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Romero-Ayuso DM, Toledano-González A, Pinilla-Cerezo M, Sánchez-Rodríguez Ó, García-Arenas JJ, Triviño-Juárez JM, Ortíz-Rubio A. Occupational Balance and Emotional Regulation in People With and Without Serious Mental Illness. Can J Occup Ther 2024; 91:100-109. [PMID: 37271981 DOI: 10.1177/00084174231178440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Background. Serious mental illness affects daily functioning, including occupational balance. Purpose. This study aims to compare occupational balance and emotional regulation between people with serious mental illness and the healthy population and to examine the relationship between occupational balance and emotional regulation. Method. A cross-sectional study was performed. Occupational balance and emotional regulation were measured using the Occupational Balance Questionnaire and the Emotional Regulation Questionnaire, respectively. A multivariate analysis (analysis of covariance) was conducted. Findings. The sample consisted of 112 individuals, divided into two groups: the serious mental illness group (n = 55); and the healthy group (n = 57). People with serious mental illness reported lower occupational balance and lower cognitive reappraisal than the healthy population. Furthermore, the higher cognitive reappraisal, the higher the occupational balance, and the higher the expressive suppression, the lower the occupational balance. Conclusion. The results provide preliminary evidence of the relationship between occupational balance and emotional regulation.
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Sakinyte K, Holmberg C. Psychometric and clinical evaluation of schizophrenia remission criteria in outpatients with psychotic disorders. BMC Psychiatry 2023; 23:207. [PMID: 36978160 PMCID: PMC10052840 DOI: 10.1186/s12888-023-04701-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Psychotic disorders such as schizophrenia have debilitating effects on health and functioning. Given symptomatic remission's recent emergence as a viable treatment goal, the Remission in Schizophrenia Working Group's criteria (RSWG-cr), based on eight items from the Positive and Negative Syndrome Scale (PANSS-8), are frequently used in clinical and research settings. Against that background, we sought to evaluate the PANSS-8's psychometric properties and examine the RSWG-cr's clinical validity among outpatients in Sweden. METHODS Cross-sectional register data were collected from outpatient psychosis clinics in Gothenburg, Sweden. Following confirmatory and exploratory factor analyses of PANSS-8 data (n = 1,744) to assess the PANSS-8's psychometric properties, internal reliability was evaluated using Cronbach's alpha. Next, 649 of the patients were classified according to the RSWG-cr and their clinical and demographic characteristics compared. Binary logistic regression was used to estimate odds ratios (OR) and assess each variable's impact on remission status. RESULTS The PANSS-8 showed good reliability (α = .85), and the 3D model of psychoticism, disorganization, and negative symptoms presented the best model fit. According to the RSWG-cr, 55% of the 649 patients were in remission; they were also more likely to live independently, be employed, not smoke, not take antipsychotics, and have recently received a health interview and physical examination. Patients living independently (OR = 1.98), who were employed (OR = 1.89), who were obese (OR = 1.61), and who had recently received a physical examination (OR = 1.56) also had an increased likelihood of remission. CONCLUSIONS The PANSS-8 is internally reliable, and, according to the RSWG-cr, remission is associated with variables of interest for patients' recovery, including living independently and being employed. Although our findings from a large, heterogeneous sample of outpatients reflect everyday clinical practice and reinforce past observations, the directions of those relationships need to be assessed in longitudinal studies.
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Affiliation(s)
- Karolina Sakinyte
- Department of Psychotic Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Christopher Holmberg
- Department of Psychotic Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
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Carpiniello B, Pinna F, Manchia M, Tusconi M, Cavallaro R, Bosia M. Sustained symptomatic remission in schizophrenia: Course and predictors from a two-year prospective study. Schizophr Res 2022; 239:34-41. [PMID: 34839071 DOI: 10.1016/j.schres.2021.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 10/18/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although remission is a priority target in psychosis, reported rates show a marked variation across studies and instability over time. Such variability, partly due to methodology, emphasizes the need to define the optimal assessment procedure, as well as to identify reliable predictors. This study aims to: 1. longitudinally compare remission status according to different criteria; 2. identify predictors of duration and stability. METHODS 112 patients with schizophrenia or schizoaffective disorder underwent comprehensive clinical evaluations, with 24-month follow-up. Remission was assessed using three criteria: Remission in Schizophrenia Working Group (RSWG) vs Positive and Negative Syndrome Scale (PANSS) positive and negative scales (PANSS-PN) vs total score (PANSS-T). Kaplan-Meier survival analysis was used for longitudinal comparison, regression models to identify predictors of duration and stability. RESULTS At enrolment 50% of patients were in remission according to RSWG, while only 23.2% reached the other criteria. PANSS-T cumulative remission rates showed the greatest stability. Stable remission according to RSWG criteria was predicted by negative symptoms, while no significant predictors emerged for PANSS-T. Remission duration was predicted by negative, positive and cognitive symptoms and treatment dosage for RSWG criteria, while for PANSS-T the predictors were cognitive symptoms and duration of illness. CONCLUSION Results are in line with previous literature on remission rates and further support the role of basal clinical predictors. In addition, this study shows that more stringent criteria are more stable over time, suggesting their predictive value and the relevance of their use to optimize evaluations also in clinical settings.
