Is it true remission? A study of remitted patients affected by schizophrenia and schizoaffective disorders Federica Pinna, Luca Deriu, Tiziana Lepori, Raffaela Maccioni, Paola Milia, Elisabetta Sarritzu, Massimo Tusconi, Bernardo Carpiniello n , for the Cagliari Recovery Study Group Department of Public Health, Clinical and Molecular Medicine-Section of Psychiatry, University of Cagliari, Via Liguria 13, 09127 Cagliari, Italy article info Article history: Received 29 August 2012 Received in revised form 30 July 2013 Accepted 7 August 2013 Keywords: Remission Symptomatology Functioning Quality of life Subjective well-being Schizophrenia Schizoaffective disorders abstract To date, few studies have reported analytical data relating to clinical remission, functional remission and subjective experience. The present study aimed to investigate these aspects in a sample of chronic outpatients. Methods: 112 schizophrenic or schizoaffective outpatients (Males ¼60; Females ¼52; mean age 43.5 79.42 yr) were evaluated with regard to symptomatology (SCID-I; PANSS, CGI-SCH scales), functioning (PSP scale), subjective wellbeing (SWN-K scale) and Quality of Life (WHO-QoL-Bref scale). Results: 50% of patients were found to be in remission. Significantly higher scores at PANNS, CGI-SCH, PSP, but not at SWN and WHO-QoL, were found among remitted patients; a relevant proportion of remitted subjects continued to manifest a moderate level of symptoms (score 43) both at PANSS (35% of cases) and CGI-SCH (29% of cases), significant functional impairment (total score o70) at PSP (68% of cases ), and a lesser degree of wellbeing (total score o80) at SWN-K (34% of cases). Conclusion: patients in whom clinical remission was confirmed may display persisting symptoms, relevant areas of functional impairment and a decreased sense of wellbeing. & 2013 Elsevier Ireland Ltd. All rights reserved. 1. Introduction In recent years increasing emphasis has been placed on remission (Nasrallah and Lasser, 2006) in schizophrenia, following the intro- duction of a set of well-established criteria by the Remission Schizophrenia Working Group (RSWG) (Andreasen et al., 2005), which has been proven to be conceptually viable and easy to use both in clinical trials and clinical practice (Van Os et al., 2006). Symptomatic remission is clinically relevant, as demonstrated by its association with improved functioning (De Hert et al., 2007; Helldin et al., 2007; Boden et al., 2009) but is not necessarily associated with functional improvement; indeed approx. 50% of patients treated achieve clinical remission, but only 20% reach functional remission (Schennach-Wolff et al., 2009). Moreover, the majority of functionally remitted patients are in clinical remission, whilst only a minority of clinically remitted patients achieve functional remission (Wunderink et al., 2007). The RSWG (Andreasen et al., 2005) underlined how the proposed criteria were somewhat arbitrary, being based upon only eight items of the PANSS and a cut-off score below 3, thus not excluding the presence of still clinically relevant symptoms. A recent study (Karow et al., 2012) revealed that remitted patients displayed persisting symptoms of emotional distress, deficits in different areas of functioning and reduced sense of wellbeing. The aim of the present study was to assess whether remitted patients according to RSWG severity criteria: (1) display a better symptomatic and func- tional status respect to non remitted patients, and the magnitude of these differences; (2) continued to manifest clinically relevant symptoms, although their symptomatic status was significantly better than that observed in non-remitted patients; (3) continued to display deficits in different areas of functioning, despite an overall better functioning compared to non-remitted patients; (4) continued to display impaired wellbeing and subjective quality of life, despite an overall higher level of wellbeing and subjective quality of life compared to non-remitted patients. 2. Materials and methods 2.1. Sample In the context of an ongoing prospective naturalistic follow-up study of chronic outpatients routinely treated in a community setting (Carpiniello et al., 2012), all patients with a diagnosis of schizophrenia or schizoaffective disorder according to DSM-IV-TR attending a university community mental health centre in the year 2010 were enrolled consecutively. Patients with other comorbid disorders, including patients with substance use disorders were included in the study, with the exception of those with comorbid mental retardation or organic brain diseases. Standard care Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/psychres Psychiatry Research 0165-1781/$ - see front matter & 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.psychres.2013.08.022 n Corresponding author. Tel.: þ39 307041518; fax: þ39 70480083. E-mail address: bcarpini@iol.it (B. Carpiniello). Psychiatry Research 210 (2013) 739–744