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What could be learned from a decade with standardized remission criteria in schizophrenia spectrum disorders: An exploratory follow-up study
Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies (from 2013). Department of psychiatry, NU Health Care Hospital, Trollhättan, Sweden.
Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies (from 2013).ORCID iD: 0000-0002-1088-9793
Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies (from 2013). Department of psychiatry, NU Health Care Hospital, Trollhättan, Sweden.
2018 (English)In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 195, no May, p. 103-109Article in journal (Refereed) Published
Abstract [en]

A decade has passed since the standardized remission criteria of schizophrenia spectrum disorders-the Andreasen Criteria-were defined. Over 2000 studies have been published, but only a few describe symptomatic remission over time. In this prospective study we followed patients for 3 and 5 years, respectively. The aim was to investigate how different symptoms affect the occurrence of remission and how the remission cut-off level affects remission sustainability. The participants were patients diagnosed with schizophrenia spectrum disorders (DSM-IV). First, the importance of each core symptom for remission was examined using the Positive and Negative Syndrome Scale (n = 274). Second, we investigated which items affect patients to either go in and out of remission or never achieve remission (n = 154). Third, we investigated how the sustainability of remission is affected by a cut-off set to 2 (minimal) and 3 (mild) points, respectively (n = 154). All core symptoms affected the occurence of remission, to a higher or lesser extent. Delusions and Hallucinatory behavior contributed the strongest to fluctuation between remission and non-remission, while the contribution of Mannerism and posturing was very marginal. Negative symptoms were enhanced when remission was never achieved. Moreover, the study found that remission duration was significantly longer for the cut-off score 2 rather than 3. The study shows that, over time, remission criteria discriminate between being stable, unstable, or never in remission. Patients with only a minimal occurrence of symptom intensity exhibit a significantly longer remission duration compared to patients with mild symptom intensity, indicating that the treatment goal should be minimal symptom intensity.

Place, publisher, year, edition, pages
Elsevier, 2018. Vol. 195, no May, p. 103-109
Keywords [en]
Symptomatic remission; Sustainability; Schizophrenia spectrum disorders
National Category
Psychiatry
Research subject
Psychology
Identifiers
URN: urn:nbn:se:kau:diva-67421DOI: 10.1016/j.schres.2017.09.007ISI: 000432466700015PubMedID: 28899583OAI: oai:DiVA.org:kau-67421DiVA, id: diva2:1211720
Available from: 2018-05-31 Created: 2018-05-31 Last updated: 2023-04-27Bibliographically approved
In thesis
1. Longitudinellt perspektiv på symtomatisk remission vid schizofreni
Open this publication in new window or tab >>Longitudinellt perspektiv på symtomatisk remission vid schizofreni
2023 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[en]
Longitudinal perspective on symptomatic remission in Schizophrenia
Abstract [en]

Objective: The overall aim of this thesis was to investigate the remission criteria according to the Remisson in Schizophrenia Working Group (RWSG), mainly from a longitudinal perspective.

Paper I showed that all remission symptoms in the RSWG criteria, affected the remission status in the cross-sectional setting. In the longitudinal setting, the symptoms Delusions and Hallucinatory behavior contributed mostly to the fluctuation between remission and non-remission, while negative symptoms were more prominent in the group that never reached remission. Finally, the sustainability of remission was significantly longer when only minimal symptom intensity occurred, compared with mild.

Paper II showed that the cognitive areas associated with long-term remission pattern were executive functioning, working memory and verbal functioning, where significant better results were shown in the group of stable remission with only minimal symptoms compared to the group never reaching remission. Verbal functioning was the only cognitive area that could predict long-term remission pattern, as a better result increased the probability of being in long-term remission.

Paper III focused on the patient’s perspective and examined the relationship between subjective quality of life (SQoL) and remission. The paper showed significant associations between a better SQoL, self-assessed with Short Form Health Survey-36, and both cross-sectional remission and long-term. A significant better SQoL was present regardless of being in stable remission over time or if remission was reached during the study period.

Conclusions: The thesis support that the RSWG criteria for remission is a valuable concept, also from a longitudinal perspective. Taken together, the results emphasize the heterogeneity of schizophrenia, where different groups within the disorder show different clinical characteristics. This thesis highlights the importance of regular assessments of broad clinical status, to support a higher frequency and sustainability of remission.

Abstract [sv]

I denna avhandling granskas remissionskriterierna enligt Remission Schizophrenia Working Group (RSWG) för personer med schizofreni ur ett longitudinellt perspektiv.

Studie I visade att alla inkluderade symtom i RSWG-kriterierna bidrog till att avgöra remissionsstatus. Negativa symtom bidrog mest till förekomsten av icke-remission över tid, medan växlingen mellan remission och icke-remission varierade mer med positiva symtom. En ökad hållbarhet i remission förelåg vid en minimal symtomintensitet, jämfört med en mild. 

Studie II visade att patienterna i stabil remission hade bättre kognitiv funktion, jämfört med de som aldrig var i remission. Ju bättre verbal funktion desto högre sannolikhet förelåg dessutom att tillhöra gruppen i stabil remission över tid. 

Studie III visade att den subjektiva livskvaliteten (SQoL) var bättre vid remission jämfört med icke-remission. En bättre SQoL förelåg oavsett om remissionsförekomsten över tid var stabil eller om den uppnåddes under studieperioden, både för den mentala och fysiska hälsan. 

Avhandlingen stöder remissionskriteriernas användbarhet ur ett longitudinellt perspektiv, och återspeglar sjukdomens heterogenitet. Avhandlingen poängterar vikten av att systematiskt följa upp de i avhandlingen undersökta faktorerna för att öka förekomsten samt hållbarheten i symtomatisk remission. 

Place, publisher, year, edition, pages
Karlstads universitet, 2023. p. 130
Series
Karlstad University Studies, ISSN 1403-8099 ; 2023:14
Keywords
Cognitive Functioning, Longitudinal, RSWG Criteria, Schizophrenia Spectrum Disorders, Subjective Quality of Life, Symptomatic Remission, Kognitiv funktion, longitudinell, RSWG-kriterier, schizofrenispektrumsyndrom, symtomatisk remission, subjektiv livskvalitet
National Category
Other Medical Sciences not elsewhere specified
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-94296 (URN)978-91-7867-370-4 (ISBN)978-91-7867-371-1 (ISBN)
Public defence
2023-06-09, 11D257, Agardhsalen, Universitetsgatan 2, Karlstad, 10:00 (Swedish)
Opponent
Supervisors
Projects
Clinical Longterm Investigation of Psychosis in Sweden (CLIPS)
Available from: 2023-05-12 Created: 2023-04-14 Last updated: 2023-06-20Bibliographically approved

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Johansson, MadeleineHjärthag, FredrikHelldin, Lars

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