Recovery in the outpatient setting: 36-month results from the Schizophrenia Outpatients Health Outcomes (SOHO) study

Recovery is an important outcome of schizophrenia that has not been well defined or researched. Using a stringent definition of recovery that included long-lasting symptomatic and functional remission as well as an adequate quality of life for a minimum of 24 months and until the 36-month visit, we determined the frequency and predictors of recovery in patients with schizophrenia during 3 years of antipsychotic treatment in the prospective, observational Schizophrenia Outpatients Health Outcomes (SOHO) study. Of the 6642 patients analysed, 33% achieved long-lasting symptomatic remission, 13% long-lasting functional remission, 27% long-lasting adequate quality of life, and 4% achieved recovery during the 3 year follow-up period. Logistic regression analysis revealed that social functioning at study entry (having good occupational/vocational status, living independently and being socially active) and adherence with medication were factors significantly associated with achieving recovery. Higher negative symptom severity, higher BMI and lack of effectiveness as the reason for change of medication at baseline were baseline factors associated with a lower likelihood of achieving recovery. Treatment with olanzapine was also associated with a higher frequency of recovery compared with risperidone, quetiapine, typical antipsychotics (oral, depot) and patients taking two or more antipsychotic medications. There were no differences among the patients taking olanzapine, clozapine and amisulpride. Predictors of long-lasting symptomatic remission, functional remission and adequate quality of life were also independently analysed. Although the results should be interpreted conservatively due to the observational, non-randomised study design, they indicate that only a small proportion of patients with schizophrenia achieve recovery and suggest that social functioning, medication adherence and type of antipsychotic are important predictors of recovery.