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Affiliation(s)
- Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Federica Pinna
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Massimo Tusconi
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Roberto Cavallaro
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Marta Bosia
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Ohnishi T, Wakamatsu A, Kobayashi H. Early Improvement of Psychiatric Symptoms with Long-Acting Injectable Antipsychotic Predicts Subsequent Social Functional Remission in Patients with Schizophrenia. Neuropsychiatr Dis Treat 2021; 17:1095-1104. [PMID: 33888985 PMCID: PMC8057833 DOI: 10.2147/ndt.s294503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study was to clarify whether early symptomatic improvement in response to a long-acting injectable antipsychotic (LAI) contributes to subsequent social functional remission in patients with schizophrenia using the previous clinical trial data (EudraCT registration number: 2011-004889-15). Associations between other factors and social functional remission were also explored. PATIENTS AND METHODS We analyzed 428 patients with schizophrenia in which the personal and social performance scale (PSP) and the involvement evaluation questionnaire (IEQ) at the time of the base line were recorded. Social functional remission was defined as participants who scored PSP >70 at the end of 65 weeks. Logistic regression analyses were done to examine associations between social functional remission and clinical and demographic characteristics including early symptomatic response evaluated by Positive and Negative Syndrome Scale (PANSS) at week one. RESULTS One hundred out of 428 patients showed social functional remission at the end of the observation period. Shorter duration of illness, higher baseline score of supervision evaluated by IEQ and higher baseline PSP were significantly associated with the social functional remission. Improvement of positive subscale of PANSS at one week was significantly associated with later social functional remission when baseline PSP scores were excluded from predictive variables. CONCLUSION Shorter duration of illness, residual type of schizophrenia, higher baseline score of supervision and higher baseline social functioning were predictors of subsequent social functional remission. Although its effect seems to be limited, early symptomatic improvement could be also was a predictor of social functional remission.
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Affiliation(s)
- Takashi Ohnishi
- Medical Affairs Division, Janssen Pharmaceutical K.K., Tokyo, Japan
| | | | - Hisanori Kobayashi
- Research and Development Clinical Science Division, Janssen Pharmaceutical K.K., Tokyo, Japan
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Kim JS, Kwon YJ, Lee HY, Lee HS, Kim S, Shim SH. Mismatch Negativity Indices as a Prognostic Factor for Remission in Schizophrenia. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2020; 18:127-135. [PMID: 31958913 PMCID: PMC7006972 DOI: 10.9758/cpn.2020.18.1.127] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/06/2019] [Accepted: 09/02/2019] [Indexed: 01/18/2023]
Abstract
Objective Mismatch negativity (MMN) is known to be associated with neuro-cognition and functional outcomes. Remission and recovery rates are related to the neuro-cognition of patients with schizophrenia. The present study explored the relationship of MMN with remission in patients with schizophrenia. Methods Forty patients with schizophrenia were recruited and divided into two groups, with or without remission, according to the Remission in Schizophrenia Working Group criteria (RSWGcr). Symptom severity (Positive and Negative Syndrome Scale, PANSS), cognitive function, functional outcome, and MMN of the patients were evaluated. A regression analysis was used to identify the factors that significantly predicted symptom improvement and remission including MMN at frontal site assessed at baseline, and anticipated clinical variables as predictive factors. Results MMN amplitudes in frontal sites were further decreased in the groups without remission compared to the groups with remission. MMN amplitude was significantly correlated with measures of symptom change and functional outcome measurements in patients with schizophrenia. Regression analysis revealed that symptom severity and MMN significantly predicted remission in patients with schizophrenia. Symptom improvement significantly predicted PANSS at baseline, illness duration, and antipsychotic dose, as did MMN amplitude at frontal site. Conclusion Our results suggest that MMN reflected symptom improvement and remission in patients with schizophrenia. MMN indices appear to be promising candidates as predictive factors for schizophrenia remission.
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Affiliation(s)
- Ji Sun Kim
- Departments of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Young Joon Kwon
- Departments of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hwa Young Lee
- Departments of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Ho-Sung Lee
- Pulmonology and Allergy, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Sungkean Kim
- Department of Biomedical Engineering, Hanyang University, Seoul, Korea
| | - Se-Hoon Shim
- Departments of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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Pietrini F, Albert U, Ballerini A, Calò P, Maina G, Pinna F, Vaggi M, Boggian I, Fontana M, Moro C, Carpiniello B. The modern perspective for long-acting injectables antipsychotics in the patient-centered care of schizophrenia. Neuropsychiatr Dis Treat 2019; 15:1045-1060. [PMID: 31118640 PMCID: PMC6503342 DOI: 10.2147/ndt.s199048] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/18/2019] [Indexed: 12/31/2022] Open
Abstract
Schizophrenia is a chronic syndrome involving different clinical dimensions, and causes significant disability with a negative impact on the quality of life of patients and their caregivers. Current guidelines for the treatment of schizophrenia focus on maximizing a patient's adaptive functioning and quality of life in a recovery-oriented approach that encourages active collaboration among patients, caregivers, and mental health professionals to design and manage a customized and comprehensive care plan. In the present study, a panel of experts (psychiatrists, psychologists, nurse, and social worker) gathered to review and explore the need for contemporary use of second-generation antipsychotic long-acting injectables (SGA LAIs) in "recovery-oriented" and "patient-centered" care of schizophrenia. Starting from the available data and from sharing personal attitudes and experiences, the panel selected three clinical dimensions considered useful in characterizing each patient: phase of disease, adherence to treatment, and level of functioning. For each clinical dimension, perspectives of patients and caregivers with regard to needs, expectations, and personal experiences were reviewed and the role of SGA LAIs in achieving shared goals examined. The experts concluded that from today's modern perspectives, SGA-LAIs may play an important role in breaking the spiral of desocialization and functional decline in schizophrenia, thus favoring the recovery process.
