Gorwood Philip, Yildirim Murat, Madera-McDonough Jessica, Fagiolini Andrea, Arango Celso, Correll Christoph U, Arcà Emanuele, Barlassina Adele, Selveindran Santhani, Sahota Navdeep, Kane John M
Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, Paris, France.
GHU-Paris Psychiatrie Et Neurosciences, Hôpital Sainte Anne, Paris, 75014, France.
BMC Psychiatry. 2025 Apr 17;25(1):398. doi: 10.1186/s12888-025-06725-3.
Treatment of schizophrenia has traditionally aimed for symptomatic remission without addressing many daily problems patients face. Although no standard definition of functional recovery in patients with first-episode psychosis (FEP) and early-phase (EP) schizophrenia exists in the literature, most clinicians consider it a useful concept in daily practice. We conducted a Delphi panel to develop expert consensus on assessing functional recovery in FEP and EP schizophrenia patients and defining its domains, which we compared with currently available patient- and clinician-reported outcome measures (PROMs, CROMs).
The three-stage modified Delphi panel consisted of a 1:1 interview round and two online survey rounds involving five expert steering committee and 16 panel members. We conducted a narrative review of the literature in PubMed to identify instruments assessing functioning in people with schizophrenia.
Panelists were presented with 38 statements about functional recovery (definition, domains, and assessment) and approaches to achieving it. Panelists defined functional recovery for FEP and EP schizophrenia patients as a multidimensional state closely related to quality of life. When evaluating functional recovery, panelists agreed that assessing (1) depression, (2) aggressive behavior, (3) social interaction, (4) family functioning, (5) education and/or employment, (6) leisure activities, (7) self-care, and (8) sexual functioning was important. Panelists also agreed that asking patients about self-care and sexual functioning was less critical at every encounter. It was agreed that patients may be said to have reached partial functional recovery if they recovered in some but not all domains. There was consensus that long-acting injectable antipsychotics can facilitate functional recovery by increasing treatment adherence, lessening disease and treatment burden, and reducing functional decline. The literature review identified eight PROMs and CROMs that assess functioning in schizophrenia. However, none evaluated all eight domains of functional recovery.
Functional recovery is an important treatment goal in FEP and EP patients. PROMs and CROMs do not evaluate all eight domains of functional recovery agreed by the Delphi panel. Further research is needed to better understand and improve how functional recovery is assessed in clinical practice.
精神分裂症的治疗传统上旨在实现症状缓解，而未解决患者面临的许多日常问题。尽管文献中不存在关于首发精神病（FEP）和早期（EP）精神分裂症患者功能恢复的标准定义，但大多数临床医生认为这在日常实践中是一个有用的概念。我们进行了一次德尔菲专家小组会议，以就评估FEP和EP精神分裂症患者的功能恢复及其领域的定义达成专家共识，并将其与目前可用的患者报告和临床医生报告的结局指标（PROMs，CROMs）进行比较。
三阶段改良德尔菲专家小组会议包括一轮一对一访谈和两轮在线调查，涉及五名专家指导委员会成员和16名小组成员。我们对PubMed中的文献进行了叙述性综述，以确定评估精神分裂症患者功能的工具。
向小组成员提供了38条关于功能恢复（定义、领域和评估）及其实现方法的陈述。小组成员将FEP和EP精神分裂症患者的功能恢复定义为与生活质量密切相关的多维状态。在评估功能恢复时，小组成员一致认为评估（1）抑郁，（2）攻击行为，（3）社交互动，（4）家庭功能，（5）教育和/或就业，（6）休闲活动，（7）自我护理和（8）性功能很重要。小组成员还一致认为，在每次就诊时询问患者关于自我护理和性功能的问题不太关键。大家一致认为，如果患者在某些但并非所有领域恢复，则可以说他们达到了部分功能恢复。大家一致认为，长效注射用抗精神病药物可通过提高治疗依从性、减轻疾病和治疗负担以及减少功能衰退来促进功能恢复。文献综述确定了八项评估精神分裂症功能的PROMs和CROMs。然而，没有一项评估了功能恢复的所有八个领域。
功能恢复是FEP和EP患者的重要治疗目标。PROMs和CROMs并未评估德尔菲专家小组一致认可的功能恢复的所有八个领域。需要进一步研究以更好地理解和改进临床实践中功能恢复的评估方式。
