Schizophrenia patients, psychiatrists differ in remission definitions

By Mark Cowen

Schizophrenia patients, their families, and psychiatrists differ significantly in their perception of remission, study results show.

The team found that standardized remission criteria, as defined by the remission in schizophrenia working group, do not reflect the perception of remission by patients, for whom good subjective wellbeing is the most important outcome.

"Consequently a more thorough consideration of patients and caregivers perspectives should supplement the experts assessment of symptomatic remission alone and may guide treatment decisions by a shared and comprehensive view," comment Anne Karow (University Medical Center Hamburg-Eppendorf, Germany) and team.

As part of the European Group on Functional Outcomes and Remission in Schizophrenia project, 131 patients with schizophrenia, with a mean age of 30 years, were asked to indicate whether they had achieved symptomatic remission. For 93 of these patients, close family members were also asked to estimate whether their relative had achieved remission.

Furthermore, 130 psychiatrists were asked to assess the patients and indicate whether they had achieved remission.

Assessments by the three groups regarding remission were then compared with standardized remission criteria.

Overall, 44% of patients were in symptomatic remission according to standardized criteria. However, 39% of patients assessed themselves as in remission, 32% of family members judged their relatives to be in remission, and 61% of patients were in remission according to the psychiatrists.

Remission as defined by the psychiatrists showed the best accordance with the standardized criteria (81%), followed by relative-defined remission (52%) and patient-defined remission (43%).

Overall, only 18% of patients, relatives, and psychiatrists agreed in their assessment of remission.

While better subjective wellbeing was found to be the most important factor for remission according to the patients, better symptom scores were the most important factor for remission in assessments by the psychiatrists. Good daily and social functioning, as well as good subjective wellbeing, were also important factors for remission in assessments by psychiatrists, the researchers note.

For family members, good subjective wellbeing and symptom reduction were the most important factors indicating remission.

Karow and team conclude in European Psychiatry that "this and other studies indicate that remission as assessed by the standardized remission criteria only plays a secondary role for patients and relatives and in daily clinical practice."

They add: "Even though a concept of recovery warrants a broader perspective than reduction of symptoms alone, such a broader concept would help to integrate the views of patients, relatives and psychiatrists."

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