THE HIGH RATE OF THE ADHERENCE TO PHARMACOTHERAPY GUIDELINE IN RECOVERY AND REMISSION IN PATIENTS WITH SCHIZOPHRENIA: A CROSS-SECTIONAL STUDY
Authors: Asada *Ryo , Hori Hikaru , Gotoh Leo , Yasumatsu Kiyohiro , Iida Hitoshi , Kawasaki Hiroaki 
Published: February 2025

Background

Recovery is considered one of the goals for patients with schizophrenia. However, a systematic review reported that the rate of recovery was 13.5% [1], and this has remained low compared with the rate of remission [2]. Thus, achieving recovery is a more difficult goal than achieving remission in schizophrenia patients. In Japan, the guideline for pharmacological therapy for schizophrenia has been published by the Japanese Society of Neuropsychopharmacology [3]. This guideline highly recommended second-generation antipsychotics monotherapy without the combination of other psychotropic drugs for patients in the acute and maintenance terms of schizophrenia. Individual fitness score (IFS) is a tool to evaluate the treatment for schizophrenia according to the guideline [4]. IFS is calculated as follows: 100 points were given for complete adherence to the guideline, and points were subtracted from the total score for any administered treatment that was not recommended. Previous studies using IFS have reported that adherence to the guideline contributes to improving psychiatric symptoms for patients with schizophrenia [5], but it is unclear whether the adherence could contribute to achieving recovery or improving functional outcome for patients with schizophrenia.

Aims & Objectives

The aim of this study was to compare the different states of schizophrenia patients (recovery, remission, non-remission) with IFS, and to assess whether adherence to the guideline could contribute to achieving recovery.

Method

This study was a cross-sectional study that included 64 Japanese schizophrenia patients. Inclusion criteria were individuals aged 20 to 65 who have not changed antipsychotics for at least 3 months and are not taking anticholinergics. Recovery was defined based on Liberman’ s criteria [6], and remission was defined based on Andreasen’ s criteria [7]. Non-remission was defined as not meeting the recovery, remission, and treatment-resistant criteria. We used the Brief Psychiatric Rating Scale (BPRS) [8] and Calgary Depression Scale (CDSS) [9] for assessment of psychiatric symptoms. This study was approved by the Fukuoka University Medical Ethics Committee (U-21-11-018), and verbal and written consent was obtained from all participants. Statistical analysis was performed using SPSS (ver. 27) with χ-square test, one-way analysis of variance, Kruskal– Wallis test, and receiver operating characteristic, with P&lt;0.05.

Results

In the demographics and clinical characteristics of each group, no significant difference was found except for employment, number of admissions, BPRS score, and CDSS score. First, the IFS was significantly different among the three groups. The IFS in the recovery and remission groups were significantly higher than that in the non-remission group. However, there was no significantly difference in IFS between the recovery group and remission group. Second, the IFS of the remission group was significantly higher compared to that of the non-remission group (area under the curve = 0.82; cut-off point = 70).

Discussion & Conclusion

The results from the present study show that pharmacotherapy following the guideline of the Japanese Society of Neuropsychopharmacology may contribute to achieving remission for patients with schizophrenia but may not be sufficient for recovery. Furthermore, we propose that an IFS of 70 may be an indicator for pharmacotherapy aimed at remission for patients with schizophrenia.

References

1.Jaaskelainen, E., et al., A systematic review and meta-analysis of recovery in schizophrenia. Schizophr Bull, 2013. 39(6): p. 1296-306.2.

2.Lally, J., et al., Remission and recovery from first-episode psychosis in adults: systematic review and meta-analysis of long-term outcome studies. Br J Psychiatry, 2017. 211(6): p. 350-358.3.

3.Japanese Society of, N., Japanese Society of Neuropsychopharmacology: "Guideline for Pharmacological Therapy of Schizophrenia".Neuropsychopharmacol Rep, 2021. 41(3): p. 266-324.4.

4.Inada, K., et al., Development of individual fitness score for conformity of prescriptions to the "Guidelines For Pharmacological Therapy of Schizophrenia". Neuropsychopharmacol Rep, 2022. 42(4): p. 502-509.5.

5.Kodaka, F., et al., Relationships Between Adherence to Guideline Recommendations for Pharmacological Therapy Among Clinicians and Psychotic Symptoms in Patients With Schizophrenia. Int J Neuropsychopharmacol, 2023. 26(8): p. 557-565.6.

6.Liberman, R.P., et al., Operational criteria and factors related to recovery from schizophrenia. International Review of Psychiatry, 2002. 14(4): p. 256-272.7.

7.Andreasen, N.C., et al., Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry, 2005. 162(3): p. 441-9.8.

8.Overall, J.E. and D.R. Gorham, The Brief Psychiatric Rating Scale. Psychological Reports, 1962. 10(3): p. 799-812.9.

9.Addington, D., J. Addington, and E. Maticka-tyndale, Assessing Depression in Schizophrenia: The Calgary Depression Scale. British Journal of Psychiatry, 1993. 163(S22): p. 39-44.