Improving patient outcomes in schizophrenia: achieving remission

Abstract

The Remission in Schizophrenia Working Group has recently proposed a consensus definition of remission in schizophrenia and, based on this definition, has developed specific operational criteria for the assessment of remission. The aim of this article was to assess the application of these consensus criteria and to discuss the barriers for achieving remission. An electronic literature search of studies published between January 1990 and December 2005 examining the concepts of remission, compliance and patient satisfaction in schizophrenia was performed using Medline and EMBASE. The primary research parameters were ‘schizophrenia’, ‘remission’, ‘antipsychotics’, ‘atypicals’ and ‘conventional’. Abstracts and posters presented at key psychiatry congresses during this period were also reviewed, where available in the public domain. To date, the remission criteria have been applied retrospectively to a number of clinical studies, and these have demonstrated that the proposed definition of remission correlates significantly with established measures of symptom severity, functioning and quality of life, and appears achievable and sustainable for a significant proportion of patients receiving pharmacotherapy. The atypical antipsychotic agents have been shown to impact favourably upon certain factors that play an integral part in the achievement of remission, such as negative symptoms, cognitive impairment, social functioning and quality of life. However, non-compliance with medication remains widespread due to illness-, treatment- and clinician-related factors. The use of long-acting antipsychotic agents, with their assured medication delivery, may facilitate compliance and improve long-term treatment outcomes, possibly assisting patients in achieving remission. Remission may, therefore, be considered as a current goal of treatment today, not a distant future aim.