Severity of core symptoms in first episode schizophrenia and long-term remission Carlo Marchesi a,b,n , Andrea Affaticati b , Alberto Monici b , Chiara De Panfilis a,b , Paolo Ossola a , Matteo Tonna b a Department of Neuroscience, Psychiatric Unit, University of Parma, Parma, Italy b Mental Health Department, Local Health Service, Parma, Italy article info Article history: Received 6 November 2013 Received in revised form 7 October 2014 Accepted 3 November 2014 Available online 11 November 2014 Keywords: First-episode schizophrenia Long-term remission Core symptoms abstract A definable concept of symptomatic remission in schizophrenia has been proposed by the Remission in Schizophrenia Working Group (RSWG). Nevertheless no studies to date assessed eventual differences in core symptoms at onset between remitters and non-remitters. The present study evaluated whether the severity of core symptoms differed among 48 patients with first episode schizophrenia (FES), and whether it predicted long-term (16-years) remission. Particularly, the present study aimed to verify if RSWG remission criteria might identify a sub-group of patients with mild core symptoms at their first episode. In the present study the severity of core symptoms was significantly lower in remitted than in non-remitted patients; interestingly, five out of the eight core symptoms already satisfied the severity criteria for remission in most remitted patients. Among the core symptoms only the severity of social withdrawal predicted the long-term outcome, while age at onset, duration of untreated psychosis and employment status did not exert any effect. Concluding, patients with FES presenting, mild core symptoms, particularly low negative symptoms, were more likely to reach long-term remission. Therefore, RSWG remission criteria seem to identify a subgroup of FES patients with mild severe core symptoms so with a higher probability to reach remission. & 2014 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Since the description of dementia praecox (Kraepelin, 1899, schizophrenia has been conceptualized as a chronic illness and remission has long been considered largely impossible, with the consequence that diagnosis and prognosis were viewed as essen- tially the same (McGlashan, 2008). However, in the recent years the Remission in Schizophrenia Working Group (RSWG) (Andreasen et al., 2005) posited that “symptomatic remission is a definable concept and an achievable stage in the treatment of schizophrenia” and proposed criteria for symptomatic remission. According to such criteria, remission is defined as: “a state in which patients have experienced an improvement in core symp- toms, to the extent that these symptoms no longer interfere significantly with daily life”. Core symptoms are those perceived as diagnostically characteristics for the condition, and eight items of the Positive and Negative Syndrome Scale (PANSS) were proposed for their evaluation. Remission is achieved if all eight items are rated as mild (Andreasen et al., 2005). According to these criteria a substantial proportion of patients with schizophrenia (45–70%) (Lambert et al., 2010) can be defined as remitters at some point during the course of their illness. However, patients who eventually reach the RSWG remission condition may be highly heterogeneous. For instance, remitted patients could have shown, at illness onset, a different severity of the core symptoms when compared to patients who will not achieve remission, even though no studies have specifically investigated this topic. Therefore, the present study aimed to evaluate whether 1) patients with first episode schizophrenia (FES) who gained remission after several years of illness differed from non-remitters with respect to the severity of the core symptoms, and 2) which of the core symptoms predicted long-term remission. Particularly, we aimed to verify if RSWG remission criteria identified a sub-group of patients with mild core symptoms at their first episode. 2. Methods The study protocol was approved by the local ethic committee. This study is a part of a more extensive evaluation of outcome in patients with a first psychotic Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/psychres Psychiatry Research http://dx.doi.org/10.1016/j.psychres.2014.11.005 0165-1781/& 2014 Elsevier Ireland Ltd. All rights reserved. n Corresponding author at: Università di Parma, Dipartimento di Neuroscienze, Unità di Psichiatria, Ospedale-Padiglione Braga, Via Gramsci 14, Parma 43125, Italy. Tel.: þ39 0521 903594; fax: þ39 0521 347047. E-mail address: carlo.marchesi@unipr.it (C. Marchesi). Psychiatry Research 225 (2015) 129–132