Depressive symptoms and chronic peripheral inflammation are associated with impaired functional remission in schizophrenia independently of psychotic remissionl

Background: While psychotic remission in schizophrenia (SZ) has been defined by consensus and associated with a rank of clinical predictive factors, there is a lack of data of factors associated with functional remission. Objectives: To identify clinical and biological factors associated with impaired functional remission in a non selected chronic stabilized SZ outpatients. Methods: This study was a cross-sectional study carried out on all admitted SZ stabilized outpatients in an academic daily care psychiatric hospital. Functional remission was defined by a global assessment of functioning score >61. Psychotic remission was defined according to international criteria. Depression was assessed with the Calgary Depression Rating scale for Schizophrenia. Sociodemographic variables, tobacco status, clozapine treatment and obesity were reported. Chronic peripheral inflammation was defined by a highly sensitive C reactive protein serum level >3 mg/L and metabolic syndrome according to international recommendations. Results: 273 patients were included, among them 51 (18.7%) were classified in the functional remission group. In the multivariate analysis, higher rate of functional remission was associated with psychotic remission (adjusted Odd ratio = 18.2, p <0.001), lower depressive symptoms (aOR=0.8, p = 0.018) and lower peripheral inflammation (aOR=0.4, p = 0.046). No association of functional remission with age, gender, illness duration, second generation antipsychotics, clozapine treatment, tobacco smoking, obesity or metabolic syndrome has been found. Conclusion: Depressive symptoms and chronic peripheral inflammation are associated with impaired functional remission in SZ independently of psychotic remission. Future intervention studies should determine if improving depressive symptoms and chronic peripheral inflammation may improve SZ patients reaching functional remission.