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Pharmacopsychiatry 2013; 46(03): 114-119
DOI: 10.1055/s-0032-1331703
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Predicting a ‘Combined Treatment Outcome’ in Chronic Schizophrenia: The Role of Demographics, Symptomatology, Functioning and Subjective ­Well-being

D. Naber
1   Department of Psychiatry and Psychotherapy, University of Hamburg, Hamburg, Germany
,
S. Kollack-Walker
2   Lilly, USA, LLC, Indianapolis, IN, USA
,
J. Chen
2   Lilly, USA, LLC, Indianapolis, IN, USA
,
V. L. Stauffer
3   Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
,
B. J. Kinon
3   Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
,
M. Case
2   Lilly, USA, LLC, Indianapolis, IN, USA
,
H. Ascher-Svanum
3   Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
,
S. Kapur
4   Institute of Psychiatry, King’s College of London, London, U.K.
,
J. M. Kane
5   Zucker Hillside Hospital, Glen Oaks, NY, USA
› Author Affiliations
Further Information

Publication History

received 05 June 2012
revised 09 November 2012

accepted 13 November 2012

Publication Date:
04 January 2013 (online)

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Abstract

Objectives:

The aim of this study was to determine what variables predict a ‘combined treatment outcome’ (COMBOUT) in patients with chronic schizophrenia.

Methods:

This analysis (n=522) was based on a randomized, double-blind, flexible-dose, 12-week study that enrolled chronically-ill patients diagnosed with schizophrenia or a related disorder. COMBOUT was assessed using the PANSS for symptoms, CGI-S for overall clinical status, MADRS for depressive symptoms, QLS for functioning/QOL, and SWN-K for subjective well-being. Possible predictors included demographics as well as baseline scores (Model I), and early change (week 2) scores (Model II).

Results:

Model I: significantly better outcome (higher COMBOUT score) was observed in patients with lower MADRS (T= − 6.36; p<0.001) or higher QLS (T=5.05; p<0.001) scores at baseline. Model II: significantly better COMBOUT was observed in patients with early improvement of QLS (T=4.93; p<0.001), SWN-K (T=3.88; p<0.001), PANSS (T= − 2.32; p=0.021) and CGI-S scores (T= − 2.22; p=0.027). Changes in EPS were not predictors of COMBOUT in the models tested.

Conclusion:

COMBOUT at endpoint was predicted by lower depressive symptom score and higher QOL at baseline and by early improvement in psychopathology, quality of life and subjective well-being.