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Affiliation(s)
- Francesco Pietrini
- Department of Mental Health and Addictions, Central Tuscany NHS Trust, Florence, Italy
| | - Umberto Albert
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Andrea Ballerini
- Department of Health Sciences, Florence University School of Medicine, Florence, Italy
| | - Paola Calò
- Department of Mental Health, Azienda Sanitaria Locale Lecce, Lecce, Italy
| | - Giuseppe Maina
- Rita Levi Montalcini Department of Neuroscience, University of Torino, Torino, Italy
| | - Federica Pinna
- Department of Medical Sciences and Public Health, Unit of Psychiatry, University of Cagliari, Cagliari, Italy
| | - Marco Vaggi
- Department of Mental Health and Drug Addiction ASL 3 Genoa, Azienda Sanitaria 3 Genovese, Genoa, Italy
| | - Ileana Boggian
- Department of Mental Health, Azienda Ulss 9 Scaligera, Legnago, Italy
| | - Maria Fontana
- Department of Mental Health, Azienda Sanitaria Locale Lecce, Lecce, Italy
| | - Cesare Moro
- Department of Mental Health and Addictions, ASST Bergamo Ovest, Treviglio, Italy
| | - Bernardo Carpiniello
- Psychiatric Clinical Unit, University Hospital of Cagliari, Cagliari, Italy.,Department of Medical Sciences and Public Health, Unit of Psychiatry, University of Cagliari, Cagliari, Italy
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Forbes A, Hobart M, Ouyang J, Shi L, Pfister S, Hakala M. A Long-Term, Open-Label Study to Evaluate the Safety and Tolerability of Brexpiprazole as Maintenance Treatment in Adults with Schizophrenia. Int J Neuropsychopharmacol 2018; 21:433-441. [PMID: 29415258 PMCID: PMC5932477 DOI: 10.1093/ijnp/pyy002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 01/25/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Brexpiprazole is a serotonin-dopamine activity modulator with efficacy in acute schizophrenia and relapse prevention. The aim of this Phase 3, multicenter study was to assess the long-term safety, tolerability, and efficacy of treatment with brexpiprazole flexible-dose 1-4 mg/d. METHODS Patients rolled over into this 52-week open-label study (amended to 26 weeks towards the end) from 3 randomized, double-blind, placebo-controlled Phase 3 studies. De novo patients, not part of the previous studies, were also enrolled. The primary outcome variable was the frequency and severity of treatment-emergent adverse events. Efficacy was assessed as a secondary objective using the Positive and Negative Syndrome Scale and the Personal and Social Performance scale. RESULTS A total of 1072 patients was enrolled (952 for 52 weeks and 120 for 26 weeks), 47.4% of whom completed the study. Among patients who took at least one dose of brexpiprazole, 14.6% discontinued due to treatment-emergent adverse events, most commonly schizophrenia (8.8%) and psychotic disorder (1.5%). Treatment-emergent adverse events with an incidence of ≥5% were schizophrenia (11.6%), insomnia (8.6%), weight increased (7.8%), headache (6.4%), and agitation (5.4%). Most treatment-emergent adverse events were mild or moderate in severity. The mean increase in body weight from baseline to week 26 was 1.3 kg and to week 52 was 2.1 kg. There were no clinically relevant findings related to prolactin, lipids, and glucose, or QT prolongation. On average, patients' symptoms and functioning showed continual improvement. CONCLUSIONS Treatment with brexpiprazole 1-4 mg/d was generally well tolerated for up to 52 weeks in patients with schizophrenia. CLINICALTRIALS.GOV IDENTIFIER NCT01397786 (https://clinicaltrials.gov/show/NCT01397786).
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Affiliation(s)
- Andy Forbes
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, New Jersey,Correspondence: Andy Forbes, PhD, Otsuka Pharmaceutical Development & Commercialization Inc., 508 Carnegie Center Drive, 1 University Square Drive, Princeton, NJ 08540 ()
| | - Mary Hobart
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, New Jersey
| | - John Ouyang
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, New Jersey
| | - Lily Shi
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, New Jersey
| | - Stephanie Pfister
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, New Jersey
| | - Mika Hakala
- Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, New Jersey,H. Lundbeck A/S, Valby, Denmark
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Naber D, Baker RA, Eramo A, Forray C, Hansen K, Sapin C, Peters-Strickland T, Nylander AG, Hertel P, Nitschky Schmidt S, Loze JY, Potkin SG. Long-term effectiveness of aripiprazole once-monthly for schizophrenia is maintained in the QUALIFY extension study. Schizophr Res 2018; 192:205-210. [PMID: 28433498 DOI: 10.1016/j.schres.2017.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 04/03/2017] [Accepted: 04/04/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate long-term safety and effectiveness of continued treatment with aripiprazole once-monthly 400mg (AOM 400) in patients with schizophrenia. METHODS Patients who completed the QUALIFY study (NCT01795547) in the AOM 400 arm were eligible for 6 additional once-monthly injections of AOM 400 during an open-label, 24-week extension (NCT01959035). Safety data were collected at each visit. Effectiveness measures included change from baseline in health-related qualify of life and functioning on the Heinrichs-Carpenter Quality of Life scale (QLS) and Clinical Global Impression - Severity (CGI-S) scale. RESULTS Of the 88 patients enrolled, 77 (88%) completed the extension study. Most common treatment-emergent adverse events (incidence ≥2%) were weight increased (6/88, 7%), toothache (3/88, 3%) and headache (3/88, 3%). Effectiveness was maintained during the extension study, with small but continued improvements from baseline: the least squares mean (LSM) change (95% CI) from baseline to week 24 was 2.32 (-1.21 to 5.85) for the QLS total score and -0.10 (-0.26 to 0.06) for the CGI-S score. The aggregated LSM change (95% CI) from baseline of the lead-in study to week 24 of the extension study was 11.54 (7.45 to 15.64) for the QLS total score and -0.98 (-1.18 to -0.79) for the CGI-S score. CONCLUSIONS AOM 400 was well tolerated in patients continuing AOM treatment during the extension phase of the QUALIFY study. Robust and clinically meaningful improvements in health-related quality of life and functioning were maintained, further supporting the long-term clinical benefits of AOM 400 for the treatment of patients with schizophrenia.
