Predictors of Remission in Schizophrenia or Schizoaffective Disorder

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In The Netherlands, researchers found data that showed remission in patients with schizophrenia who are aged 60 or older correlates with having a partner and less intense positive symptoms.

Nearly 50% of older patients with schizophrenia or schizoaffective disorder were in symptomatic remission at a 5-year follow-up, according to a study published in Schizophrenia Research. The predictors were a lower Positive and Negative Syndrome Scale positive symptom subscale score and having a partner.

Researchers explored the relationship between the 5-year symptomatic remission rate of older patients with schizophrenia or schizoaffective disorder and potential predictors, including diagnosis, age at onset, total Positive and Negative Syndrome Scale scores, duration of illness, global cognitive state, physical comorbidity, substance abuse, depressive symptoms, limitations in daily activities, social characteristics, medication, and adherence to psychiatric services.

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All included patients were in a psychiatric catchment area, aged 60 years or over, and diagnosed with either schizophrenia or schizoaffective disorder. Data collection included symptomatology assessments, sociodemographic data, clinical evaluations, psychiatric services, and social characteristics. Follow-up data collection occurred 5 years following baseline collection.

Of the 77 patients included in this study, the mean age was 66 years old. At baseline, 27.3% of the patients were in remission, and at follow-up, 49.4% of the patients were in remission. Of the patients in remission at baseline, 3.9% converted to nonremission, while of the patients not in remission at baseline, 26.0% converted to remission.

Bivariate analysis indicated that the patients who converted to remission were more frequently diagnosed with schizoaffective disorder (P =.004), had lower total Positive and Negative Syndrome Scale scores (P <.001) with a lower positive symptom subscale score (P =.001) and lower negative symptom subscale score (P =.005), had a partner (P =.031), and had a larger social network (P =.023). Multivariate analysis indicated the positive symptom subscale score on the Positive and Negative Syndrome Scale (OR 0.75; 95% CI, 0.58–0.96; P =.023) and having a partner (OR 8.48; 95% CI, 1.10–65.5; P =.04) were the only 2 variables to predict conversion to remission at the 5-year follow-up.

Limitations of this study include the absence of patient information between baseline and follow-up, a potential bias of participation due to remission status, the small sample size based on the number of older adults diagnosed with schizophrenia or schizoaffective disorder, a possibility of type 1 errors, and the sizable number of older adults served by mental health services after a schizophrenia or schizoaffective disorder diagnosis.

The researchers concluded that “the possibility of a positive symptomatic course in late-life schizophrenia, with a quarter of patients newly attaining symptomatic remission over a 5-year period. However, with lower intensity of positive psychotic symptoms, and having a partner emerging as the only longitudinal predictors of remission, there remains a clear need to search for modifiable predictors of symptomatic remission.”

Lange SMM, Meesters PD, Stek ML, Wunderink L, Penninx BWJH, Rhebergen D. Course and predictors of symptomatic remission in late-life schizophrenia: A 5-year follow-up study in a Dutch psychiatric catchment area [published online May 9, 2019]. Schizophr Res. doi: 10.1016/j.schres.2019.04.025