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Pharmacopsychiatry 2008; 41(5): 190-195
DOI: 10.1055/s-2008-1078745
Original Paper

© Georg Thieme Verlag KG Stuttgart · New York

Standardized Remission Criteria in Schizophrenia: Descriptive Validity and Comparability with Previously Used Outcome Measures

M. Jäger 1 , T. Messer 2 , G. Laux 3 , H. Pfeiffer 4 , D. Naber 5 , L. G. Schmidt 6 , W. Gaebel 7 , J. Klosterkötter 8 , I. Heuser 9 , W. Maier 10 , M. R. Lemke 11 , E. Rüther 12 , G. Buchkremer 13 , M. Gastpar 14 , M. Riedel 1 , R. Bottlender 1 , A. Strauß 1 , H.-J. Möller 1
  • 1Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
  • 2Psychiatric Clinic, District Hospital,Augsburg, Germany
  • 3Psychiatric Clinic, Inn-Salzach Hospital,Wasserburg/Gabersee, Germany
  • 4Psychiatric Clinic, Isar-Amper Hospital, München-Haar, Germany
  • 5Department of Psychiatry, University of Hamburg, Hamburg, Germany
  • 6Department of Psychiatry, University of Mainz, Mainz, Germany
  • 7Department of Psychiatry, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
  • 8Department of Psychiatry, University of Cologne, Cologne, Germany
  • 9Department of Psychiatry, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany
  • 10Department of Psychiatry, University of Bonn, Bonn, Germany
  • 11Psychiatric Clinic, Rheinische Kliniken, Bonn, Germany
  • 12Department of Psychiatry, University of Göttingen, Göttingen, Germany
  • 13Department of Psychiatry, University of Tübingen, Tübingen, Germany
  • 14Department of Psychiatry, University of Essen, Essen, Germany
Further Information

Publication History

received 20.11.2007 revised 12.03.2008

accepted 14.03.2008

Publication Date:
01 September 2008 (online)

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Abstract

Introduction: Standardized consensus criteria for remission in schizophrenia were recently proposed. As yet, the validity of these criteria and their comparability with previously used outcome measures are unclear.

Methods: The symptom-severity component of the proposed remission criteria was applied to 288 inpatients who fulfilled the ICD-10 criteria for schizophrenia. Global functioning and psychopathological symptoms were assessed using GAF, PANSS, SANS, HAM-D and CDSS.

Results: When patients with symptom remission at discharge from hospitalization (n=158, 54.9%) were compared to those without symptom remission, significant differences were found with respect to the global functioning (GAF) and all observed psychopathological symptom dimensions. The percentage agreement with previously used outcome measures ranged between 52.6 and 80.0%, the kappa values between 0.120 and 0.594. A moderate accordance (kappa value: 0.495) was found with a Clinical Global Impression (CGI) severity score of three or less.

Discussion: The results indicate a high descriptive validity of the symptom-severity component of the proposed remission definition. However, the new criteria differ partially from previously used outcome measures. This aspect should be considered in the interpretation of clinical trials.

