Remission and recovery

How are remission and recovery defined? 

Remission has been defined as a level of symptomology that does not interfere with an individual’s behaviour, and is also below that required for a diagnosis of schizophrenia. Symptom improvements should last for a minimum of six months in order for remission to be reached. Recovery is less precisely defined. In addition to the symptom improvements required for remission, improvements in social and functional dimensions are required. These domains usually include, but are not restricted to; functional independence, maintaining satisfying relationships, being productive, having a sense of empowerment, and overcoming feelings of internalised stigma. Improvements in either clinical or functional domains need to be seen for at least two years.

What is the evidence for remission and recovery?

Moderate quality evidence finds the overall rate of remission is around 36% in people with schizophrenia. In people with first-episode psychosis, the rate is around 58% by 5.5 years. Moderate to low quality evidence finds rates of remission vary considerably in the developing world, with remission rates by 25 years ranging from 31% in Colombia to 77% in India.

Moderate quality evidence finds the rate of recovery in people with schizophrenia is between 13% and 16%, with annual rates around 1.4%. For first-episode psychosis, the rate is around 38% by 7.2 years. Recovery rates are highest in low or low-medium income countries (36.4%) and lowest in high (13%) or high-medium income countries (12.1%).

Moderate quality evidence finds rates of recovery and remission increase over time, with combined rates around 13% by 5 years after a first diagnosis, to around 68% by 32 years after a first diagnosis.

Moderate to high quality evidence finds small to medium-sized associations between increased symptom severity and decreased ratings of personal recovery (where symptoms may still be apparent). A small association was also found between increased functioning and increased personal recovery ratings.

August 2020

Last updated at: 11:46 pm, 17th August 2020
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