CLINICAL HANDBOOK OF SCHIZOPHRENIA

54. Remission 561ery generally means complete cessation of signs and symptoms of pathology. This doesnot imply a cure, because relapse from recovery is possible. The term cure implies eradicationof the disease. Any apparent recurrence would be a new onset of the disease, not arelapse of existing disease. Recovery from a nonmedical point of view represents a processof optimal adaptation, with certain core values such as autonomy and hope. This isdealt with in Chapter 55. The differences in the concepts are illustrated in Figure 54.1.The narrow, but vitally important, medical goal is to establish a symptomatic response,minimize psychopathology, and achieve clinical stability. Simultaneously, work on theroad to recovery should begin. This work can be described within the biopsychosocialmedical model, with attention to quality of life and personal goals related to decisionmaking, independent living, attainable self-defined goals, and responsibility for treatment.RELEVANT RESEARCHPrevious Studies and Defining Remission in SchizophreniaA number of studies have tracked the outcomes of people diagnosed with schizophrenia,but most of these studies have not focused on remission per se, but have looked at groupsof patients and their illness course. Good outcomes have been variously defined as lack ofsymptoms, absence of hospitalizations, decreased or no use of antipsychotics, and soforth. Recognizing that people diagnosed with schizophrenia do not have a uniformlypoor prognosis, the next step is to use this information. Being able to define, in measurableterms, what is meant by concepts such as remission will allow researchers to test interventionsand make statements about results. Furthermore, having an agreed-upon definitionof remission will allow comparison of interventions across trials and effectivecommunication in the field.To this end, a working group of experts in schizophrenia convened to determinepractical criteria for establishing remission in schizophrenia. This group examined remis-FIGURE 54.1. An illustration of the distinctions between the concepts of response, remission, and recoveryin schizophrenia. Note that the concepts build on one another toward the ultimate goal ofrecovery.