Patients' awareness of recovery mediates the link between clinical and level of functional remission in schizophrenia to a larger extent in those treated with long-acting antipsychotics

Jasmina Mallet; Clément Dondé; Caroline Dubertret; Philip Gorwood

doi:10.1177/20451253241231269

Patients' awareness of recovery mediates the link between clinical and level of functional remission in schizophrenia to a larger extent in those treated with long-acting antipsychotics

Ther Adv Psychopharmacol. 2024 Feb 16:14:20451253241231269. doi: 10.1177/20451253241231269. eCollection 2024.

Authors

Jasmina Mallet^{1

2}, Clément Dondé^{3

4}, Caroline Dubertret^{1

2}, Philip Gorwood^{5

6}

Affiliations

¹ Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (INSERM UMR1266), Paris, France.
² Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France.
³ Univ. Grenoble Alpes, Inserm, U1216, Adult Psychiatry Department CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France.
⁴ Psychiatry Department, CH Alpes-Isère, Saint-Egrève, France.
⁵ Université Paris Cité, GHU Paris Psychiatrie et Neurosciences, Clinique des Maladies Mentales et de l'Encéphale (Sainte-Anne Hospital), 100 rue de la Santé, Paris 75014, France.
⁶ Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR1266, Paris, France.

Abstract

Background: Clinical remission is a step towards functional remission for subjects with schizophrenia. While recovery is both a subjective personal journey and a clinical outcome to be targeted, data on patient self-rated outcomes are scarce.

Objectives: (i) To determine the extent to which the association between clinical and functional remission is mediated by the subjective experience of recovery as reported by patients versus their relatives or their psychiatrist and (ii) to assess differences according to treatment, specifically with oral antipsychotics only versus long-acting injectable antipsychotics (LAIs).

Design: Clinical observational study.

Methods: Community-dwelling participants with schizophrenia enrolled in the EGOFORS cohort (N = 198) were included. Clinical symptoms and remission were assessed using the Positive and Negative Syndrome Scale. Functional remission was assessed with the Functional Remission of General Schizophrenia Scale. Awareness of recovery was assessed with one question 'What percentage of recovery do you think you have now (from 0% - no recovery - to 100% - full recovery)?', asked of the patient, also of the patient's close relative, and the psychiatrist. We used mediation analyses, taking into account the type of pharmacological treatment.

Results: Remission criteria and perceived remission measures were significantly correlated, both within and between groups (r > 0.330). The patient's awareness of recovery mediated the relationship between clinical remission and level of functional remission, while the level of recovery according to psychiatrists or close relatives did not. The direct effect of clinical remission on the level of functional remission became non-significant when taking into account the mediator (patients' awareness of recovery) in the group of patients with LAI (t = 1.5, p = 0.150) but not in the group of patients with other treatments (t = 3.1, p = 0.003).

Conclusion: Patients with LAIs may be more efficient in reporting their level of functional remission. Higher patient awareness could be an interesting candidate to explain this. However, as the study was cross-sectional, such a proposal should be tested with a more specifically designed protocol, such as a long-term cohort.

Keywords: antipsychotics; functional outcome; long-acting antipsychotics; patient-reported outcome measures; recovery; remission; schizophrenia.