References

  • 1 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorders (DSM). 4th edition. Washington DC: American Psychiatric Association 1994
  • 2 Andreasen NC. The scale for the assessment of negative symptoms (SANS). Iowa City: University of Iowa 1983
  • 3 Andreasen NC, Carpenter Jr WT, Kane JM, Lasser RA, Marder SR, Weinberger DR. Remission in schizophrenia: proposed criteria and rationale for consensus.  Am J Psychiatry. 2005;  162 441-449
    CrossrefPubMedGoogle Scholar
  • 4 Anghelescu IG, Kohnen R Szegedi A, Klement S, Kieser M. Comparison of Hypericum extract WS 5570 and paroxetine in ongoing treatment after recovery from an episode of moderate to severe depression: results from a randomized multicenter study.  Pharmacopsychiatry. 2006;  39 213-219
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Cohen J. A coefficient of agreement for nominal scales.  Educ Psychol Measure. 1960;  20 37-46
    CrossrefPubMedGoogle Scholar
  • 6 Curtis CE, Calkins ME, Grove WM, Feil KJ, Iacono WG. Saccadic disinhibition in patients with acute and remitted schizophrenia and their first-degree biological relatives.  Am J Psychiatry. 2002;  158 100-106
    PubMedGoogle Scholar
  • 7 Dunayevich E, Sethuraman G, Enerson M, Taylor CC, Lin D. Characteristics of two alternative schizophrenia remission definitions: relationship to clinical and quality of life outcomes.  Schizophr Res. 2006;  86 300-308
    CrossrefPubMedGoogle Scholar
  • 8 Emsley R, Rabinowitz J, Medori R. Time course for antipsychotic treatment response in first-episode schizophrenia.  Am J Psychiatry. 2006;  263 743-745
    PubMedGoogle Scholar
  • 9 Emsley R, Oosthuizen PP, Kidd M, Koen L, Niehaus DJ, Turner HJ. Remission in early psychosis: rates, predictors, and clinical and functional outcome correlates.  Schizophr Res. 2007;  89 129-139
    CrossrefPubMedGoogle Scholar
  • 10 Guy W. Clinical Global Impressions.  , ECDUE Assessment Manual for psychopharmacology, revised (DHEW PUBL. No. ADM 76-338) National Instituteof Mental Health, Rockville, MD 1976;  218-222
    PubMedGoogle Scholar
  • 11 Hamilton M. A rating scale for depression.  J Neurol Neurosurg Psychiatry. 1960;  23 56-62
    CrossrefPubMedGoogle Scholar
  • 12 Haro JM, Kamath SA, Ocheoa S, Novick D, Rele K, Fargas A. et al . The Clinical Global Impression-Schizophrenia scale: a simple instrument to measure the diversity of symptoms present in schizophrenia.  Acta Psychiatr Scand. 2003;  107 ((suppl. 416)) 16-23
    CrossrefPubMedGoogle Scholar
  • 13 Haro JM, Ochoa S, Gervin M, Mavreas V, Jones P. Assessment of remission in schizophrenia with the CGI and CGI-SCH scales.  Acta Psychiatr Scand. 2007;  115 263-264
    PubMedGoogle Scholar
  • 14 Harrison G, Hopper K, Craig T, Laska E, Siegel C, Wanderling J. et al . Recovery from psychotic illness: a 15- and 25-year international follow-up study.  Br J Psychiatry. 2001;  178 506-517
    CrossrefPubMedGoogle Scholar
  • 15 Honer WG, Thornton AE, Chen EY, Chan RC, Wong JO, Bergmann A. et al . Clozapine alone versus clozapine and risperidone with refractory schizophrenia.  N Engl J Med. 2006;  354 472-482
    Google Scholar
  • 16 Jäger M, Bottlender R, Strauss A, Möller HJ. Classification of functional psychoses and its implication for prognosis. Comparison between ICD-10 and DSM IV.  Psychopathology. 2004;  37 110-117
    CrossrefPubMedGoogle Scholar
  • 17 Jäger M, Riedel M, Messer T, Laux G, Pfeiffer H, Naber D. et al . Psychopathological characteristics and treatment response of first episode compared with multiple episode schizophrenic disorders.  Eur Arch Psychiatry Clin Neurosci. 2007;  257 47-53
    CrossrefPubMedGoogle Scholar
  • 18 Jäger M, Riedel M, Schmauß M, Laux G, Pfeiffer H, Naber D. et al . Prediction of symptom remission in schizophrenia during inpatient treatment.  World J Biol Psychiatry. , DOI: 10.1080/15622970701541054
    Google Scholar
  • 19 Kay SR. Positive and negative syndromes in schizophrenia: Assessment and research. Clinical and experimental psychiatry monography No. 5. New York, NY: Brunner/Mazel 1991
  • 20 Kujawa, Bossie CA, Lasser RA. Measuring remission in schizophrenia: response to Sethuraman et al., 2005.  Schizophr Res. 2006;  83 109-110
    CrossrefPubMedGoogle Scholar
  • 21 Landis JR, Koch GG. The measurement of observer agreement for categorical data.  Biometrics. 1977;  33 159-174
    CrossrefPubMedGoogle Scholar
  • 22 Lasser RA, Bossie CA, Gharabawi GM, Kane JM. Remission in schizophrenia: results from a 1-year study of long-acting risperidone injection.  Schizophr Res. 2005;  77 215-227
    CrossrefPubMedGoogle Scholar
  • 23 Lauronen E, Koskinen J, Veijola J, Miettunen J, Jones PB, Fenton WS, Isohanni M. Recovery from schizophrenic psychoses within the Northern Finland Birth Cohort.  J Clin Psychiatry. 2005;  66 375-383
    CrossrefPubMedGoogle Scholar
  • 24 Leucht S, Lasser RA. The concepts of remission and recovery in schizophrenia.  Pharmacopsychiatry. 2006;  39 161-170
    Google Scholar
  • 25 Leucht S, Beitinger R, Kissling W. On the concept of remission in schizophrenia.  Psychopharmacology (Berl). 2007;  194 453-461
