CLINICAL HANDBOOK OF SCHIZOPHRENIA

564 VIII. SPECIAL TOPICSbased on evidence of treatments achieving remission may be more informative than smallchanges based on symptom rating scales. Available evidence already suggests that integratedtreatment that personalizes treatment decisions, and incorporates medication andpsychosocial interventions, leads to the most favorable outcome. Finally, work toward remissioncan be responsive to the recovery/wellness movement of patients, families, andadvocates.KEY POINTS• Schizophrenia is a syndrome with varied prognosis and does not necessarily entail an inevitabledownhill course.• There is a need for a consensus definition of the medical concept of remission in schizophrenia.• The proposed definition of remission is at least 6 months of no symptoms or mild symptomsthat do not interfere with a person’s behavior.• A consistent definition will allow both standardization in research and new ways of measuringtreatment.• Clinicians should integrate medication and psychosocial interventions to maximize outcomeof patients.• Remission should be the clinical goal in treating people with schizophrenia.• The clinical concept of remission should be integrated with the concept of recovery.REFERENCES AND RECOMMENDED READINGSOn RemissionAndreason, N. C., Carpenter, Jr., W. T., Kane, J. M., Lasser, R. A., Marder, S. R., & Weinberger, D. R.(2005). Remission in schizophrenia: Proposed criteria and rationale for consensus. AmericanJournal of Psychiatry, 182(3), 441–449.Doyle, A. C., & Pollack, M. H. (2003). Establishment of remission criteria for anxiety disorders. Journalof Clinical Psychiatry, 64(Suppl. 15), 40–45.On Outcomes in SchizophreniaCarpenter, W. T., Jr. (Ed.). (2005). Recovery [Special issue]. Schizophrenia Bulletin, 31(3).Vaillant, G. E. (Guest Ed.). (1978). Prognosis and the course of schizophrenia [Special issue]. SchizophreniaBulletin, 4(1).Medication Trials and Their EvaluationCochrane Library: Available online at www.cochrane.orgHegarty, J. D., Baldessarini, R. J., Tohen, M., Waternaux, C., & Oepen, G. (1995). One hundred yearsof schizophrenia: A meta-analysis of the outcome literature. American Journal of Psychiatry,152(11), 1409–1416.Jones, P. B., Barnes, T. R., Davies, L., Dunn, G., Lloyd, H., Hayhurst, K. P., et al. (2006). Randomizedcontrolled trial of the effect on quality of life of second- vs. first-generation antipsychotic drugsin schizophrenia: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study(CUtLASS 1). Archives of General Psychiatry, 63, 1079–1087.Leucht, S., Barnes, T. R., Kissling, W., Engel, R. R., Corell, C., & Kane, J. M. (2003). Relapse preventionin schizophrenia with new-generation antipsychotics: A systematic review and exploratorymeta-analysis of randomized, controlled trials. American Journal of Psychiatry, 160(7), 1209–1222.Lieberman, J. A., Stroup, T. S., McEvoy, J. P., Swartz, M. S., Rosenbeck, R. A., Perkins, D. O., et al.(2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New EnglandJournal of Medicine, 353(12), 1209–1223.