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Dollfus S, Petit M. Principal-component analyses of PANSS and SANS-SAPS in schizophrenia: their stability in an acute phase. Eur Psychiatry 2020; 10:97-106. [DOI: 10.1016/0924-9338(96)80320-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/1993] [Accepted: 12/03/1993] [Indexed: 11/26/2022] Open
Abstract
SummaryWhether studies agree or disagree on the positive-negative dichotomy in schizophrenia, the relevance of a third component, disorganization, remains a point of debate. Disorganization, as expressed by the scale for the assessment of negative symptoms and positive symptoms (SANS-SAPS) and the positive and negative syndrome scale (PANSS) principal-component analyses, could be considered as permanent and determinant a dimension as the positive and negative components. The aim of this study therefore was to determine whether this disorganization, with the negative and positive components, is stable and has the same composition in the acute and postacute phases of illness. This study was carried out in 57 patients, broadly defined by at least one of four diagnostic criteria (American Psychiatric Association, Langfeldt, Carpenter and Schneider), established with a computerized checklist, and evaluated with SANS-SAPS and PANSS. Principal component analyses (PCA) of these scales were performed at admission and discharge from hospital.The PCA of SANS-SAPS displayed a 3-factor solution, regardless of the phase of illness (acute or postacute), showing that the negative, positive and disorganization components were stable. The PCA of PANSS yielded negative and positive components perfectly stable over time and a disorganization component whose composition varied between admission and discharge. At admission, this component included the conceptual disorganization item negatively correlated with one of depression. At discharge, this disorganization component included two additional items, autistic preoccupation and mannerisms and one depression component appeared. The instability of the PCA of PANSS could express the role played by the phase of illness; in an acute phase, this disorganization component was constituted by more “positive” items such as grandiosity, unusual thought content and active social avoidance whereas in the postacute phase, it included items that reflected more the chronicity of the illness, such as mannerisms and autistic preoccupation. Moreover, the depressive item appeared, in the postacute phase, in a specific depressive component. This result could be due to the fact that depressive symptoms cannot be expressed when positive symptoms are very severe, which explains why no depressive components were shown during the acute phase.
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Kjelby E, Gjestad R, Sinkeviciute I, Kroken RA, Løberg EM, Jørgensen HA, Johnsen E. Trajectories of depressive symptoms in the acute phase of psychosis: Implications for treatment. J Psychiatr Res 2018; 103:219-228. [PMID: 29890508 DOI: 10.1016/j.jpsychires.2018.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 12/25/2022]
Abstract
Depression is common in schizophrenia and associated with negative outcomes. Previous studies have identified heterogeneity in treatment response in schizophrenia. We aimed to investigate different trajectories of depression in patients suffering from psychosis and predictors of change in depressive symptoms during antipsychotic treatment. Two hundred and twenty-six patients >18 years acutely admitted due to psychosis were consecutively included and the follow-up was 27 weeks. The Calgary Depression Scale for Schizophrenia (CDSS) sum score was the primary outcome. Latent growth curve (LGCM) and Growth Mixture Models (GMM) were conducted. Predictors were the Positive sum score of the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), Schizophrenia spectrum/non-spectrum psychoses, gender and being antipsychotic naive at inclusion. We found support for three depression-trajectories, including a high- (14.7%), a low depression-level (69.6%) class and a third depressed class quickly decreasing to a low level (15.7%). Change in CDSS was associated with change in PANSS positive score in all time intervals (4 weeks: b = 0.18, p < 0.001, 3 months: 0.21, p < 0.023, 6 months: 0.43, p < 0.001) and with a diagnosis within schizophrenia spectrum but not with antipsychotic naivety or gender. The schizophrenia-spectrum patients had less depressive symptoms at inclusion (-2.63, p < 0.001). In conclusion, an early responding and a treatment refractory group were identified. The treatment-refractory patients are candidates for enhanced anti-depressive treatment, for which current evidence is limited. The post-psychotic depression group was characterized by depressive symptoms in the acute phase as well. We could not identify differentiating characteristics of the depression trajectories.
