Clinical meaningful outcomes in schizophrenia: remission and recovery

The traditional view of schizophrenia as a disabling and irremediably progressive disease is being reconsidered because of the evidences arising from long-term follow-up studies. On the other hand, recent advances of therapies have yielded significant functional improvements for some patients. Together, these facts are serving to raise treatment prospects, placing the focus on functional recovery. Although the availability of a valid set of consensus remission criteria has been an important step toward the definition of therapeutic objectives and the conceptualization of recovery, remission and recovery still are rare concepts in the setting of routine clinical practice. The present article includes a brief review of these concepts, and presents the results from two observational European studies that provide empirical data about the actual situation of ambulatory patients with schizophrenia in terms of symptomatic remission, and that help in advancing the conceptualization of recovery, contributing to the development of clinical and research definitional criteria. Such results indicate that remission of symptoms constitutes a realistic therapeutic goal in a number of patients, with a considerable temporal stability; on the other hand, recovery definitions should include functional and subjective dimensions. In conclusion, remission is a tenable and clinically valid concept, with a significant contribution to functional improvement. Meanwhile, the recovery construct still requires substantial development.