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Affiliation(s)
- Dieter Naber
- Department for Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Wellingsbütteler Landstr 136, 22337 Hamburg, Germany.
| | - Ross A Baker
- Otsuka Pharmaceutical Development & Commercialization, Inc., 508 Carnegie Center, Princeton, NJ 08540, USA.
| | - Anna Eramo
- Lundbeck LLC, 4 Parkway North, Deerfield, IL 60015, USA.
| | - Carlos Forray
- Lundbeck LLC, 215 College Road, Paramus, NJ 07652, USA.
| | - Karina Hansen
- Lundbeck SAS, 41-43 Quai du Président Roosevelt, 92445 Issy-les-Moulineaux, France.
| | - Christophe Sapin
- Lundbeck SAS, 41-43 Quai du Président Roosevelt, 92445 Issy-les-Moulineaux, France.
| | - Timothy Peters-Strickland
- Otsuka Pharmaceutical Development & Commercialization, Inc., 508 Carnegie Center, Princeton, NJ 08540, USA.
| | | | - Peter Hertel
- H. Lundbeck A/S, Ottiliavej 9, 2500 Valby, Denmark.
| | | | - Jean-Yves Loze
- Otsuka Pharmaceutical Europe Ltd., Gallions, Wexham Springs, Framewood Road, Wexham SL3 6PJ, United Kingdom.
| | - Steven G Potkin
- Department of Psychiatry and Human Behavior, University of California, Irvine, 5251 California Ave., Suite 240, Mail Code: 1680, Irvine, CA 92617, USA.
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Li N, Feng Y, Lu H, Cai SL, Zhuo J, Si T, Zhang L. Factors related to improvement of symptoms, function, and caregiver burden in Chinese patients with schizophrenia after switching to paliperidone palmitate once-monthly from oral antipsychotics. Neuropsychiatr Dis Treat 2018; 14:825-837. [PMID: 29606876 PMCID: PMC5868613 DOI: 10.2147/ndt.s158353] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Paliperidone palmitate once-monthly (PP1M) demonstrated symptomatic and functional remission in patients with schizophrenia. This post hoc analysis aimed to identify factors associated with improved clinical outcomes in patients switching to PP1M (75-150 mg eq.). METHODS The improved patient outcomes were observed as Positive and Negative Symptom Scale (PANSS, symptoms) score <70:66.7% (407/610), Personal and Social Performance (PSP, function) score >70:34.3% (199/581), and Involvement Evaluation Questionnaire (IEQ, caregiver burden) reduction ≥6:50.2% (270/538). Independent variables including demographics, disease duration, employment status, and clinical scores were screened individually using a univariate analysis and subsequently, variables (cutoff p<0.15) were analyzed using a multivariate regression analysis for association with better clinical outcomes at week 13. RESULTS The factors significantly associated with favorable clinical outcomes were reduction in PANSS at week 5 (odds ratio [OR]=1.14, 95% CI=1.11-1.17) with symptom reduction; baseline PSP total score (OR=1.07, 95% CI=1.05-1.10), PSP change at week 5 (OR=1.07, 95% CI=1.05-1.10), PANSS reduction at week 5 (OR=1.06, 95% CI=1.03-1.08) with functional improvement, reduction in PANSS at week 5 (OR=1.02, 95% CI=1.01-1.03), and total IEQ score at baseline (OR=1.09, 95% CI=1.07-1.11) with caregiver burden reduction. CONCLUSION Thus, symptom and functional improvements with caregiver burden reduction were observed in patients, and PANSS reduction at week 5 was commonly associated with favorable outcomes.
