Design and validation of standardized clinical and functional remission criteria in schizophrenia

Figures & data

Table 1 Distribution of categorical (clinical) remission types (cross-section population study)

	Remission types	Patients/% of patients in remission (N=182)
Patients in partial remission: 167 (82.3% of included patients)
Symptomatic remission	Total: 84, 46.2%
	Thymopathic	20/11%
	Obsessive	1/0.5%
	Hypochondriac	2/1.0%
	Paranoid	61/33.5%
Syndromic remission	Total: 83, 45.6%
	Sthenic	4/2.2%
	Pseudopsychopathic	25/13.7%
	Apathetic	35/19.2%
	Asthenic	19/10.4%

Table 2 SCFRC in schizophrenia according to the ICD10 diagnosis

Dimensions of psychopathology	ICD10 diagnosis (clinical forms)	F20.01 F20.03 F25	F20.00	F20.02	F20.3	F20.5	F20.6
	PANSS items	Severity threshold score
Psychoticism (reality distortion)	Delusions (P1)	≤3	≤5	≤3	≤4	–	–
	Unusual thought content (G9)	≤3	≤5	≤3	≤4	≤3	–
	Hallucinations (P3)	≤3	≤4	≤3	≤4	–	–
Disorganization	Conceptual disorganization (P2)	≤3	≤3	≤3	≤3	≤3	–
	Mannerisms/posturing (G5)	≤3	≤3	≤3	≤3	≤3	≤3
Negative symptoms	Blunted affect (N1)	≤3	≤4	≤4	≤4	≤4	≤4
	Social withdrawal (N4)	≤3	≤4	≤4	≤4	≤4	≤4
	Lack of spontaneity and flow of conversation (N6)	≤3	≤4	≤3	≤4	≤4	≤4
Autistic remission	Emotional withdrawal (N2)	–	≤4	≤4	≤4	≤4	–
Affective symptoms	Depression (G6)	≤3	≤3	≤3	≤3	≤3	≤3
Remission similar to that in acquired cyclothymia	Hyperactivity (P4)	≤3	–	≤3	≤3	–	–
Disturbance of volition (changes similar to those in dependent personality)	Disturbance of volition (G13)	≤3	–	≤3	–	≤3	–
Insight	Lack of judgment and insight (G12)	≤3	≤4	≤3	≤3	≤3	≤3
Supplemental aggression risk symptoms (pseudopsychopathic remission)	Difficulties in delay of gratification (S2)	–	≤4	≤4	≤4	≤4	–
	Affective lability (S3)	–	≤4	≤4	≤4	≤4	–
PSP scale		71–80 or more	51–60 or more	51–70 or more	51–60 or more	51–70 or more	51–70 or more

Note: Duration criterion was defined as maintenance of symptomatic remission over 6-month period.

Abbreviations: SCFRC, Standardized Clinical and Functional Remission Criteria; ICD10, International Classification of Diseases Version 10; PANSS, Positive and Negative Syndrome Scale; PSP, Personal and Social Performance scale.

Figure 1 Comparative sensitivity and validity of symptomatic IRC and SCFRC in two independent populations of schizophrenic outpatients.

Note: Cross-sectional population studies in two different outpatient services.
Abbreviations: IRC, International Remission Criteria; SCFRC, Standardized Clinical and Functional Remission Criteria.

Figure 2 Comparative sensitivity and validity of IRC and SCFRC.

Note: Cohort observational, 12-month prospective, switch study from naturalistic antipsychotic therapy to RLAI in stable schizophrenic outpatients.
Abbreviations: IRC, International Remission Criteria; SCFRC, Standardized Clinical and Function Remission Criteria; RLAI, risperidone long-acting injectable.

Figure 3 Remission rate according to SCFRC and IRC on 12 months of comparative randomized trial of RLAI and olanzapine.

Abbreviations: SCFRC, Standardized Clinical and Functional Remission Criteria; IRC, International Remission Criteria; RLAI, risperidone long-acting injectable; p/o, per os (to be taken orally).

Table 3 Distribution of patients in remission who met the SCFRC and the IRC, according to the ICD10 diagnosis in an independent sample of schizophrenic outpatients (cross-sectional population study)

Diagnosis (ICD10)	Number of patients	IRC	SCFRC
			Symptomatic criteria	Functional criterion	Symptomatic and functional criteria
F20.00	25 (100%)	0 (0%)	12 (48%)	14 (60.9%)	9 (36%)
F20.01	23 (100%)	16 (69.6%)	15 (65.2%)	11 (47.8%)	10 (43.5%)
F20.02	27 (100%)	5 (21.7%)	19 (70.4%)	19 (70.4%)	18 (66.7%)
F20.03	5 (100%)	4 (80%)	3 (60%)	5 (100%)	3 (60%)
F20.3	7 (100%)	3 (42.9%)	4 (57.1%)	6 (85.7%)	4 (57.1%)
F20.5	6 (100%)	0 (0%)	5 (83.3%)	5 (83.3%)	5 (83.3%)
F20.6	3 (100%)	0 (0%)	2 (66.7%)	2 (66.7%)	2 (66.7%)
F25	8 (100%)	8 (100%)	7 (87.5%)	8 (100%)	7 (87.5%)
Total	104 (100%)	36 (35%)	68 (65%)	70 (67%)	58 (56%)

Abbreviations: SCFRC, Standardized Clinical and Functional Remission Criteria; IRC, International Remission Criteria; ICD10, International Classification of Diseases Version 10.

