Classifying episodes in schizophrenia and bipolar disorder: Criteria for relapse and remission applied to recent-onset samples

Nuechterlein, Keith H.; Miklowitz, David J.; Ventura, Joseph; Gitlin, Michael J.; Stoddard, Mitchell; Lukoff, David

doi:10.1016/j.psychres.2004.04.018

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Volume 144, Issue 2 , Pages 153-166, 15 November 2006

Classifying episodes in schizophrenia and bipolar disorder: Criteria for relapse and remission applied to recent-onset samples

Keith H. Nuechterlein
- UCLA Department of Psychiatry and Biobehavioral Sciences, 300 UCLA Medical Plaza, Room 2251, Los Angeles, CA 90095-6968, United States
- Corresponding author. Tel.: +1 310 825 0036; fax: +1 310 206 3651.
David J. Miklowitz
- Department of Psychology, University of Colorado, Boulder, United States
Joseph Ventura
- UCLA Department of Psychiatry and Biobehavioral Sciences, 300 UCLA Medical Plaza, Room 2251, Los Angeles, CA 90095-6968, United States
Michael J. Gitlin
- UCLA Department of Psychiatry and Biobehavioral Sciences, 300 UCLA Medical Plaza, Room 2251, Los Angeles, CA 90095-6968, United States
Mitchell Stoddard
- UCLA Department of Psychiatry and Biobehavioral Sciences, 300 UCLA Medical Plaza, Room 2251, Los Angeles, CA 90095-6968, United States
David Lukoff
- Saybrook Graduate School, San Francisco, CA, United States

Received 31 January 2000; received in revised form 17 April 2004; accepted 23 April 2004.

Abstract

Research on predicting and preventing episodes of schizophrenia and mood disorder lacks consistent, specific definitions of episodes. We present an operational system for identifying relapse, exacerbation, and remission of schizophrenia and bipolar disorder within longitudinal studies that involve repeated symptom assessments. Three major classes of episodic outcome are defined: relapse or significant exacerbation, nonrelapse, and stable, severe persisting symptoms. These major classes are further subdivided to distinguish nine categories of episodic outcome. To examine ease of use, interrater reliability, and validity, the classification system was applied to recent-onset samples of schizophrenia patients (N=77) and bipolar mood disorder patients (N=23) followed on medication for 9- to 12-month periods. A range of episodic outcomes were distinguished with high interrater reliability. Despite being prescribed continuous medication, 21% of the recent-onset schizophrenia patients and 61% of bipolar patients met criteria for relapse or significant exacerbation during this follow-up period. Predictive relationships support the validity of this system for classifying episodes. A computer program is available to facilitate its use. Use of these explicit definitions of episodes may help to clarify the relationship between episodic outcome and other fundamental domains of illness outcome, particularly other symptom dimensions, work functioning, and social functioning.