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Affiliation(s)
- Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, People's Republic of China
| | - Yu Feng
- Regional Medical Affairs, Janssen Pharmaceutical Companies of Johnson and Johnson, Singapore
| | - Huafei Lu
- Medical Affairs, Xian Janssen Pharmaceutical Ltd, Beijing, People's Republic of China
| | - Shang Li Cai
- Medical Affairs, Xian Janssen Pharmaceutical Ltd, Beijing, People's Republic of China
| | - Jianmin Zhuo
- Department of Statistics, Janssen China Research and Development, Shanghai, People's Republic of China
| | - Tianmei Si
- National Clinical Research Center for Mental Disorders and The Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, People's Republic of China.,Peking University Institute of Mental Health (The Sixth Hospital), Beijing, People's Republic of China
| | - Lili Zhang
- Medical Affairs, Xian Janssen Pharmaceutical Ltd, Beijing, People's Republic of China
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El Gharbi I, Chhoumi M, Mechri A. [Symptomatic remission and its relationship to social functioning in Tunisian out-patients with schizophrenia]. Encephale 2017; 45:15-21. [PMID: 29195805 DOI: 10.1016/j.encep.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/09/2017] [Accepted: 09/15/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The concept of symptomatic and functional remission represents an important challenge in the care of the mentally ill, particularly in patients with schizophrenia. Operational criteria for symptomatic remission in schizophrenia have been proposed by Andreasen et al. (2005). Over the last decade, these criteria have been widely validated; however few studies have been conducted outside developed countries. Moreover, the association of symptomatic remission with functional outcome has not yet been established in developing countries including Tunisia, as there may be variability in the social and familial environment. OBJECTIVES To determine the frequency and associated factors of symptomatic remission in a sample of Tunisian out-patients with schizophrenia and to explore the relationship between symptomatic remission and some indicators of social functioning. METHODS A cross-sectional study was carried-out on 115 out-patients with schizophrenia (87 males, 28 females, mean age=37.56±10.2 years) in the psychiatry department of the university hospital in Monastir (Tunisia). Nearly all of the patients (98.26%) had been hospitalized at least once in a psychiatric unit. The last hospitalization dated back to 39 months on average (range=6 months to 16 years). Symptomatic remission was assessed by the eight core items of the positive and negative syndrome scale (PANSS). These are the items P1 "Delusions"; P3 "Hallucinatory behavior" and G9 "Unusual thought content" for the positive dimension, the items P2 "Conceptual disorganization" and G5 "Mannerism and disorders of posture" for the disorganization dimension and the items N1 "Blunted affect", N4 "Social withdrawal" and N6 "Lack of spontaneity and flow of conversation" for the negative dimension. A score of mild or less on all eight-core symptoms constitutes symptomatic remission. This symptom level should have been maintained for six months. The social functioning was assessed by the Social and Occupational Functioning Assessment Scale (SOFAS) and the Social Autonomy Scale (SAS) exploring personal care, management of daily life, resource management, the relationship with the outside and the emotional life and relationships social. A multivariate analysis using a binary logistic regression was conducted with as a dependent variable "symptomatic remission" and as explanatory variables the associated variables with symptomatic remission in bivariate analysis with age and gender. RESULTS The symptomatic remission was observed in 50.4% of patients. The items corresponding to positive dimension (P1, P3 and G9) and the item P2 "conceptual disorganization" had a better predictive value of symptomatic remission. After multivariate analysis, the associated factors of symptomatic remission were the acute of onset (P=0.026), the low score of negative symptoms during the last hospitalization (P=0.017) and the episodic course (P<0.0001). However, age or gender of the patients, educational or socioeconomic level, psychiatric family history, age of onset, duration of untreated psychosis, number and duration of previous hospitalizations, antipsychotic treatment dosage were not associated with symptomatic remission in our sample. The mean score of the SOFAS was 48.47±14.44, and the mean score of the SAS was 56.6±16.84. A significant association was shown between the SOFAS score and the symptomatic remission (P<0.0001) and between the SAS score and the symptomatic remission (P<0.0001). Moreover, a significant association was found between symptomatic remission and occupational activity (P=0.03). CONCLUSION The frequency of symptomatic remission according the PANSS criteria in our sample is above the average of the reported rates in literature (30 to 60%). This can be explained by the frequency of symptomatic remission in outpatient versus inpatients, or in relation to the notion of a more favorable course of schizophrenia in developing countries, although this notion is controversial. Remitter patients had significantly an acute onset of disorders, a low score of negative symptoms during the last hospitalization and an episodic course. They also showed a significant trend for better social functioning. In fact, a significant association was shown in our sample between symptomatic remission and social functioning. These results suggest that the concept of remission has important implications for the treatment of patients with schizophrenia.
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Affiliation(s)
- I El Gharbi
- Service de psychiatrie, hôpital universitaire de Monastir, 5000 Monastir, Tunisie
| | - M Chhoumi
- Service de psychiatrie, hôpital universitaire de Monastir, 5000 Monastir, Tunisie
| | - A Mechri
- Service de psychiatrie, hôpital universitaire de Monastir, 5000 Monastir, Tunisie; Faculté de médecine de Monastir, université de Monastir, 5000 Monastir, Tunisie.
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Validity of remission and recovery criteria for schizophrenia and major depression: comparison of the results of two one-year follow-up naturalistic studies. Eur Arch Psychiatry Clin Neurosci 2017; 267:303-313. [PMID: 27785605 DOI: 10.1007/s00406-016-0741-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 10/13/2016] [Indexed: 01/15/2023]
Abstract
The objective of the present study was the application and comparison of common remission and recovery criteria between patients with the diagnosis of schizophrenia and major depressive disorder (MDD) under inclusion of other outcome parameters. Patients with schizophrenia and MDD who were treated as inpatients at the beginning of the study were examined within two naturalistic follow-up trials from admission to discharge of an inpatient treatment period and the one-year follow-up assessment. PANSS criteria of the Remission in Schizophrenia Working Group (RSWG) for schizophrenia and HAMD criteria of the ACNP Task Force in MDD for depressive patients as well as the Clinical Global Impression-Severity Scale (CGI-S) were applied as symptomatic outcome measures additionally to functional outcome parameters. Data of 153 schizophrenia patients and 231 patients with a MDD episode have been included in the analysis. More depressive than schizophrenia patients reached a threshold score of ≤3 on the CGI-S, indicating symptomatic remission at discharge and at the one-year follow-up. In contrast similar proportions of patients reaching symptomatic remission at discharge from inpatient treatment and at the one-year follow-up in the schizophrenia and in the MDD group were found when disease-related consensus criteria (RSWG vs. ACNP Task Force) were used. Functional remission and recovery rates were significantly lower in schizophrenia than in depressive patients at the one-year follow-up visit. Common outcome criteria for remission and recovery in schizophrenia and major depression were not directly comparable. However, our results indicated a significantly poorer outcome in schizophrenia than in depressive patients according to terms of remission and recovery.
