Dr. Andreasen Replies

Thank you, Drs. Remington and Kapur, for your thoughtful discussion about our choice of words. You are perhaps correct that the term “remission” may be misinterpreted and that “symptomatic remission” might have been a better choice.

I certainly concur that a definition that includes measures of quality of life and psychosocial function is preferable. As we stated in the article, we were somewhat handicapped by the lack of widespread consensus on appropriate rating methods for these aspects of schizophrenia. The field will progress, however, and a new and more complete definition of remission will be presented eventually. In fact, here at Iowa, we have been working on a “local” definition that we are already using that incorporates measures of psychosocial function.

I would disagree with you about only one small issue. There is tremendous pressure from patients and family members to have psychiatrists think and speak about schizophrenia in a less pessimistic and more upbeat manner. As you are no doubt aware, there is considerable emphasis on the concept of “recovery.” Many families wish we would discuss that possibility more often. In this context, use of the term “remission” is definitely a more modest approach.