Measurements of Response, Remission, and Recovery in Schizophrenia and Examples for Their Clinical Application

Article AbstractDifferent definitions of response, remission, and recovery are used in schizophrenia research, which makes comparing and applying results in clinical practice difficult. Response criteria are often based on reductions in rating scale scores (eg, ≥ 20% reduction from baseline). However, when reduction scores from rating scales, such as the Positive and Negative Syndrome Scale (PANSS) and Brief Psychiatric Rating Scale (BPRS), are linked to Clinical Global Impressions (CGI) scores, which are more easily understood, rating scale scores have better clinical application. This linking process also reveals that the widely used response cutoff of 20% does not reflect clinically meaningful improvement in patients with acute, nonrefractory schizophrenia. This article provides suggestions for selecting response criteria, displaying responder rates, and using standard definitions (eg, remission, recovery) in research studies. The ultimate goal of recovery in schizophrenia treatment includes sustained symptom resolution and a return to full functioning. From the Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany. This article is derived from the planning teleconference series "Measurement-Based Strategies to Assess and Manage Schizophrenia," which was held in August 2013 and supported by an educational grant from Genentech. Dr Leucht is a consultant for Janssen, has received grant/research support from Eli Lilly, and is a member of the speakers/advisory boards for Roche, Lundbeck, Eli Lilly, Pfizer, Janssen, Bristol-Myers Squibb, Johnson & Johnson, and Sanofi-Aventis. In the last 3 years, Dr Leucht has received honoraria for lectures from AbbVie, AstraZeneca, Bristol-Myers Squibb, ICON, Eli Lilly, Janssen, Johnson & Johnson, Roche, Sanofi-Aventis, Lundbeck, and Pfizer and for consulting/advisory boards from Roche, Eli Lilly, MedAvante, Bristol-Myers Squibb, Alkermes, Janssen, Johnson & Johnson, and Lundbeck. Eli Lilly has provided medication for a study with Dr Leucht as primary investigator. Corresponding author: Stefan Leucht, MD, Klinik und Poliklinik für Psychiatrie und Psychotherapie der Technischen Universität München am Klinikum rechts der Isar, Ismaningerstr 22, 81675 München, Germany (Stefan.Leucht@lrz.tu-muenchen.de). doi:10.4088/JCP.13049su1c.02 © Copyright 2014 Physicians Postgraduate Press, Inc.