Early improvement as a predictor of remission and response in schizophrenia: Results from a naturalistic study.
OBJECTIVE
To examine the predictive validity of early improvement in a naturalistic sample of inpatients and to identify the criterion that best defines early improvement.


METHODS
Two hundred and forty-seven inpatients who fulfilled ICD-10 criteria for schizophrenia were assessed with the Positive And Negative Syndrome Scale (PANSS) at admission and at biweekly intervals until discharge from hospital. Remission was defined according to the recently proposed consensus criteria, response as a reduction of at least 40% in the PANNS total score from admission to discharge.


RESULTS
Receiver operating characteristic (ROC) analyses showed that early improvement (reduction of the PANSS total score within the first 2 weeks of treatment) predicts remission (AUC=0.659) and response (AUC=0.737) at discharge. A 20% reduction in the PANSS total score within the first 2 weeks was the most accurate cut-off for the prediction of remission (total accuracy: 65%; sensitivity: 53%; specificity: 76%), and a 30% reduction the most accurate cut-off for the prediction of response (total accuracy: 76%; sensitivity: 47%; specificity: 90%).


CONCLUSIONS
The findings of clinical drug trials that early improvement is a predictor of subsequent treatment response were replicated in a naturalistic sample. Further studies should examine whether patients without early improvement benefit from an early change of antipsychotic medication.
Jäger
M
M
Department of Psychiatry, Ludwig-Maximilians University, Munich, Germany. Markus.Jaeger@bkh-guenzburg.de
Schmauss
M
M
Laux
G
G
Pfeiffer
H
H
Naber
D
D
Schmidt
L G
LG
Gaebel
W
W
Klosterkötter
J
J
Heuser
I
I
Maier
W
W
Lemke
M R
MR
Degner
D
D
Buchkremer
G
G
Gastpar
M
M
Möller
H-J
HJ
Riedel
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D019540:Area Under Curve; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D012559:Schizophrenia / Q000175:diagnosis* / Q000188:drug therapy*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014149:Tranquilizing Agents / Q000627:therapeutic use; D016896:Treatment Outcome
D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D014149:Tranquilizing Agents