title: Towards a pragmatic and operational definition of relapse in schizophrenia: A Delphi consensus approach.
abstract: OBJECTIVE
  To develop pragmatic and operational definitions of relapse in schizophrenia.
  
  
  METHODS
  A two-round Delphi consensus approach was used. The final questionnaire based on seven pre-established definition relapse models developed by a panel of eight experts was presented to 33 general psychiatrists who attended an "ad hoc" meeting.
  
  
  RESULTS
  The most frequent components of the pragmatic definition were the psychopathological severity of the psychotic spectrum (70%), more intense management of the case (68%), a previously stabilized episode (67%), and impairment in functioning and social behavior (67%). In the operational definition, reappearance of symptoms was considered indispensable by 71% of the participants, and reappearance of positive symptoms measured by clinical scales was considered recommendable by 67%. Between 46% and 53% rated worsening of severity status and worsening of functioning as indispensable or recommendable. An increase of ≥ 10 points in the positive subscale of Positive and Negative Symptom Scale was rated by 51% of the participants, a score of 6 points in the Clinical Global Impression scale (much worse) by 89%, and a reduction of ≥ 20 points in the Global Assessment of Functioning scale by 62%.
  
  
  CONCLUSIONS
  A better understanding of the definition of relapse in schizophrenia is necessary to improve effective prevention strategies.
authors.affiliation: Department of Child and Adolescent Psychiatry, Hospital Sant Joan de Déu, CIBERSAM , Barcelona , Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: San
authors.forename: Manuel
authors.initials: M
authors.lastname: Serrano
authors.forename: Fernando
authors.initials: F
authors.lastname: Cañas
authors.forename: Samuel Leopoldo
authors.initials: SL
authors.lastname: Romero
authors.forename: Ángeles
authors.initials: Á
authors.lastname: Sánchez-Cabezudo
authors.forename: Mariano
authors.initials: M
authors.lastname: Villar
mesh_terms: D032921:Consensus; D003697:Delphi Technique; D018450:Disease Progression; D006801:Humans; D012008:Recurrence; D012559:Schizophrenia / Q000175:diagnosis* / Q000503:physiopathology*; D012720:Severity of Illness Index
keywords: Schizophrenia; relapse; treatment outcome