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Affiliation(s)
- E Kjelby
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
| | - R Gjestad
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway.
| | - I Sinkeviciute
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway.
| | - R A Kroken
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Section of Psychiatry, Faculty of Medicine and Dentistry, University of Bergen, Norway; NORMENT Centre of Excellence, University of Oslo, Norway.
| | - E-M Løberg
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; NORMENT Centre of Excellence, University of Oslo, Norway; Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Norway.
| | - H A Jørgensen
- Department of Clinical Medicine, Section of Psychiatry, Faculty of Medicine and Dentistry, University of Bergen, Norway.
| | - E Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Section of Psychiatry, Faculty of Medicine and Dentistry, University of Bergen, Norway; NORMENT Centre of Excellence, University of Oslo, Norway.
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W. SOPPITT & MAX BIRCHWOOD RICHARD. Depression, beliefs, voice content and topography: A cross-sectional study of schizophrenic patients with auditory verbal hallucinations. J Ment Health 2009. [DOI: 10.1080/09638239718617] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Depression during an acute episode of schizophrenia or schizophreniform disorder and its impact on treatment response. Psychiatry Res 2008; 158:297-305. [PMID: 18280582 DOI: 10.1016/j.psychres.2007.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 08/31/2006] [Accepted: 01/07/2007] [Indexed: 11/21/2022]
Abstract
The aim of the present study was to examine the relevance of depressive symptoms during an acute schizophrenic episode for the prediction of treatment response. Two hundred inpatients who fulfilled DSM-IV criteria for schizophrenia or schizophreniform disorders were assessed at hospital admission and after 6 weeks of inpatient treatment using the Positive and Negative Syndrome Scale (PANSS) and the Hamilton Rating Scale for Depression (HAM-D). Depressive symptoms showed positive correlations with both positive and negative symptoms at admission and after 6 weeks, and decreased during 6 weeks of treatment. Pronounced depressive symptoms (HAM-D score> or =16) were found in 28% of the sample at admission and in 9% after 6 weeks of treatment. Depressive symptoms at admission predicted a greater improvement of positive and negative symptoms over 6 weeks of treatment, but also more, rather than fewer remaining symptoms after 6 weeks. Both results, however, lost statistical significance when analyses were controlled for the influence of positive and negative symptoms at admission. Therefore, the hypothesis that depressive symptoms are predictive of a favorable treatment response was not supported by the present study.
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Kulkarni J, de Castella AR, Filia KM, Filia SL, Marston N, Montgomery W, Christova L, Fitzgerald PB. Australian Schizophrenia Care and Assessment Programme: real-world schizophrenia: outcomes. Aust N Z J Psychiatry 2007; 41:969-79. [PMID: 17999269 DOI: 10.1080/00048670701689410] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE It has been increasingly recognized that there is need to assess patient outcomes in schizophrenia across a broad range of dimensions. But few studies have attempted to do this in clinical populations and no systematic study has broadly assessed outcomes in schizophrenia in Australia using a longitudinal design. Thus, a real-world study, the Schizophrenia Care and Assessment Programme (SCAP), was structured to collect comprehensive information over time to inform policy debate and extend current knowledge about the course of schizophrenia in an Australian context. METHODS A cohort of 347 patients with schizophrenia was followed up over 3 years. Clinical outcomes, occupational and psychosocial functioning and quality of life were assessed at 6 monthly intervals, and resource utilization and costing data were collected continuously from internal and external databases as well as from participants directly. RESULTS The participants as a group experienced an overall decline in positive and negative symptoms of schizophrenia, a reduction in general psychopathology and a reduction in severity of depression. There was an improvement in functioning, a reduction in mental health-related disability and an improvement in patient- and observer-rated quality of life. Change of severity within the variously assessed domains over time appeared to be relatively independent. CONCLUSIONS In the present sample of schizophrenia patients treatment was associated with positive health outcomes; but outcomes across assessment domains did not closely correlate across time. The scrutiny of a broad range of patient outcomes will assist with the assessment of new treatment modalities and with service planning.
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Affiliation(s)
- Jayashri Kulkarni
- Alfred Psychiatry Research Centre, Alfred and Monash University School of Psychology, Psychiatry and Psychological Medicine, Alfred Hospital, Melbourne, Vic, Australia.
