Objective: To examine the past and current research into the concepts of remission and recovery in schizophrenia. Data Sources: An electronic literature search of studies published between January 1990-April 2005 examining the concepts of remission and recovery in schizophrenia and the treatment of schizophrenia with antipsychotic agents was performed using Medline and EMBASE. Primary research parameters were ‘schizophrenia’, ‘remission’, ‘recovery’, ‘meta-analysis’, ‘antipsychotics’, ‘atypicals’, ‘conventional’, ‘cognition’, ‘function’ and ‘quality of life’. Study selection: English language articles, original research articles, reviews and other articles of interest were reviewed. Data extraction: Data quality was determined by publication in the peer-reviewed literature and the most important information was identified. Data synthesis: A number of different definitions of remission and recovery have been previously used, which has made comparison of study results problematic. Recently, the first operational definition of remission, based on Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria (DSM-IV) for schizophrenia, was developed. It is hoped that this will provide a standard tool for assessing the effectiveness of treatments for schizophrenia. Recovery, which encompasses both symptom remission and more functional aspects of patient's well being, such as cognition, social functionality and quality of life, is still to be satisfactorily defined. Although recent studies on new generation antipsychotics have examined some proxy outcomes related to recovery, further research is required. Conclusions: Until the definition for ‘recovery’ is further elucidated, factors such as symptom control and remission, and functional aspects of recovery such as improvements in cognition and social functioning, which are quantifiable, should be used as measures of treatment outcome and markers of recovery.
References
1
Amminger GP, Resch F, Mutschlechner R, Friedrich MH, Emst E.
Premorbid adjustment and remission of positive symptoms in first-episode psychosis.
Eur Child Adolesc Psychiatry.
1997;
6
212-218
2
Andreasen N, Carpenter W, Kane J, Lasser RA, Marder SR, Weinberger DR.
Remission in schizophrenia: proposed criteria and rationale for consensus.
Am J Psychiatry.
2005;
162
441-449
3
Andresen R, Oades L, Caputi P.
The experience of recovery from schizophrenia: towards an empirically validated stage model.
Aust N Z J Psychiatry.
2003;
37
586-594
6
Bouchard RH, Merette C, Pourcher E, Demers MF, Villenueve J, Roy-Gagnon MH. et al .
Longitudinal comparative study of risperidone and conventional neuroleptics for treating patients with schizophrenia. The Quebec Schizophrenia Study Group.
J Clin Psychopharmacol.
2000;
20
295-304
11
Colonna L, Saleem P, Dondey-Nouvel L, Rein W.
Long-term safety and efficacy of amisulpride in subchronic or chronic schizophrenia. Amisulpride Study Group.
Int Clin Psychopharmacol.
2000;
15
13-22
12
Correll CU, Leucht S, Kane JM.
Lower risk for tardive dyskinesia associated with second-generation antipsychotics: a systematic review of 1-year studies.
Am J Psychiatry.
2004;
161
414-425
13
Curtis CE, Calkins ME, Lacono WG.
Saccadic disinhibition in schizophrenia patients and their first-degree biological relatives. A parametric study of the effects of increasing inhibitory load.
Exp Brain Res.
2001;
137
228-236
16
Dolder CR, Lacro JP, Dunn LB, Jeste DV.
Antipsychotic medication adherence: is there a difference between typical and atypical agents?.
Am J Psychiatry.
2002;
159
103-108
20
Frank E, Prien RF, Jarrett RB, Keller MB, Kupfer DJ, Lavori PW.
Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse and recurrence.
Arch Gen Psychiatry.
1991;
48
851-855
22
Geddes J, Freemantle N, Harrison P, Bebbington P.
Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis.
BMJ.
2000;
321
1371-1376
26
Green MF, Marshall JrBD, Wirshing WC, Ames D, Marder SR, McGurk S.
Does risperidone improve verbal working memory in treatment-resistant schizophrenia?.
Am J Psychiatry.
