These differences hamper the populations these

These differences hamper the populations these criteria could be applied

for and the comparability of results. With respect to stringency of the criteria, data have shown that a realistic proportion of patients could fulfill the RSWG remission criteria and that more stringent criteria (eg, lower thresholds for the severity criteria of ≤2 or =1) are not realistic in clinical settings. The inclusion of an improvement criterion (eg, achievement of 50% reduction in BPRS total score from baseline), Inhibitors,research,lifescience,medical as applied in the criteria by Lieberman et al,8 increases the stringency and thereby the predictive validity for other outcome dimensions; however, only a minority of patients could reach such on outcome. Further, such a criterion implicates that studies including varying patient populations Inhibitors,research,lifescience,medical regarding baseline psychopathology are difficult (if not impossible) to compare. Applying less stringent severity criteria as proposed by Liberman et al11 (“moderately ill” or better) leads to higher

frequencies of patients in remission, but lowers Inhibitors,research,lifescience,medical the predictive validity for other outcome dimensions; further, its validity was hitherto insufficiently studied. Of note, the inclusion of other symptoms such as depression and suicidality in the set of remission items did not change the remission frequencies considerably. This result supports the conceptualization of the RSWG criteria, which used the most diagnostically specific items of the Positive and Negative Symptoms Scale (PANSS) to define remission.5 Items such as depression or Inhibitors,research,lifescience,medical anxiety relate to symptoms that are not diagnostic for schizophrenia. Conceptually, it may be subject of further discussion, whether depression and anxiety should be included in the RSWG criteria, as these dimensions were linked to poor quality of life. It may, however, be argued that these dimensions Inhibitors,research,lifescience,medical play a more import role in the broader concept of recovery. The applied 6-month

time criterion of the RSWG remission criteria is still a matter of debate. The only available study to date has found that a 3-month criterion has a comparable Brefeldin_A predictive validity for the stability of remission over time.13 Further, studies on early response and the proportion of patients with early response being in stable remission over time have shown that even shorter time periods are predictive for the stability of remission.62,63 Applying shorter time periods is additionally supported by the fact that approximately 75% of patients reaching the symptom severitycriteria threshold without fulfilling the 6-month time criterion remain in remission throughout a 6- to 60month follow-up period.

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