title: Should early improvement be re-defined to better predict the maintenance of response in first-episode schizophrenia patients?
abstract: OBJECTIVE
  To evaluate the predictive validity of early response in first-episode schizophrenia within a 1-year follow-up trial and to compare the resulting cutoff to the currently proposed early response definition (20% improvement by week 2).
  
  
  METHODS
  Receiver operator characteristic (ROC) analyses were used to identify the predictive validity of the psychopathological improvement of treatment from week 1 to week 8, regarding the maintenance of response until week 52 as well as to define the most reasonable cutoff in 132 first-episode patients. The Youden Index (maximum of sensitivity and specificity) was used to compare the newly developed and the commonly used early response definition.
  
  
  RESULTS
  Starting with week 6, a reasonable validity to predict the maintenance of response was found (area under the curve = 0.721) with the best fitting cutoff being a 51.6% PANSS total score improvement. Using this cutoff 74 patients (56%) were correctly identified to become responder and maintain response during follow-up (sensitivity: 0.747). The Youden Index was higher applying the newly developed early response cutoff featuring higher specificity compared to the commonly used early response definition.
  
  
  CONCLUSIONS
  Regarding long-term treatment, it seems more appropriate to base predictions of the patient's maintenance of response not before 6 weeks of treatment.
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich Department of Psychiatry and Psychotherapy, University of Göttingen, Germany. rebecca.schennach@med.uni-muenchen.de
authors.forename: R
authors.initials: R
authors.lastname: Schennach
authors.forename: M
authors.initials: M
authors.lastname: Riesbeck
authors.forename: A
authors.initials: A
authors.lastname: Mayr
authors.forename: F
authors.initials: F
authors.lastname: Seemüller
authors.forename: W
authors.initials: W
authors.lastname: Maier
authors.forename: S
authors.initials: S
authors.lastname: Klingberg
authors.forename: I
authors.initials: I
authors.lastname: Heuser
authors.forename: J
authors.initials: J
authors.lastname: Klosterkötter
authors.forename: M
authors.initials: M
authors.lastname: Gastpar
authors.forename: A
authors.initials: A
authors.lastname: Schmitt
authors.forename: H
authors.initials: H
authors.lastname: Sauer
authors.forename: F
authors.initials: F
authors.lastname: Schneider
authors.forename: M
authors.initials: M
authors.lastname: Jäger
authors.forename: W
authors.initials: W
authors.lastname: Wölwer
authors.forename: W
authors.initials: W
authors.lastname: Gaebel
authors.forename: H-J
authors.initials: HJ
authors.lastname: Möller
authors.forename: M
authors.initials: M
authors.lastname: Riedel
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D018450:Disease Progression; D004311:Double-Blind Method; D005260:Female; D006220:Haloperidol / Q000627:therapeutic use*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012372:ROC Curve; D018967:Risperidone / Q000627:therapeutic use*; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D006220:Haloperidol; D018967:Risperidone