Should early improvement be re-defined to better predict the maintenance of response in first-episode schizophrenia patients?

  1. R. Schennach1,
  2. M. Riesbeck2,
  3. A. Mayr1,3,
  4. F. Seemüller1,
  5. W. Maier4,
  6. S. Klingberg5,
  7. I. Heuser6,
  8. J. Klosterkötter7,
  9. M. Gastpar8,
  10. A. Schmitt9,10,
  11. H. Sauer11,
  12. F. Schneider12,
  13. M. Jäger1,
  14. W. Wölwer2,
  15. W. Gaebel2,
  16. H.-J. Möller1,
  17. M. Riedel1,13

Article first published online: 8 SEP 2012

DOI: 10.1111/acps.12006

Issue

Acta Psychiatrica Scandinavica

Acta Psychiatrica Scandinavica

Volume 127, Issue 6, pages 474–481, June 2013

Additional Information

How to Cite

Schennach, R., Riesbeck, M., Mayr, A., Seemüller, F., Maier, W., Klingberg, S., Heuser, I., Klosterkötter, J., Gastpar, M., Schmitt, A., Sauer, H., Schneider, F., Jäger, M., Wölwer, W., Gaebel, W., Möller, H.-J. and Riedel, M. (2013), Should early improvement be re-defined to better predict the maintenance of response in first-episode schizophrenia patients?. Acta Psychiatrica Scandinavica, 127: 474–481. doi: 10.1111/acps.12006

Author Information

  1. 1

    Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich

  2. 2

    Department of Psychiatry and Psychotherapy, University of Göttingen, Germany

  3. 3

    Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuernberg, Bavaria

  4. 4

    Department of Psychiatry and Psychotherapy, University of Bonn, Bonn

  5. 5

    Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen

  6. 6

    Department of Psychiatry and Psychotherapy, Charite Berlin, Campus Benjamin Franklin, Berlin

  7. 7

    Department of Psychiatry and Psychotherapy, University of Cologne, Cologne

  8. 8

    Department of General Psychiatry, Rhein Hospital Essen, Essen

  9. 9

    Department of Psychiatry and Psychotherapy, University of Göttingen, Göttingen

  10. 10

    Central Institute of Mental Health, Mannheim

  11. 11

    Department of Psychiatry and Psychotherapy, University of Jena, Jena

  12. 12

    Department of Psychiatry and Psychotherapy, RWTH Aachen University, Aachen

  13. 13

    Psychiatric Clinic, Vinzenz-von-Paul-Hospital, Rottweil, Germany

*Rebecca Schennach, Department of Psychiatry, Ludwig-Maximilians-University Munich, Nussbaumstr. 7, 80336 München, Germany. E-mail: rebecca.schennach@med.uni-muenchen.de

Publication History

  1. Issue published online: 12 MAY 2013
  2. Article first published online: 8 SEP 2012
  3. Accepted for publication July 12, 2012

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Keywords:

  • first-episode schizophrenia;
  • early response;
  • predictive validity;
  • long-term study

Schennach R, Riesbeck M, Mayr A, Seemüller F, Maier W, Klingberg S, Heuser I, Klosterkötter J, Gastpar M, Schmitt A, Sauer H, Schneider F, Jäger M, Wölwer W, Gaebel W, Möller H-J, Riedel M. Should early improvement be re-defined to better predict the maintenance of response in first-episode schizophrenia patients?

Objective:  To evaluate the predictive validity of early response in first-episode schizophrenia within a 1-year follow-up trial and to compare the resulting cutoff to the currently proposed early response definition (20% improvement by week 2).

Method:  Receiver operator characteristic (ROC) analyses were used to identify the predictive validity of the psychopathological improvement of treatment from week 1 to week 8, regarding the maintenance of response until week 52 as well as to define the most reasonable cutoff in 132 first-episode patients. The Youden Index (maximum of sensitivity and specificity) was used to compare the newly developed and the commonly used early response definition.

Results:  Starting with week 6, a reasonable validity to predict the maintenance of response was found (area under the curve = 0.721) with the best fitting cutoff being a 51.6% PANSS total score improvement. Using this cutoff 74 patients (56%) were correctly identified to become responder and maintain response during follow-up (sensitivity: 0.747). The Youden Index was higher applying the newly developed early response cutoff featuring higher specificity compared to the commonly used early response definition.

Conclusion:  Regarding long-term treatment, it seems more appropriate to base predictions of the patient’s maintenance of response not before 6 weeks of treatment.

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