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. 2016 Mar;25(1):3-11.
doi: 10.1002/mpr.1476. Epub 2015 Jul 14.

Challenging the understanding of significant improvement and outcome in schizophrenia - the concept of reliable and clinically significant change methods

Rebecca Schennach  1   2 , Hans-Jürgen Möller  1 , Michael Obermeier  1 , Florian Seemüller  1 , Markus Jäger  1 , Max Schmauss  3 , Gerd Laux  4 , Herbert Pfeiffer  5 , Dieter Naber  6 , Lutz G Schmidt  7 , Wolfgang Gaebel  8 , Joachim Klosterkötter  9 , Isabella Heuser  10 , Wolfgang Maier  11 , Matthias R Lemke  12 , Eckart Rüther  13 , Stefan Klingberg  14 , Markus Gastpar  15 , Richard Musil  1 , Ilja Spellmann  1 , Michael Riedel  1   16
Affiliations

Challenging the understanding of significant improvement and outcome in schizophrenia - the concept of reliable and clinically significant change methods

Rebecca Schennach et al. Int J Methods Psychiatr Res. 2016 Mar.

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.

Keywords: clinically significant change; outcome; reliable change; schizophrenia.

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Figures

Figure 1
Figure 1
Reliable change of the PANSS in schizophrenia inpatients.
Figure 2
Figure 2
The reliable change index (including the cutoff of clinical significant changes) in Cut in dependence of the scale's test–retest reliability and the study populations PANSS standard deviation.
Figure 3
Figure 3
Reliable and clinically significant change in schizophrenia inpatients applying a PANSS threshold of 40 points to define clinical significance.
Figure 4
Figure 4
Reliable and clinically significant change in schizophrenia inpatients applying a PANSS threshold of 45 points to define clinical significance.
Figure 5
Figure 5
Reliable and clinically significant change in schizophrenia inpatients applying a PANSS threshold of 50 points to define clinical significance.
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