Towards a pragmatic and operational definition of relapse in schizophrenia: a Delphi consensus approach.

Towards a pragmatic and operational definition of relapse in schizophrenia: a Delphi consensus approach.

Int J Psychiatry Clin Pract. 2014 Dec 30;:1-25

Authors: San L, Serrano M, Cañas F, Romero SL, Sánchez-Cabezudo Á, Villar M

Abstract
Abstract Objective: To develop pragmatic and operational definitions of relapse in schizophrenia. Methods: A two-round Delphi consensus approach was used. The final questionnaire based on seven pre-established definition relapse models developed by a panel of eight experts was presented to 33 general psychiatrists who attended an 'ad hoc' meeting. Results: The most frequent components of the pragmatic definition were the psychopathological severity of the psychotic spectrum (70%), more intense management of the case (68%), a previously stabilized episode (67%) and impairment in functioning and social behaviour (67%). In the operational definition, reappearance of symptoms was considered indispensable by 71% of the participants, and reappearance of positive symptoms measured by clinical scales was considered recommendable by 67%. Between 46% and 53% rated worsening of severity status and worsening of functioning as indispensable or recommendable. An increase of ≥ 10 points in the positive subscale of PANSS was rated by 51% of the participants, a score of 6 points in the CGI (much worse) by 89% and a reduction of ≥ 20 points in the GAF scale by 62%. Conclusions: A better understanding of the definition of relapse in schizophrenia is necessary to improve effective prevention strategies.

PMID: 25547440 [PubMed - as supplied by publisher]