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Pinna F, Tusconi M, Dessì C, Pittaluga G, Fiorillo A, Carpiniello B. Violence and mental disorders. A retrospective study of people in charge of a community mental health center. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 47:122-128. [PMID: 27180213 DOI: 10.1016/j.ijlp.2016.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Numerous studies conducted in inpatient settings have highlighted how mental disorders are associated with an increased risk of violence, particularly during acute phases. However, to date a more limited number of studies have been performed to assess the risk of violence in outpatients, particularly in Italy. The present study aims to evaluate the prevalence of violent events in a sample of patients in charge of a community mental health center in Italy. METHODS Based on data obtained from standardized clinical records, a retrospective study was undertaken to investigate acts of violence (physical aggression only) in a total of 678 patients (Males=308, 45.4%) in charge of a university mental health center; patients were mainly affected by anxiety disorders (30.7%), depressive disorder (17.2%), bipolar disorder (18.3%) and schizophrenia or other psychotic disorders (25.0%). RESULTS 27.6% of the sample had committed at least one act of violence during their lifetime, 10.5% over the previous year. 56.7% of those who committed violence acts had acted violently twice or more during their lifetime. A significant association of lifetime violence was found with gender (male), younger age, low education, unemployment, living with parents. With regard to diagnosis, a significant association was found with schizophrenia and other psychotic disorders, personality disorders, mental retardation, and comorbidity between two or more psychiatric disorders. Violence was moreover associated with early age at onset and at first psychiatric treatment, longer duration of the disorder, previous hospital admissions, previous violent events. CONCLUSION Violent behavior is relatively common among outpatients.
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Affiliation(s)
- Federica Pinna
- Department of Public Health, Clinical and Molecular Medicine, Unit of Psychiatry, University of Cagliari, Italy
| | - Massimo Tusconi
- Department of Public Health, Clinical and Molecular Medicine, Unit of Psychiatry, University of Cagliari, Italy
| | - Claudio Dessì
- Department of Public Health, Clinical and Molecular Medicine, Unit of Psychiatry, University of Cagliari, Italy
| | - Giuseppe Pittaluga
- Department of Public Health, Clinical and Molecular Medicine, Unit of Psychiatry, University of Cagliari, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, Second University of Naples (SUN), Italy
| | - Bernardo Carpiniello
- Department of Public Health, Clinical and Molecular Medicine, Unit of Psychiatry, University of Cagliari, Italy.
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Carpiniello B, Pinna F. Critical appraisal of 3-monthly paliperidone depot injections in the treatment of schizophrenia. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:1731-42. [PMID: 27307704 PMCID: PMC4887041 DOI: 10.2147/dddt.s86301] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aims Three-monthly injections of paliperidone palmitate (PP-3M) represent a new and recently introduced long-acting antipsychotic therapeutic option. This review focuses on available data relating to the efficacy and safety of PP-3M and its position in the current therapeutic scenario. Method An analysis of PubMed, Scopus, and ISI Web of Knowledge databases was conducted, and all available papers on PP-3M, including poster presentations, were selected and considered for the purpose of the present review. Findings: to date, three full papers have been published, the first, a Phase 1 randomized, open label study investigating the pharmacokinetics, safety, and tolerability of the drug; the second, a Phase 3 double blind study vs placebo focusing on efficacy and tolerability; and the last relating to the practical use of PP-3M. The five posters identified describe data reported in the above-cited papers. Overall, the pharmacokinetic findings obtained in these studies highlight the feasibility of administering PP-3M on a 3-monthly basis, subsequent to the administration of four 1-monthly injections of PP at doses 3.5 times higher than the stabilized dose of 1-monthly injections of PP (ie, 175, 300, 450, and 525 mgs). The published studies highlight a significantly longer time to relapse compared to placebo, and significantly better results compared to placebo for all secondary end-points (Positive and Negative Syndrome Scale, Clinical Global Impression-Severity Scale, Personal and Social Performance Scale scores), in addition to reasonably good safety and tolerability profiles. Conclusion PP-3M emerges as a potential candidate for use as a first-line long-acting agent in the maintenance treatment of patients with schizophrenia. Further studies should however be conducted to confirm this expectation. In view of its efficacy, tolerability, and safety, together with the longer timespan between injections, PP-3M currently represents one of the best available options, and may contribute towards addressing the issue of poor adherence, even in early psychosis.
