Universität zu Köln

Schennach, Rebecca, Moeller, Hans-Juergen, Obermeier, Michael, Seemueller, Florian, Jaeger, Markus, Schmauss, Max, Laux, Gerd, Pfeiffer, Herbert, Naber, Dieter, Schmidt, Lutz G., Gaebel, Wolfgang, Klosterkoetter, Joachim, Heuser, Isabella, Maier, Wolfgang, Lemke, Matthias R., Ruether, Eckart, Klingberg, Stefan ORCID: 0000-0001-8081-7181, Gastpar, Markus, Musil, Richard ORCID: 0000-0002-0792-8413, Spellmann, Ilja and Riedel, Michael (2016). Challenging the understanding of significant improvement and outcome in schizophrenia - the concept of reliable and clinically significant change methods. Int. J. Methods Psychiatr. Res., 25 (1). S. 3 - 12. HOBOKEN: WILEY. ISSN 1557-0657

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Abstract

Significant changes of schizophrenia patients during inpatient treatment were evalutaed and compared to established outcome criteria. The concept of reliable and clinically significant change methods was applied to three hundred and ninety-six patients suffering from a schizophrenia spectrum disorder. First, information on whether or not the change of the patient's condition is sufficient in order to declare that it is beyond a measurement error or random effect (= reliable change) was evaluated and in a second step it was observed if the reliable change was clinically meaningful (= clinically significant change). Different Positive and Negative Syndrome Scale for Schizophrenia (PANSS) thresholds were applied to define the clinically significant change (40, 45 and 50 points). These changes were then compared to established outcome criteria such as response and remission. Seventy-nine of the 396 patients (20%) showed a reliable improvement of symptoms, whereas 70% improved without achieving a reliable change of their condition. Of the 79 patients achieving a reliable change during treatment 8-15% concurrently showed a clinically significant change depending on the respective PANSS threshold. In contrast, 56% of the patients achieved response and 60% were in remission at discharge when applying established outcome criteria. Our results showed that a rather small number of schizophrenia patients were found to reliably change during inpatient treatment, with even less patients achieving a clinically significant change. The concept of reliable and clinically significant changes revealed to be a lot more stringent than today's established outcome criteria and should be critically evaluated regarding its use in schizophrenia patients. Copyright (c) 2015 John Wiley & Sons, Ltd. Significant changes of schizophrenia patients during inpatient treatment were evalutaed and compared to established outcome criteria. The concept of reliable and clinically significant change methods was applied to three hundred and ninety-six patients suffering from a schizophrenia spectrum disorder. First, information on whether or not the change of the patient's condition is sufficient in order to declare that it is beyond a measurement error or random effect (=reliable change) was evaluated and in a second step it was observed if the reliable change was clinically meaningful (=clinically significant change). Different Positive and Negative Syndrome Scale for Schizophrenia (PANSS) thresholds were applied to define the clinically significant change (40, 45 and 50 points). These changes were then compared to established outcome criteria such as response and remission. Seventy-nine of the 396 patients (20%) showed a reliable improvement of symptoms, whereas 70% improved without achieving a reliable change of their condition. Of the 79 patients achieving a reliable change during treatment 8-15% concurrently showed a clinically significant change depending on the respective PANSS threshold. In contrast, 56% of the patients achieved response and 60% were in remission at discharge when applying established outcome criteria. Our results showed that a rather small number of schizophrenia patients were found to reliably change during inpatient treatment, with even less patients achieving a clinically significant change. The concept of reliable and clinically significant changes revealed to be a lot more stringent than today's established outcome criteria and should be critically evaluated regarding its use in schizophrenia patients.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Schennach, Rebecca UNSPECIFIED UNSPECIFIED UNSPECIFIED Moeller, Hans-Juergen UNSPECIFIED UNSPECIFIED UNSPECIFIED Obermeier, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Seemueller, Florian UNSPECIFIED UNSPECIFIED UNSPECIFIED Jaeger, Markus UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmauss, Max UNSPECIFIED UNSPECIFIED UNSPECIFIED Laux, Gerd UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfeiffer, Herbert UNSPECIFIED UNSPECIFIED UNSPECIFIED Naber, Dieter UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmidt, Lutz G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Gaebel, Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Klosterkoetter, Joachim UNSPECIFIED UNSPECIFIED UNSPECIFIED Heuser, Isabella UNSPECIFIED UNSPECIFIED UNSPECIFIED Maier, Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Lemke, Matthias R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Ruether, Eckart UNSPECIFIED UNSPECIFIED UNSPECIFIED Klingberg, Stefan UNSPECIFIED orcid.org/0000-0001-8081-7181 UNSPECIFIED Gastpar, Markus UNSPECIFIED UNSPECIFIED UNSPECIFIED Musil, Richard UNSPECIFIED orcid.org/0000-0002-0792-8413 UNSPECIFIED Spellmann, Ilja UNSPECIFIED UNSPECIFIED UNSPECIFIED Riedel, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-282642
DOI:	10.1002/mpr.1476
Journal or Publication Title:	Int. J. Methods Psychiatr. Res.
Volume:	25
Number:	1
Page Range:	S. 3 - 12
Date:	2016
Publisher:	WILEY
Place of Publication:	HOBOKEN
ISSN:	1557-0657
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language QUALITY-OF-LIFE; MEANINGFUL CHANGE; REMISSION; SCALE; PANSS; PSYCHIATRY; ARRINDELL; VALIDITY; HAGEMAN; TRIALS Multiple languages Psychiatry Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/28264