Key words

schizophrenia - risperidone - olanzapine - antipsychotics - prediction
 

  • References

  • 1 Agid O, Kapur S, Arenovich T, Zipursky RB. Delayed-onset hypothesis of antipsychotic action: a hypothesis tested and rejected. Arch Gen Psychiatry 2003; 60: 1228-1235
    Google Scholar
  • 2 Leucht S, Busch R, Hamann J, Kissling W, Kane JM. Early-onset hypothesis of antipsychotic drug action: a hypothesis tested, confirmed and extended. Biol Psychiatry 2005; 57: 1543-1549
    CrossrefPubMedGoogle Scholar
  • 3 Ascher-Svanum H, Nyhuis AW, Faries DE, Kinon BJ, Baker RW, Shekhar A. Clinical, functional and economic ramifications of early nonresponse to antipsychotics in the naturalistic treatment of schizophrenia. Schizophr Bull 2008; 34: 1163-1171
    CrossrefPubMedGoogle Scholar
  • 4 Correll CU, Malhotra AK, Kaushik S, McMeniman M, Kane JM. Early prediction of antipsychotic response in schizophrenia. Am J Psychiatry 2003; 160: 2063-2065
    CrossrefPubMedGoogle Scholar
  • 5 Kinon BJ, Chen L, Ascher-Svanum H, Stauffer VL, Kollack-Walker S, Sniadecki JL, Kane JM. Predicting response to atypical antipsychotics based on early response in the treatment of schizophrenia. Schizophr Res 2008; 102: 230-240
    PubMedGoogle Scholar
  • 6 Kinon BJ, Chen L, Ascher-Svanum H, Stauffer VL, Kollack-Walker S, Zhou W, Kapur S, Kane JM. Early response to antipsychotic drug therapy as a clinical marker of subsequent response in the treatment of schizophrenia. Neuropsychopharmacology 2010; 35: 581-590
    Google Scholar
  • 7 Leucht S, Busch R, Kissling W, Kane JM. Early prediction of antipsychotic nonresponse among patients with schizophrenia. J Clin Psychiatry 2007; 68: 352-360
    Google Scholar
  • 8 Leucht S, Shamsi SA, Busch R, Kissling W, Kane JM. Predicting antipsychotic drug response – replication and extension to six weeks in an international olanzapine study. Schizophr Res 2008; 101: 312-319
    CrossrefPubMedGoogle Scholar
  • 9 Warner R. Recovery from schizophrenia and the recovery model. Curr Opin Psychiatry 2009; 22: 374-380
    Google Scholar
  • 10 Naber D. Subjective effects of antipsychotic treatment. Acta Psychiatr Scand 2005; 111: 81-83
    CrossrefPubMedGoogle Scholar
  • 11 Kinon BJ, Chen L, Ascher-Svanum H, Stauffer VL, Kollack-Walker S, Zhou W, Kapur S, Kane JM, Naber D. Challenging the assumption that improvement in functional outcomes is delayed relative to improvement in symptoms in the treatment of schizophrenia. Schizophr Res 2010; 118: 176-182
    CrossrefPubMedGoogle Scholar
  • 12 Lambert M, Schimmelmann BG, Naber D, Elch F-X, Schulz H, Huber CG, Karow A. Early and delayed antipsychotic response and prediction of outcome in 528 severely impaired patients with schizophrenia treated with amisulpride. Pharmacopsychiatry 2009; 42: 277-283
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13: 261-276
    Google Scholar
  • 14 Guy W. ECDEU Assessment Manual for Psychopharmacology, Revised (Publication ADM 76-338). US Dept of Health, Education, and Welfare; Rockville, MD: 1976. 218-222
    Google Scholar
  • 15 Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry 1979; 134: 382-389
    CrossrefPubMedGoogle Scholar
  • 16 Heinrichs DW, Hanlon TE, Carpenter Jr WT. The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophr Bull 1984; 10: 388-398
    CrossrefPubMedGoogle Scholar
  • 17 Kleinman L, Lieberman J, Dube S, Mohs R, Zhao Y, Kinon B, Carpenter W, Harvey PD, Green MF, Keefe RS, Frank L, Bowman L, Revicki DA. Development and psychometric performance of the schizophrenia objective functioning instrument: an interviewer administered measure of function. Schizophr Res 2009; 107: 275-285
    CrossrefPubMedGoogle Scholar
  • 18 Naber D, Moritz S, Lambert M, Pajonk F, Holzbach R, Mass R, Andresen B. Improvement of schizophrenic patients’ subjective well-being under atypical antipsychotic drugs. Schizophr Res 2001; 50: 79-88
    CrossrefPubMedGoogle Scholar
  • 19 Simpson GM, Angus JW.. A rating scale for extrapyramidal side effects. Acta Psychiatr Scand Suppl 1970; 212: 11-19
    PubMedGoogle Scholar