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Affiliation(s)
- Bernardo Carpiniello
- Department of Public Health, Clinical and Molecular Medicine - Psychiatry Research Unit and Psychiatric Clinic, University Hospital, Cagliari, Italy
| | - Federica Pinna
- Department of Public Health, Clinical and Molecular Medicine - Psychiatry Research Unit and Psychiatric Clinic, University Hospital, Cagliari, Italy
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Abstract
OBJECTIVE To investigate the correlation between insight and recovery in schizophrenic patients according to criteria for both symptomatic and functional remission. METHODS Seventy patients affected by paranoid schizophrenia were recruited and treated with olanzapine, risperidone, aripiprazole, haloperidol and ziprasidone; visits were scheduled at baseline, 12 and 36 months. We administered PANSS (Positive and Negative Syndrome Scale), GAF (Global Assessment of Functioning), SF-36 (Short Form 36 Health Survey), PGWBI (Psychological General Well-Being index) and SAI (Schedule for the Assessment of Insight). RESULTS After 1 year, 50% of the subjects obtained symptom remission and 25.5% had adequate social functioning for 2 years or more. Only 12% of subjects met full recovery criteria for 2 years or longer. The recovery group also showed an improvement in insight levels, especially patients treated with second-generation antipsychotics (SGA). Recovery was predicted by female sex, higher age, SGA treatment, pre-morbid social adaptation and low level of negative symptoms at baseline. CONCLUSIONS Only a small proportion of schizophrenic patients achieved recovery, therefore greater patient's insight could have prognostic validity in terms of treatment outcome. More sensitive instruments and a larger sample are necessary to confirm these results.
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Affiliation(s)
- Dario Cannavò
- a Psychiatry Unit , Department of Clinical and Experimental Medicine - 'Policlinico - Vittorio Emanuele' University Hospital of Catania , Catania , Italy
| | - Giuseppe Minutolo
- a Psychiatry Unit , Department of Clinical and Experimental Medicine - 'Policlinico - Vittorio Emanuele' University Hospital of Catania , Catania , Italy
| | - Eliana Battaglia
- a Psychiatry Unit , Department of Clinical and Experimental Medicine - 'Policlinico - Vittorio Emanuele' University Hospital of Catania , Catania , Italy
| | - Eugenio Aguglia
- a Psychiatry Unit , Department of Clinical and Experimental Medicine - 'Policlinico - Vittorio Emanuele' University Hospital of Catania , Catania , Italy
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Pinna F, Fiorillo A, Tusconi M, Guiso B, Carpiniello B. Assessment of functioning in patients with schizophrenia and schizoaffective disorder with the Mini-ICF-APP: a validation study in Italy. Int J Ment Health Syst 2015; 9:37. [PMID: 26526168 PMCID: PMC4628277 DOI: 10.1186/s13033-015-0030-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/21/2015] [Indexed: 11/19/2022] Open
Abstract
Background The aim of the study was to evaluate validity of the Italian Mini-ICF-APP (Mini-ICF Rating for Limitations of Activities and Participation in Psychological Disorders) in schizophrenia and related disorders. Methods 74 outpatients affected by schizophrenia or schizoaffective disorders attending a University-based community mental health centre were recruited to the study. All participants underwent comprehensive evaluation using standardized instruments to assess clinical, neurocognitive and functional status. Concurrent validity of Mini-ICF-APP was evaluated and compared to severity scores obtained using the Clinical Global Impression-Schizophrenia scale (CGI-SCH), Positive and Negative Syndrome scale (PANSS), Mini Mental State Examination test (MMSE), Brief Assessment of Cognition in Schizophrenia scale (BACS) and Personal and Social Performance scale (PSP). Construct validity was evaluated by comparing scores obtained at Mini-ICF-APP by remitted versus non-remitted patients, and by recovered versus unrecovered patients. Discriminant validity was evaluated comparing scores on Mini-ICF-APP and Subjective Well-being (SWN) scale. Results: the total score and 12 out of the 13 Mini-ICF-APP items correlated significantly with total score at PSP; Mini-ICF-App total score was moreover significantly correlated with total scores at CGI-SCH, PANSS, MMSE, as well as with several BACS items. Total scores obtained at Mini-ICF-APP were significantly higher among remitted and recovered patients. No relevant correlations were found between scores of Mini-ICF-APP and SWN scales. Results The total score and 12 out of the 13 Mini-ICF-APP items correlated significantly with total score at PSP; Mini-ICF-App total score was moreover significantly correlated with total scores at CGI-SCH, PANSS, MMSE, as well as with several BACS items. Total scores obtained at Mini-ICF-APP were significantly higher among remitted and recovered patients. No relevant correlations were found between scores of Mini-ICF-APP and SWN scales. Conclusion the Italian version of Mini-ICF-APP is a valid instrument for use in evaluating functioning in chronic patients with schizophrenia and related disorders.
