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Background: After a first episode in schizophrenia guidelines recommend antipsychotic maintenance treatment (MT) for at least 1year. Recent RCTs on subsequent targeted intermittent treatment (IT) after stepwise drug discontinuation yielded noticeably higher relapse rates than during MT also in first-episode patients. Nevertheless, about 50% of patients remain stable under IT. Given the potential adverse effects of antipsychotics and the preference of many patients to discontinue drugs, valid predictors for the feasibility of IT are urgently needed to support decision making.Methods: Based on a one-year RCT phase comparing MT with IT in first-episode patients after 1year of MT, conducted within the German Research Network on Schizophrenia (GRNS), predictors for deterioration under IT in 19 feasible patients were identified by logistic regression analysis.Results: Deterioration occurred in 10 patients (52.6%). Univariate analyses indicated a lower PANSS positive score after acute treatment as well as after one year of MT as significant predictors; in multivariate logistic regression, in addition to the lower PANSS positive score after acute treatment, reaching enduring remission and having had a deterioration both during MT evolved as significant predictors and indicate a higher risk for deterioration.Conclusions: Although limited by the small sample size, our findings suggest that patients who show a favorable response and full and enduring symptom remission during antipsychotic treatment, as well as those with marked deterioration despite MT should rather be recommended to remain on treatment because they are at higher risk for symptom re-exacerbation after (stepwise) drug discontinuation. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Full and sustained symptom remission is a major treatment objective after a first-episode in schizophrenia. Findings regarding differences in remission between first- and second-generation antipsychotics are inconclusive. This study aimed to provide rates and predictors of remission in first-episode schizophrenia and to identify symptoms that prevent remission. Methods: Prevalence rates of “symptomatic remission” (symptom criteria only) and “enduring remission” (symptom and 6-month time criteria), defined according to Andreasen et al. (2005), were determined in first-episode patients participating in a RCT by the German Research Network on Schizophrenia (GRNS) that compared post-acute, 1-year maintenance treatment with risperidone or haloperidol. Respective predictors at baseline were identified by logistic and Cox regression analysis. Results: Prevalence rates were 91.5% for symptomatic remission (n=152/166 eligible patients) and 58.6% for enduring remission (n=65 of 111 patients who continued for at least 6months; 39.2% of all 166 patients included), with no significant differences between risperidone and haloperidol in either type of remission. Enduring remission often was not reached because of negative symptoms: After 6months, 40.5% of the patients had at least 1 negative symptom, whereas only 10.8% of the patients had “persisting” positive symptoms. Of the different predictors identified in univariate analyses, (lower) negative symptoms and participating in standardized psychological treatment remained significant in multivariate (stepwise forward) analyses for enduring remission. Conclusions: By far most of the first-episode patients reached a temporary state of full symptomatic remission within 1year of antipsychotic treatment. However, only about 50% achieved sustained, enduring remission. Negative symptoms are still a major treatment obstacle to enduring remission in schizophrenia. [Copyright &y& Elsevier]

Infections play an important role in childhood. For Germany, few data are available on the epidemiology of infectious diseases such as otitis media and pneumonia in children. We therefore described the prevalence, first episode proportions and recurrence of these childhood infection diseases in selected regions of Germany in children up to 6 years of age. The analysis was based on data from the LISA Study, a prospective population-based birth cohort study including 3,097 full-term infants. Information was collected by parent questionnaire. The first episode proportions for the first 6 years of life were high for otitis media (66.7%; 95%CI 0.65-0.69) and pneumonia (13.5%; 95%CI 0.12-0.15). The annual first episode proportions for otitis media ranged from 7.3% to 25.6% and for pneumonia from 1.4% to 3.4%; both peaked during the second year. The average number of otitis media episodes was 2.2 (SD 2.0) episodes per child within the first 2 years. During the first 2 years of life, hospitalisations due to otitis and pneumonia occurred in up to 7.8 per thousand and 3.0 per thousand of the children, respectively. On average, 50.6% of the children with otitis media were treated with antibiotics during the first year of life. In conclusion, this analysis shows that infectious diseases, especially otitis media, are very frequent childhood diseases in Germany. Thus, parents and physicians should not per se worry about a high frequency of otitis media during early childhood. [ABSTRACT FROM AUTHOR]