    CrossrefPubMedGoogle Scholar
  • 26 Leucht S, Davis JM, Engel RR, Kane JR, Wagenpfeil S. Defining “response” in antipsychotic drug trials: recommendations for the use of scale-derived cutoffs.  Neuropsychopharmacology. 2007;  DOI 10 , .1038/sj.nnp.1301325
    PubMedGoogle Scholar
  • 27 Liberman R, Kopelowicz, Ventura J, Gutkind D. Operational criteria and factors related to recovery from schizophrenia.  Int Rev Psychiatry. 2002;  14 265-272
    PubMedGoogle Scholar
  • 28 Lieberman JA, Phillips M, Gu H, Stroup S, Zhang P, Kong L. Atypical and conventional antipsychotic drugs in treatment naïve first-episode schizophrenia: a 52-week randomized trial of clozapine vs. chlorpromazine.  Neuropsychopharmacology. 2003;  28 995-1003
    PubMedGoogle Scholar
  • 29 Marder SR, Davis JM, Chouinard G. The effects of risperidone on the five dimensions of schizophrenia derived by factor analysis: com-bined results of the North American trials.  J Clin Psychiatry. 1997;  58 538-546
    CrossrefPubMedGoogle Scholar
  • 30 Mauri MC, Volonteri LS, Dell’Osso B, Regispani F, Papa P, Baldi M, Bareggi SR. Predictors of clinical outcome in schizophrenic patients responding to clozapine.  J Clin Psychopharmacol. 2003;  23 660-664
    CrossrefPubMedGoogle Scholar
  • 31 Möller HJ, Hohe-Schramm M, Cording-Tömmel C, Schmid-Bode W, Wittchen HU, Zaudig MV, Zerssen D. The classification of functional psychoses and its implications for prognosis.  Br J Psychiatry. 1989;  154 467-472
    CrossrefPubMedGoogle Scholar
  • 32 Möller HJ. Therapieresistenz auf Antidepressiva. Definition, Häufigkeit, Prädiktoren und Interventionsmöglichkeiten.  Nervenarzt. 2004;  75 499-517
    CrossrefPubMedGoogle Scholar
  • 33 Müller MJ, Marx-Dannigkeit P, Schlösser R, Wetzel H, Addington D, Benkert O. The Calgary Depression Rating Scale for Schizophrenia: development and interrater reliability of a German version (CDSS-G).  J Psychiatr Res. 1999;  33 433-443
    CrossrefPubMedGoogle Scholar
  • 34 Nasrallah HA, Lasser R. Improving patient outcomes in schizophrenia: achieving remission.  J Psychopharmacol. 2006;  20 ((6 Suppl)) 57-61
    CrossrefPubMedGoogle Scholar
  • 35 Perkins DO, Lieberman JA, Gu H, Tohen M, McEvoy J, Green AI. et al . Predictors of antipsychotic treatment response in patients with first-episode schizophrenia, schizoaffective and schizophreniform disorders.  Br J Psychiatry. 2004;  185 18-24
    CrossrefPubMedGoogle Scholar
  • 36 Pjrek E, Winkler D, Stastny J, Praschak-Rieder N, Willeit M, Kasper S. Escitalopram in saisonal affective disorder: results of an open trial.  Pharmacopsychiatry. 2007;  40 20-24
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Sethuraman G, Taylor CC, Enerson M, Dunayevich E. A retrospective comparison of cumulative time spent in remission during treatment with olanzapine or risperidone among patients with schizophrenia.  Schizophr Res. 2005;  79 337-340
    CrossrefPubMedGoogle Scholar
  • 38 Simpson GM, Glick ID, Weiden PJ, Romano SJ, Siu CO. Randomized, controlled, double-blind multicenter comparison of the efficacy and tolerability of ziprasidone and olanzapine in acutely ill inpatients with schizophrenia or schizoaffective disorder.  Am J Psychiatry. 2004;  161 1837-1847
    CrossrefPubMedGoogle Scholar
  • 39 Simpson GM, Weiden P, Pigott T, Murray S, Siu CO, Romano SJ. Six month, blinded multicenter continuation study of ziprasidone versus olanzapine in schizophrenia.  Am J Psychiatry. 2005;  162 1535-1538
    CrossrefPubMedGoogle Scholar
  • 40 Os J, Burns T, Cavallaro R, Leucht S, Peuskens J, Helldin L. et al . Standardized remission criteria in schizophrenia.  Acta Psychiatr Scand. 2006;  113 91-95
    CrossrefPubMedGoogle Scholar
  • 41 Os J, Drukker M, a Campo J, Meijer J, Back M, Delespaul P. Validation of remission criteria for schizophrenia.  Am J Psychiatry. 2006;  163 2000-2002
    CrossrefPubMedGoogle Scholar
  • 42 WHO .The ICD-10 Classification of Mental and Behavioural Disorders. Diagnostic Criteria for Research. WHO, Geneva 1993
  • 43 Wölwer W, Buchkremer G, Häfner H, Klosterkötter J, Maier W, Möller HJ, Gaebel W. German research network on schizophrenia. Bridging the gap between research and care.  Eur Arch Clin Neurosci. 2003;  253 321-329
    CrossrefPubMedGoogle Scholar
  • 44 Wunderink L, Nienhuis FJ, Sytema S, Wiersma D. Predictive validity of proposed remission criteria in first-episode schizophrenic patients responding to antipsychotics.  Schizophr Bull. 2007;  33 792-796
    CrossrefPubMedGoogle Scholar
  • 45 Yen CF, Chen CS, Yeh ML, Yen JY, Ker JH, Yang SJ. Comparison of insight in patients with schizophrenia and bipolar disorder in remission.  J Nerv Ment Dis. 2002;  190 847-849
    CrossrefPubMedGoogle Scholar

Correspondence

M. Jäger

Department of Psychiatry II

Ulm University

BKH Günzburg

Ludwig-Heilmeyer-Str. 2

89312 Günzburg

Germany

Phone: +49/8221/96 22 04

Fax: +49/8221/96 27 37

Email: Markus.Jaeger@bkh-guenzburg.de

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