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Affiliation(s)
- Federica Pinna
- Department of Public Health, Clinical and Molecular Medicine-Unit of Psychiatry, University of Cagliari, Via Liguria 13, 0917 Cagliari, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Massimo Tusconi
- Department of Public Health, Clinical and Molecular Medicine-Unit of Psychiatry, University of Cagliari, Via Liguria 13, 0917 Cagliari, Italy
| | - Beatrice Guiso
- Department of Public Health, Clinical and Molecular Medicine-Unit of Psychiatry, University of Cagliari, Via Liguria 13, 0917 Cagliari, Italy
| | - Bernardo Carpiniello
- Department of Public Health, Clinical and Molecular Medicine-Unit of Psychiatry, University of Cagliari, Via Liguria 13, 0917 Cagliari, Italy
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Pinna F, Deriu L, Diana E, Perra V, Randaccio RP, Sanna L, Tusconi M, Carpiniello B. Clinical Global Impression-severity score as a reliable measure for routine evaluation of remission in schizophrenia and schizoaffective disorders. Ann Gen Psychiatry 2015; 14:6. [PMID: 25699085 PMCID: PMC4332923 DOI: 10.1186/s12991-015-0042-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 01/07/2015] [Indexed: 11/10/2022] Open
Abstract
AIMS This study aimed to compare the performance of Positive and Negative Syndrome Scale (PANSS) symptom severity criteria established by the Remission in Schizophrenia Working Group (RSWG) with criteria based on Clinical Global Impression (CGI) severity score. The 6-month duration criterion was not taken into consideration. METHODS A convenience sample of 112 chronic psychotic outpatients was examined. Symptomatic remission was evaluated according to RSWG severity criterion and to a severity criterion indicated by the overall score obtained at CGI-Schizophrenia (CGI-SCH) rating scale (≤3) (CGI-S). RESULTS Clinical remission rates of 50% and 49.1%, respectively, were given by RSWG and CGI-S, with a significant level of agreement between the two criteria in identifying remitted and non-remitted cases. Mean scores at CGI-SCH and PANSS scales were significantly higher among remitters, independent of the remission criteria adopted. Measures of cognitive functioning were largely independent of clinical remission evaluated according to both RSWG and CGI-S. When applying RSWG and CGI-S criteria, the rates of overall good functioning yielded by Personal and Social Performance scale (PSP) were 32.1% and 32.7%, respectively, while the mean scores at PSP scale differed significantly between remitted and non-remitted patients, independent of criteria adopted. The proportion of patients judged to be in a state of well-being on Social Well-Being Under Neuroleptics-Short Version scale (SWN-K) were, respectively, 66.1% and 74.5% among remitters according to RSWG and CGI-S; the mean scores at the SWN scale were significantly higher only among remitters according to CGI-S criteria. CONCLUSIONS CGI severity criteria may represent a valid and user-friendly alternative for use in identifying patients in remission, particularly in routine clinical practice.
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Affiliation(s)
- Federica Pinna
- Department of Public Health, Clinical and Molecular Medicine-Unit of Psychiatry, University of Cagliari, Via Liguria 13, 09127 Cagliari, Italy
| | - Luca Deriu
- Department of Public Health, Clinical and Molecular Medicine-Unit of Psychiatry, University of Cagliari, Via Liguria 13, 09127 Cagliari, Italy
| | - Enrica Diana
- Department of Public Health, Clinical and Molecular Medicine-Unit of Psychiatry, University of Cagliari, Via Liguria 13, 09127 Cagliari, Italy
| | - Valeria Perra
- Department of Public Health, Clinical and Molecular Medicine-Unit of Psychiatry, University of Cagliari, Via Liguria 13, 09127 Cagliari, Italy
| | - Rachele Pisu Randaccio
- Department of Public Health, Clinical and Molecular Medicine-Unit of Psychiatry, University of Cagliari, Via Liguria 13, 09127 Cagliari, Italy
| | - Lucia Sanna
- Department of Public Health, Clinical and Molecular Medicine-Unit of Psychiatry, University of Cagliari, Via Liguria 13, 09127 Cagliari, Italy
| | - Massimo Tusconi
- Department of Public Health, Clinical and Molecular Medicine-Unit of Psychiatry, University of Cagliari, Via Liguria 13, 09127 Cagliari, Italy
| | - Bernardo Carpiniello
- Department of Public Health, Clinical and Molecular Medicine-Unit of Psychiatry, University of Cagliari, Via Liguria 13, 09127 Cagliari, Italy
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Pinna F, Bosia M, Cavallaro R, Carpiniello B. Consensus five factor PANSS for evaluation of clinical remission: effects on functioning and cognitive performances. SCHIZOPHRENIA RESEARCH-COGNITION 2014; 1:187-192. [PMID: 29379752 PMCID: PMC5779203 DOI: 10.1016/j.scog.2014.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/23/2014] [Accepted: 11/03/2014] [Indexed: 11/18/2022]
Abstract
Criteria developed by the Remission in Schizophrenia Working Group (RSWG), based upon 8 core symptoms of PANSS, are generally used for evaluation of Remission. However, some concerns have arisen as regard to the ability of the RSWG criteria to detect truly remitted cases. This study aims to compare the severity criteria of remission defined by the RSWG (RSWG-cr) with more restrictive criteria, based upon the use of PANSS factor model. Methods 112 chronic psychotic outpatients were examined. Symptomatic remission according to RSWGcr was compared with remission according to criteria based on the 20-items of PANSS considered in the consensus five factor model (PANSS-FCTcr), in relation to functional and neurocognitive outcomes. Results Data from the study demonstrated the superiority of PANSS-FCTcr in identifying patients with higher functional and cognitive outcomes. Conclusion PANSS-FCTcr seems to be suitable for use in both common clinical practice and research setting, being associated with improved identification of truly remitted patients.
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Affiliation(s)
- Federica Pinna
- Department of Public Health. Clinical and Molecular Medicine-Section of Psychiatry, University of Cagliari, Via Liguria 13, 09127 Cagliari, Italy
| | - Marta Bosia
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Via Stamira d’Ancona 20, 20127, Milan, Italy
- Institute for Advanced Study, IUSS, Center for Neurolinguistics and TheoreticalSyntax (NeTS), Piazza della Vittoria 15, 27100 Pavia, Italy
| | - Roberto Cavallaro
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Via Stamira d’Ancona 20, 20127, Milan, Italy
- Corresponding author at: Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Via Stamira d’Ancona 20, 20127, Milan, Italy. Tel.: + 39 0226433218; fax: + 39 0226433265.
| | - Bernardo Carpiniello
- Department of Public Health. Clinical and Molecular Medicine-Section of Psychiatry, University of Cagliari, Via Liguria 13, 09127 Cagliari, Italy
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