One-year functional outcomes of naturalistically treated patients with schizophrenia Ilja Spellmann ⁎, Michael Riedel, Rebecca Schennach, Felix Seemüller, Michael Obermeier, Richard Musil, Markus Jäger, Max Schmauß, Gerd Laux, Herbert Pfeiffer, Dieter Naber, Lutz G. Schmidt, Wolfgang Gaebel, Joachim Klosterkötter, Isabella Heuser, Wolfgang Maier, Matthias R. Lemke, Eckart Rüther, Stefan Klingberg, Markus Gastpar, Hans-Jürgen Möller Psychiatrische Klinik der LMU München, Nußbaumstr. 7, 80336 München, Germany abstract article info Article history: Received 31 July 2011 Received in revised form 2 December 2011 Accepted 30 December 2011 Keywords: Schizophrenia Symptomatic remission Functional remission Against the background of the growing evidence that the patient's functioning significantly influences the course and outcome of schizophrenia, the aims of this analysis were to examine what proportion of patients achieve func- tional outcome criteria after 1 year, and to identify clinical and sociodemographic predictive factors for functional remission. Patients with the diagnosis of schizophrenia who were treated as inpatients at the beginning of the study were examined within a naturalistic follow-up trial. The present study reports on the time frame from ad- mission to discharge of an inpatient treatment period and the 1-year follow-up assessment. The Global Assessment of Functioning (GAF) Scale and Social and Occupational Functioning Assessment Scale (SOFAS) were evaluated with respect to functional outcome, whereas Positive and Negative Syndrome Scale (PANSS) scores were rated as psychopathological outcome measures. Functional remission thresholds were defined according to a GAF score of ≥61 points and a SOFAS score ≥61 points. Symptomatic remission criteria were applied according to the remission criteria of the Schizophrenia Working Group. The Strauss–Carpenter Prognostic Scale (SCPS), the Phillips Premorbid Adjustment Scale, medical history, sociodemographic and psychopathologic parameters were evaluated in order to find valuable predictors for functional remission. One year after discharge from inpatient treatment, 211 out of 474 patients were available for analysis according to both rating scales used to assess func- tional remission (GAF and SOFAS). Forty-seven percent of patients fulfilled criteria for functional remission (GAF and SOFAS) at discharge and 51% of patients at the 1-year follow-up visit. With regard to symptomatic remission criteria, the corresponding remitter rates were 61% of patients at discharge and 54% at the 1-year follow-up visit. Forty-two percent of patients fulfilled both remission criteria at discharge and 37% at the 1-year follow-up visit. A significant association was found between functional and symptomatic remission at discharge and at the 1-year follow-up visit. The strongest predictors for functional remission at the 1-year follow-up visit were: a higher SCPS total score at admission, a lower number of previous hospitalizations, a status of employment, lower scores in all PANSS subscales at discharge, a better premorbid social adjustment, the occurrence of a first psychotic epi- sode, a younger age, a lower PANSS negative subscore at admission, a status of being an early responder, a shorter duration of inpatient treatment, a later age of onset, and female gender. © 2012 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Traditionally, treatment conceptions in schizophrenia have empha- sized the reduction of psychotic symptoms. At least since the develop- ment of second-generation antipsychotics (SGAs), however, the targets of therapeutic efforts have been extended. Additional positive effects of SGAs on depressive or cognitive symptoms contribute to improvements in quality of life or in social and occupational functioning of patients. Re- cently, symptomatic remission criteria have been proposed by the Re- mission in Schizophrenia Working Group concurrently acknowledging that their definition for remission requires further examination of its validity and utility, as well as future refinement, particularly in relation to psychosocial functioning and cognitive dysfunctions (Andreasen et al., 2005). The importance of functional outcome parameters in patients with schizophrenia was acknowledged in 1980 with its formal inclusion as one of the five axes of patient clinical status in the Diagnostic and Sta- tistical Manual of Mental Disorders, Third Edition (DSM-III) classification system (American Psychiatric Association, 1987), which was retained in the subsequent DSM-IV (American Psychiatric Association, 2000). Im- pairments in patient functioning can lead to decreased medication ad- herence, increased risk of hospitalization, and diminished ability to either engage in relationships or to maintain employment, which can further impact the disease progression (Leucht and Heres, 2006; Lieberman et al., 2006; Leifker et al., 2009). Furthermore, schizophrenia is associated with considerable eco- nomic burden due to the loss in productivity as well as the costs of Psychiatry Research 198 (2012) 378–385 ⁎ Corresponding author. Tel.: + 49 89/5160 5888; fax: + 49 89/5160 5188. E-mail address: ilja.spellmann@med.uni-muenchen.de (I. Spellmann). 0165-1781/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.psychres.2011.12.047 Contents lists available at SciVerse ScienceDirect Psychiatry Research journal homepage: www.elsevier.com/locate/psychres