Sustained remission in older patients with very chronic schizophrenia, similar to that experienced by Nobel laureate John Nash in the movie “A Beautiful Mind,” is possible if somewhat rare, according to a study by researchers at the University of California, San Diego (UCSD) School of Medicine and the Veterans Affairs San Diego Healthcare System.
Published in the August 2004 issue of the American Journal of Psychiatry, the study showed that 8 percent of 155 middle-aged and elderly individuals diagnosed with schizophrenia, met the criteria for sustained full remission.
“While our results show that true recovery from schizophrenia is an exception rather than a rule, they still indicate that sustained remission occurs in patients with very chronic illness and offer hope that there can be a light at the end of the tunnel,” said the study’s principal investigator, Dilip Jeste, M.D., UCSD professor of psychiatry and neurosciences and a geriatric psychiatrist at the VA San Diego Healthcare System.
As to what brings about remission in schizophrenia patients, Jeste said that psycho-social support may be an important factor. For example, John Nash got excellent support from his ex-wife as well as from his professional colleagues at Princeton University.
“We hope that our study with its look at remission from a scientific perspective, will encourage the development of better management including more psycho-social support programs to strive for remission in as many patients as possible,” said Jeste, who is also the director of the UCSD Sam and Rose Stein Institute for Research on Aging, and the Estelle and Edgar Levi Chair in Aging,
A serious medical illness, schizophrenia affects more than 2 million Americans or about one percent of the population worldwide. Tormented by hallucinations, delusions and other forms of bizarre behavior, these individuals are usually unable to work or interact with society. Many patients develop schizophrenia as adolescents or young adults, while a small proportion of older patients manifest the illness for the first time in their later years.
While many psychiatrists believe that schizophrenia is associated with a progressive personality deterioration without possibility of remission, previous studies have reported rates of remission ranging from 3 percent to 64 percent.
According to Jeste, the criteria used to define remission in past studies were often questionable or unclear with few, if any, standardized rating scales of psychopathology being used.
For the UCSD study, the research team studied 155 patients who had, at some point, been diagnosed with schizophrenia, as defined by the DSM-III-R or DSM-IV psychiatric manuals. Eighteen of these individuals were designated in “full remission” by their medical providers. However, the UCSD team found that only 12 of the 18 met the following criteria for “full remission”:
- Living independently of supervision by caregivers for the past two years;
- No hospitalization for a psychiatric illness for the last five years;
- Presently reported psychosocial functioning within a normal range: and
- Either not taking antipsychotic medication or taking no more than one-half of the highest daily dose prescribed in the past.
Although the UCSD study found only an 8 percent sustained remission rate, Jeste noted that the actual percentage of patients in remission may be as high as 15 to 20 percent, since the study did not include symptom-free individuals who had decided to stop physician visits.
“Some individuals without symptoms do not wish to be followed by medical personnel,” said Jeste, who is also director of the UCSD Stein Institute for Research on Aging. He stressed, however, that most people with chronic schizophrenia need continued medication and other psychiatric care in order to avoid relapse.
The UCSD researchers also found that although the individuals in sustained remission had similar levels of positive, negative, and depressive symptoms as normal comparison subjects, the previously diagnosed schizophrenia patients continued to display cognitive and functional impairments statistically similar to those of symptomatic schizophrenia patients.
“Although this may seem to be at variance with the notion of true remission, it is consistent with the neurodevelopmental aspects of schizophrenia,” Jeste said. “It is believed that cognitive and functional deficits precede the onset of overt psychotic symptoms by years and are independent of positive or other clinical symptoms in schizophrenia. So, it is not surprising that such impairments could outlast symptom remission.”
The paper’s first author was Lisa A. Auslander, Ph.D., a research fellow in the UCSD Department of Psychiatry when the study was done, and currently the recipient of a career develop award from the Veterans Administration. The study was supported by the National Institute of Mental Health and by the Department of Veterans Affairs.
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