1997;
154
799-804
28
Harding CM, Brooks GW, Ashikaga T, Strauss JS, Breier A.
The Vermont longitudinal study of persons with severe mental illness, II: Long-term outcome of subjects who retrospectively met DSM-III criteria for schizophrenia.
Am J Psychiatry.
1987;
144
727-735
29
Harrison G, Hopper K, Craig T, Laska E, Siegel C, Wanderling J.
Recovery from psychotic illness: a 15- and 25-year international follow-up study.
Br J Psychiatry.
2001;
178
506-517
31
Ho BC, Andreasen NC, Flaum M, Nopoulos P, Miller D.
Untreated initial psychosis: its relation to quality of life and symptom remission in first-episode schizophrenia.
Am J Psychiatry.
2000;
157
808-815
33
Keefe RS, Silva SG, Perkins DO. et al .
The effects of atypical antipsychotic drugs on neurocognitive impairment in schizophrenia: a review and meta-analysis.
Schizophr Bull.
1999;
25
201-222
36
Lambert M, Schimmelmann B, Karow A. et al .
Subjective well-being and initial dysphoric reaction under antipsychotic drugs - concepts, measurement and clinical review.
Pharmacopsychiatry.
2003;
36
181-190
37
Larsen NE, Hansen LB.
Prediction of the optimal perphenazine decanoate dose based on blood samples drawn within the first three weeks.
ThermDrug Monit.
1989;
11
642-646
40
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
41
Leucht S, Barnes TR, Kissling W, Engel RR, Correll C, Kane JM.
Relapse prevention in schizophrenia with new-generation antipsychotics: a systematic review and exploratory meta-analysis of randomized, controlled trials.
Am J Psychiatry.
2003;
160
1209-1222
42
Leucht S, Pitschel-Walz G, Abraham D, Kissling W.
Efficacy and extrapyramidal side-effects of the new antipsychotics olanzapine, quetiapine, risperidone, and sertindole compared to conventional antipsychotics and placebo. A meta-analysis of randomized controlled trials.
Schizophr Res.
1999;
35
51-68
43
Leucht S, Wahlbeck K, Hamann J, Kissling W.
New generation antipsychotics versus low-potency conventional antipsychotics: a systematic review and meta-analysis.
Lancet.
2003;
361
1581-1589
44
Leucht S, Pitschel-Walz G, Engel RR. et al .
Amisulpride, an unsual atypical antipsychotic: a meta-analysis of randomised controlled trials.
Am J Psychiatry.
2002;
159
180-190
45
Liberman R, Kopelowicz A, Ventura J, Gutkind D.
Operational criteria and factors related to recovery from schizophrenia.
Int Rev Psychiatry.
2002;
14
256-272
46
Lieberman J, Jody D, Geisler S, Alvir J, Loebel A, Szymanski S.
Time course and biologic correlates of treatment response in first-episode schizophrenia.
Arch Gen Psychiatry.
1993;
50
369-376
47
Lieberman JA, Phillips M, Gu H, Stroup S, Zhang P, Kong L.
Atypical and conventional antipsychotic drugs in treatment-naive first-episode schizophrenia: a 52-week randomized trial of clozapine vs chlorpromazine.
Neuropsychopharmacology.
2003;
28
995-1003
48
Lieberman JA, Stroip TS, McEvoy. et al .
Effectiveness of antipsychotic drugs in patients with chronic schizophrenia.
N Engl J Med.
2005;
353
1209-1223
49
Lindenmayer JP, Eerdekens E, Berry SA, Eerdekens M.
Safety and efficacy of long-acting risperidone in schizophrenia: a 12-week, multicenter, open-label study in stable patients switched from typical and atypical oral antipsychotics.
J Clin Psychiatry.
2004;
65
1084-1089
52
Mishara AL, Goldberg TE.
A meta-analysis and critical review of the effects of conventional neuroleptic treatment on cognition in schizophrenia: opening a closed book.
Biol Psychiatry.
