Original article Remitted but still impaired? Symptomatic versus functional remission in patients with schizophrenia A. Karow 1, *, S. Moritza 1 , M. Lambert, D. Scho ¨ ttle, D. Naber, on behalf of the EGOFORS initiative Psychosis Early Detection and Intervention Centre (PEDIC), Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany 1. Introduction Along with the development of new psychological and pharmacological treatment strategies for schizophrenia and a higher proportion of patients with a satisfactory long-term outcome on one hand, and the use of variable definitions for outcome on the other hand the call for a consensual definition of symptomatic remission for patients with schizophrenia became louder. In 2005, the Remission in Schizophrenia Working Group defined symptomatic remission as the relative absence of core positive and negative symptoms such as hallucinations, delusions, and disorganized speech and behaviour [1]. The corresponding European Working group suggested that this definition would enhance the conduct of clinical investigations and reset expecta- tions for treatment outcome at a higher level [24]. Different studies reported that symptomatic remission as defined by Andreasen et al. is significantly associated with better social and daily functioning but not necessarily accompanied with functional remission in all domains. Boden et al. applied the remission criteria to a sample of patients with first-episode schizophrenia and explored the association with functional outcome five years after their first presentation to mental health care. They found symptomatic remission strongly associated with better functioning and subjective life satisfaction [5]. Robinson et al. on the contrary reported that after five years of treatment nearly 50% of patients with a first-episode of schizophrenia spectrum disorders had achieved symptomatic remission, but only half of them had achieved an adequate social functioning. Lambert et al. found relevant differences between symptomatic and functional remission in three different samples of patients with schizophrenia as well. In patients with multiple episodes of schizophrenia symptomatic remission was achieved by 33% after 18 months of treatment, whereas combined symptomatic and functional remission was found in 21% [13]. In a sample of 392 never-treated patients with schizophrenia 60% were in symptom- atic remission and 45% in functional remission after three years of treatment and s large schizophrenia outpatients study showed symptomatic remission for 47% and functional remission for 27% European Psychiatry xxx (2011) xxx–xxx ARTICLE INFO Article history: Received 24 August 2010 Received in revised form 13 January 2011 Accepted 14 January 2011 Keywords: Schizophrenia Remission Recovery Functional outcome Subjective well-being ABSTRACT Introduction. – Studies reported close associations between functional outcome and symptomatic remission as defined by the Remission in Schizophrenia Working Group. This observational study was aimed at the investigation of deficits in daily functioning, symptoms and subjective well-being in remitted and non-remitted patients with schizophrenia. Methods. – Symptoms (PANSS), functional outcome (FROGS, GAF), subjective well-being (SWN-K) and other characteristics were assessed in 131 patients with schizophrenia (DSM-IV) within the European Group on Functional Outcomes and Remission in Schizophrenia (EGOFORS) project. Results. – A significant better level of functioning was measured for remitted versus non-remitted patients, though remitted patients still showed areas with an inadequate level of functioning. Functional deficits were most often seen in social relations (40%), work (29%) and daily life activities (17%). Best functioning was assessed for self-care, self-control, health management and medical treatment. A moderate to severe level of disorganization and emotional distress was observed in 38% and impaired subjective well-being in 29% of patients defined as being in symptomatic remission. Discussion. – The results confirm a close association between symptomatic remission and functional outcome. However, deficits in different areas of functioning, symptoms and well-being underline the need for combined outcome criteria for patients with schizophrenia. ß 2011 Elsevier Masson SAS. All rights reserved. * Corresponding author. Tel.: +49 40 7410 57384; fax: +49 40 7410 55455. E-mail address: karow@uke.de (A. Karow). 1 Denotes equal contribution. G Model EURPSY-2937; No. of Pages 5 Please cite this article in press as: Karow A, et al. Remitted but still impaired? Symptomatic versus functional remission in patients with schizophrenia. European Psychiatry (2011), doi:10.1016/j.eurpsy.2011.01.012 0924-9338/$ – see front matter ß 2011 Elsevier Masson SAS. All rights reserved. doi:10.1016/j.eurpsy.2011.01.012