8±11.7 yrs) (t=1.3; p=0.19) and duration of illness (R: 16.0±4.8 yrs; NR: 16.3±5.1 yrs) (t=0.1; p=0.85), while the number of psychotic episodes requiring hospitalization were higher in NR (3.6±1.0) than in R (2.2±0.6) (t=4.7; p<0.001).