  • 20 Barnes TR.. A rating scale for drug-induced akathisia. Br J Psychiatry 1989; 154: 672-676
    CrossrefPubMedGoogle Scholar
  • 21 Aiken LR.. Formulas for equating ratings on different scales. Educational and Psychological Measurement 1987; 47: 51-54
    CrossrefPubMedGoogle Scholar
  • 22 Flyckt L, Mattsson M, Edman G, Carlsson R, Cullberg J.. Predicting 5-year outcome in first-episode psychosis: construction of a prognostic rating scale. J Clin Psychiatry 2006; 67: 916-924
    CrossrefPubMedGoogle Scholar
  • 23 Lipkovich IA, Deberdt W, Csernansky JG, Buckley P, Peuskens J, Kollack-Walker S, Rotelli M, Houston JP. Defining “good” and “poor” outcomes in patients with schizophrenia or schizoaffective disorder: A multidimensional data-driven approach. Psychiatry Res 2009; 170: 161-167
    CrossrefPubMedGoogle Scholar
  • 24 Schennach-Wolff R, Jäger M, Obermeier M, Schmauss M, Laux G, Pfeiffer H, Naber D, Schmidt LG, Gaebel W, Klosterkötter J, Heuser I, Kühn KU, Lemke MR, Rüther E, Klingberg S, Gastpar M, Seemüller F, Möller HJ, Riedel M. Quality of life and subjective well-being in schizophrenia and schizophrenia spectrum disorders: valid predictors of symptomatic response and remission?. World J Biol Psychiatry 2010; 11: 729-738
    CrossrefPubMedGoogle Scholar
  • 25 Conley RR. The burden of depressive symptoms in people with schizophrenia. Psychiatr Clin North Am 2009; 32: 853-861
    CrossrefPubMedGoogle Scholar
  • 26 Jin H, Zisook S, Palmer BW, Patterson TL, Heaton RK, Jeste DV. Association of depressive symptoms with worse functioning in schizophrenia: a study in older outpatients. J Clin Psychiatry 2001; 62: 797-803
    CrossrefPubMedGoogle Scholar
  • 27 Emsley RA, Oosthuizen PP, Joubert AF, Roberts MC, Stein DJ. Depressive and anxiety symptoms in patients with schizophrenia and schizophreniform disorder. J Clin Psychiatry 1999; 60: 747-751
    CrossrefPubMedGoogle Scholar
  • 28 Rieckmann N, Reichenberg A, Bowie CR, Parrella M, White L, Friedman JI, Harvey PD. Depressed mood and its functional correlates in institutionalized schizophrenia patients. Schizophr Res 2005; 77: 179-187
    CrossrefPubMedGoogle Scholar
  • 29 Hansson L. Determinants of quality of life in people with severe mental illness. Acta Psychiatr Scand Suppl 2006; 429: 46-50
    PubMedGoogle Scholar
  • 30 Huppert JD, Weiss KA, Lim R, Pratt S, Smith TE. Quality of life in schizophrenia: contributions of anxiety and depression. Schizophr Res 2001; 51: 171-180
    CrossrefPubMedGoogle Scholar
  • 31 Narvaez JM, Twamley EW, McKibbin CL, Heaton RK, Patterson TL. Subjective and objective quality of life in schizophrenia. Schizophr Res 2008; 98: 201-208
    CrossrefPubMedGoogle Scholar
  • 32 Sim K, Mahendran R, Siris SG, Heckers S, Chong SA. Subjective quality of life in first episode schizophrenia spectrum disorders with comorbid depression. Psychiatry Res 2004; 129: 141-147
    CrossrefPubMedGoogle Scholar
  • 33 Karow A, Moritz S, Lambert M, Schoder S, Krausz M. PANSS syndromes and quality of life in schizophrenia. Psychopathology 2005; 38: 320-326
    CrossrefPubMedGoogle Scholar
  • 34 Kim J-H, Ann J-H, Kim M-J. The relationship between depressive symptoms and subjective well-being in newly admitted patients with schizophrenia. Compr Psychiatry 2010; 51: 165-170
    CrossrefPubMedGoogle Scholar
  • 35 de Haan L, Nimwegen L, Amelsvoort T, Dingemans P, Linszen D. Improvement of subjective well-being and enduring symptomatic remission, a 5-year follow-up of first episode schizophrenia. Pharmacopsychiatry 2008; 41: 125-128
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Marder SR, Davis JM, Chouinard G. The effects of risperidone on the five dimensions of schizophrenia derived by factor analysis: combined results of the North American trials. J Clin Psychiatry 1997; 58: 538-546
    CrossrefPubMedGoogle Scholar
  • 37 Chen L, Ascher-Svanum H, Lawson A, Stauffer V, Nyhuis A, Haynes VS, Schuh K, Kinon BJ. Movement disorders trajectories and treatment outcomes in a 1-year study of patients with schizophrenia. ACNP 2011;
    PubMedGoogle Scholar