Figure 4 One-way analysis of variance of correspondence to the remission criteria (IRC and SCFRC) to diagnosis by ICD10.

Abbreviations: PAR, paranoid; NDIF, non-differentiated; RES, residual; SIMP, simple; SCAF, schizoaffective disorder; Cont, continuous; Epis progr, episodic progressive; Epis stable, episodic stable; Epis remit, episodic remittent; SCFRC, Standardized Clinical and Functional Remission Criteria; IRC, International Remission Criteria.

Table 4 Descriptive statistics of PANSS items and mean PSP score, according to ICD10 diagnosis

PANSS items	ICD10 diagnosis
	F20.00	F20.01	F20.02	F20.03	F20.3	F20.5	F20.6	F25
	Mean score ± SD/75^th percentile
Delusions (P1)	3.9 (±1.0)/4	1.9 (±0.8)/2	2.3 (±1.0)/3	1.4 (±0.5)/2	2.6 (±1.6)/4	1.0 (±0)/1	1.0 (±0)/1	1.3 (±0.5)/1.5
Unusual thought content (G9)	3.6 (±0.8)/4	2.2 (±0.8)/3	2.5 (±0.8)/3	1.8 (±1.1)/3	2.6 (±0.8)/3	1.0 (±0)/1	1.0 (±0)/1	1.5 (±0.5)/2
Hallucinations (P3)	2.7 (±1.5)/4	1.4 (±0.7)/2	1.5 (±0.8)/2	1.0 (±0)/1	1.9 (±1.2)/3	1.0 (±0)/1	1.0 (±0)/1	1.0 (±0)/1
Conceptual disorganization (P2)	3.5 (±1.1)/4	2.4 (±0.8)/3	2.5 (±0.9)/3	1.2 (±0.4)/1	2.7 (±1.1)/3	2.5 (±0.8)/3	1.3 (±0.5)/2	1.6 (±0.5)/2
Mannerisms/posturing (G5)	3.1 (±0.6)/3	1.9 (±0.9)/2	2.7 (±0.8)/3	1.8 (±0.8)/2	2.7 (±1.4)/4	3.0 (±0)/3	2.3 (±1.2)/3	2.0 (±0.9)/3
Blunted affect (N1)	3.6 (±0.9)/4	2.7 (±0.9)/3	3.7 (±0.7)/4	2.2 (±0.5)/3	3.4 (±1.4)/4	4.0 (±0)/4	4.0 (±0)/4	2.1 (±0.8)/3
Social withdrawal (N4)	4.0 (±0.8)/4	2.3 (±1.0)/3	3.6 (±0.9)/4	1.8 (±1.3)/2	3.0 (±1.3)/4	3.7 (±1.4)/4	4.3 (±0.6)/5	1.9 (±0.6)/2
Lack of spontaneity and flow of conversation (N6)	3.2 (±1.0)/4	1.9 (±0.9)/3	2.9 (±0.8)/3	1.4 (±0.9)/1	2.7 (±1.8)/4	3.5 (±0.5)/4	3.7 (±0.6)/4	2.0 (±0.8)/2.5
Emotional withdrawal (N2)	3.4 (±0.9)/4	–	2.9 (±1.1)/4	–	2.1 (±1.6)/3	2.8 (±1.5)/4	–	–
Depression (G6)	1.8 (±0.8)/2	2.0 (±0.9)/3	2.0 (±1.1)/3	1.4 (±0.9)/1	1.3 (±0.8)/1	1.7 (±1.0)/3	2.7 (±1.5)/4	1.6 (±1.2)/2
Hyperactivity (P4)	–	1.3 (±0.8)/1	1.4 (±0.7)/2	1.4 (±0.6)/2	2.2 (±1.0)/3	–	–	1.8 (±1.0)/3
Disturbance of volition (G13)	–	2.4 (±0.8)/3	2.9 (±0.7)/3	1.6 (±0.9)/2	–	2.3 (±1.0)/3	–	2.3 (±0.8)/3
Lack of judgment and insight (G12)	4.0 (±1.0)/4	2.5 (±0.8)/3	3.0 (±1.1)/4	3.2 (±1.1)/3	3.1 (±1.3)/4	2.5 (±0.8)/3	3.3 (±0.6)/4	2.1 (±0.6)/2.5
Difficulties in delay of gratification (S2)	2.7 (±1.3)/4	–	2.2 (±1.3)/3	–	1.7 (±1.0)/3	1.8 (±1.3)/3	–	–
Affective lability (S3)	2.6 (±1.1)/3	–	2.0 (±1.0)/3	–	1.7 (±0.8)/2	2.0 (±1.3)/3	–	–
PSP scale	49.3 (±9.2)/55	67.3 (±11.0)/72	57.1 (±12.0)/66	77.0 (±4.2)/81	58.1 (±14.2)/71	60.8 (±12.5)/69	54.0 (±6.0)/60	75.0 (±3.7)/78

Abbreviations: PANSS, Positive and Negative Syndrome Scale; ICD10, International Classification of Diseases Version 10; SD, standard deviation; PSP, Personal and Social Performance scale.