Towards a pragmatic and operational definition of relapse in schizophrenia: A Delphi consensus approach

Abstract

Objective. To develop pragmatic and operational definitions of relapse in schizophrenia. Methods. A two-round Delphi consensus approach was used. The final questionnaire based on seven pre-established definition relapse models developed by a panel of eight experts was presented to 33 general psychiatrists who attended an “ad hoc” meeting. Results. The most frequent components of the pragmatic definition were the psychopathological severity of the psychotic spectrum (70%), more intense management of the case (68%), a previously stabilized episode (67%), and impairment in functioning and social behavior (67%). In the operational definition, reappearance of symptoms was considered indispensable by 71% of the participants, and reappearance of positive symptoms measured by clinical scales was considered recommendable by 67%. Between 46% and 53% rated worsening of severity status and worsening of functioning as indispensable or recommendable. An increase of ≥ 10 points in the positive subscale of Positive and Negative Symptom Scale was rated by 51% of the participants, a score of 6 points in the Clinical Global Impression scale (much worse) by 89%, and a reduction of ≥ 20 points in the Global Assessment of Functioning scale by 62%. Conclusions. A better understanding of the definition of relapse in schizophrenia is necessary to improve effective prevention strategies.

Key words::

• Schizophrenia
• relapse
• treatment outcome

Acknowledgments

The authors acknowledge Content’Ed Net Communications, S.L., for editorial assistance and Marta Pulido, MD, for editing the manuscript.

Statement of interests

Janssen-Cilag. provided unrestricted support to the meeting and development of this consensus paper.

Dr. San has served as a consultant or speaker for Alexza, AstraZeneca, Bristol-Myers-Squibb, Ferrer, Janssen-Cilag, Lilly, Lundbeck, Organon, Otsuka, Pfizer, Servier, and Wyeth and has received grant support from AstraZeneca, Ferrer, FIS, Janssen-Cilag, Lilly, Health Ministry, Otsuka, and Pfizer. Dr. Cañas has served as a consultant or speaker for Janssen, Lundbeck, Otsuka, Pfizer, and Servier. Dr. Romero has served as speaker for Janssen-Cilag, Pfizer, and Lundbeck. Dr. Villar has served as speaker for Janssen-Cilag and has received hospitality and honoraria from various pharmaceutical firms. Dr Sanchez-Cabezudo has served as speaker for Janssen-Cilag, Lundbeck, Otsuka, Pfizer, Lilly, and Bristol-Meyers. The other authors declared no conflict of interests.