On the concept of remission in schizophrenia.
BACKGROUND
Criteria for remission in schizophrenia have recently been presented. It is unclear how many acutely ill patients meet these criteria and how they compare with previously suggested definitions.


OBJECTIVE
We re-analysed seven anti-psychotic drug trials (n = 1,708) of patients with schizophrenia to find out how many met the new remission criteria and their single components, how many met two previously used remission criteria, and how many met simpler measures of response (at least 50% Brief Psychiatric Rating Scale [BPRS] reduction, a Clinical Global Impressions [CGI] improvement score of at least 'much better' or a CGI severity score of 'mild or better').


RESULTS
Thirty-seven percent/41% (last observation carried forward [LOCF]/completer analysis [CO]) of the initially acutely ill patients with positive symptoms met the severity criteria of remission at 4 weeks, and 27%/52% (worst case/CO) met the severity and time criteria at 1 year. Only 13%/21% (LOCF) met the severity criteria at 4 weeks/1 year when an item threshold 'at best very mild symptoms' was applied, and almost no patients were absolutely symptom-free. The psychotic symptoms component was more difficult to achieve than the negative component. The criteria were more stringent than 'at least 50% BPRS reduction' and than 'CGI improvement score of at least much better.' However, the definition 'CGI severity score mild or better' was of a stringency similar to the new remission criteria, which probably explains why fewer patients met previously defined criteria that included this scale.


CONCLUSIONS
The new remission criteria proved to be an achievable goal for clinical trials. A consensus on the application of their time component is still needed.
Leucht
Stefan
S
Department of Psychiatry and Psychotherapy, Technische Universität München, Klinikum rechts der Isar, Ismaningerstr 22, 81675, Munich, Germany. Stefan.Leucht@lrz.tum.de
Beitinger
Romain
R
Kissling
Werner
W
D014150:Antipsychotic Agents / Q000627:therapeutic use*; D010054:Brief Psychiatric Rating Scale / Q000706:statistics & numerical data; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004305:Dose-Response Relationship, Drug; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D012559:Schizophrenia / Q000188:drug therapy* / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome
D014150:Antipsychotic Agents