2004;
55
1013-1022
53
Molina V, Sanz J, Sarramea F, Benito C, Palomo T.
Lower prefrontal gray matter volume in schizophrenia in chronic but not in first episode schizophrenia patients.
Psychiatry Res.
2004;
131
45-56
55
Naber D.
A self-rating to measure subjective effects of neuroleptic drugs, relationships to objective psychopathology, quality of life, compliance and other clinical variables.
Int Clin Psychopharmacol.
1995;
10
((Suppl 3))
133-138
56
Nasrallah H, Duchesne I, Mehnert A, Janagap C, Eerdekens M.
Health-related quality of life with schizophrenia during treatment with long-acting risperidone injection.
J Clin Psychiatry.
2004;
65
531-536
57
Ogawa K, Miya M, Watarai A, Nakazawa M, Yuasa S, Utena H.
A long-term follow-up study of schizophrenia in Japan with special reference to the course of social adjustment.
Br J Psychiatry.
1987;
151
758-765
59
Revicki DA, Genduso LA, Hamilton SH, Ganoczy D, Beasley Jr CM.
Olanzapine versus haloperidol in the treatment of schizophrenia and other psychotic disorders: quality of life and clinical outcomes of a randomized clinical trial.
Qual Life Res.
1999;
8
417-426
60
Robinson DG, Woerner MG, McMeniman, Mendelowitz A, Bilder RM.
Symptomatic and functional recovery from a first episode of schizophrenia or schizoaffective disorder.
Am J Psychiatry.
2004;
161
473-479
61
Rosenheck R, Cramer J, Xu W, Thomas J, Henderson W, Frisman L.
A comparison of clozapine and haloperidol in hospitalized patients with refractory schizophrenia. Department of Veterans Affairs Cooperative Study Group on Clozapine in Refractory Schizophrenia.
N Engl J Med.
1997;
337
809-815
63
Schooler N, Rabinowitz J, Davidson M, Emsley R, Harvey PD, Kopala L, McGorry PD, Van Hove I, Eerdekens M, Swyzen W, De Smedt G.
Risperdione and haloperidol in first-episdoe psychosis: a long-term randomsied trial.
Am J Psychiatry.
2005;
162
947-953
64
Sernyak MJ, Leslie DL, Alarcon RD, Losonczy MF, Rosenheck R.
Association of diabetes mellitus with use of atypical neuroleptics in the treatment of schizophrenia.
Am J Psychiatry.
2002;
159
561-566
65
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
67 Turkoz I, Lasser R, Rodriguez S, Locklear J, Mahableshwarkar A, Gharabawi G. Functioning and quality of life during long-acting risperidone maintenance treatment. In: American Psychiatric Association, May 22-26 2005 Atlanta, USA; Abstract N205
68
Valenstein M, Copeland LA, Owen R, Blow FC, Visnic S.
Adherence assessments and the use of depot antipsychotics in patients with schizophrenia.
J Clin Psychiatry.
2001;
62
545-551
69
van Os J, Bossie C, Lasser R.
Improvements in stable patients with psychotic disorders switched from oral conventional antipsychotics therapy to long-acting risperidone.
Int Clin Psychopharmacol.
2004;
19
229-232
70
Velligan DI, Mahurin RK, Diamond PL, Hazleton BC, Eckert SL, Miller AL.
The functional significance of symptomatology and cognitive function in schizophrenia.
Schizophr Res.
1997;
25
21-31
71
Wahlbeck K, Cheine M, Essali A. et al .
Evidence of clozapine's effectiveness in schizophrenia: a systematic review and meta-analysis of randomised trials.
Am J Psychiatry.
1999;
156
990-999
74
Woodward ND, Purdon SE, Meltzer HY, Zald DH.
A meta-analysis of neuropsychological change to clozapine, olanzapine, quetiapine, and risperidone in schizophrenia.
Int J Neuropsychopharmacol.
2005;
8
457-472
76
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