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Rocca P, Bellino S, Calvarese P, Marchiaro L, Patria L, Rasetti R, Bogetto F. Depressive and negative symptoms in schizophrenia: different effects on clinical features. Compr Psychiatry 2005; 46:304-10. [PMID: 16175763 DOI: 10.1016/j.comppsych.2004.09.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE The primary aim of this study was to investigate whether depressive symptoms were significantly associated with functional outcome measures in a clinically stable group of outpatients with schizophrenia. We also analyzed whether depressive and negative symptoms presented different patterns of predictors. METHOD Seventy-eight consecutive outpatients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for schizophrenia in the stable period were enrolled in this cross-sectional study. Assessment were performed using the Calgary Depression Scale for Schizophrenia, Positive and Negative Syndromes Scale (PANSS), Clinical Global Impression Scale-severity, Social and Occupational Functioning Assessment Scale, Sheehan Disability Scale, and Quality of Life Scale. A neuropsychologic battery including the vocabulary and block design subtests of the Wechsler Adult Intelligence Scale-Revised, Wechsler Memory Scale, Wisconsin Card Sorting Test, and Continuous Performance Test was also administered to the patients. Two multiple regressions were performed testing demographic and clinical factors, rating scales, and cognitive measures as independent variables and Calgary Depression Scale for Schizophrenia and PANSS-negative subscale scores as dependent variables. RESULTS Four variables were predictors of depressive symptoms in our sample of schizophrenic patients: 2 outcome measures (Sheehan Disability Scale and Quality of Life Scale), gender, and Continuous Performance Test reaction time. Predictors of negative symptoms were the measures of severity of psychopathology (Clinical Global Impression Scale-severity and PANSS-general psychopathology subscale) and the cognitive tests Wechsler Adult Intelligence Scale-Revised block design and Wechsler Memory Scale. CONCLUSION We found that depressive symptoms in schizophrenia are mainly a function of the level of social adjustment and quality of life, whereas negative symptoms constitute an indicator of severity of schizophrenia. The 2 symptom dimensions showed also distinct cognitive correlates.
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Affiliation(s)
- Paola Rocca
- Department of Neuroscience, Unit of Psychiatry, University of Turin, 10126 Torino, Italy.
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Rijcken CAW, Knegtering H, Bruggeman R, Tobi H, de Jong-van den Berg LTW. Sex differences in concomitant medication with benzodiazepines or antidepressants in first-break schizophrenic patients treated with antipsychotic medication. Psychiatry Res 2005; 134:143-50. [PMID: 15840415 DOI: 10.1016/j.psychres.2003.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2003] [Accepted: 06/25/2003] [Indexed: 11/26/2022]
Abstract
During a first episode of psychosis, treatment with antipsychotic drugs can improve both positive and negative symptoms. If sufficient amelioration does not occur, adding psychotropic comedication may result in a favorable outcome. To establish sex differences in psychotropic comedication use, we conducted an exploratory retrospective study among first-break patients diagnosed with schizophrenia or schizophreniform disorder. Concerning patient characteristics, no difference in age or antipsychotic drug use was established. At admission, men significantly more often had comorbid substance abuse. Analysis showed that significantly more women than men received benzodiazepines after the onset of psychosis (OR 1.92, 95% CI 1.13-1.27). No sex difference was found in antidepressant comedication (OR 1.22, 95% CI 0.48-3.11). We established a definite sex difference in concomitant benzodiazepine use in first-break patients with schizophrenia. Since women have a better prognosis, we suggest further research to evaluate the efficacy and safety of early benzodiazepine use in the course of schizophrenia. Furthermore, we recommend investigating the possible correlation between benzodiazepine use and substance abuse as a way of treating premorbid symptoms of schizophrenia.
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Affiliation(s)
- Claudia A W Rijcken
- Department of Social Pharmacy and Pharmacoepidemiology, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
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Serretti A, Mandelli L, Lattuada E, Smeraldi E. Depressive syndrome in major psychoses: a study on 1351 subjects. Psychiatry Res 2004; 127:85-99. [PMID: 15261708 DOI: 10.1016/j.psychres.2003.12.025] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2003] [Revised: 12/23/2003] [Accepted: 12/23/2003] [Indexed: 01/22/2023]
Abstract
The aim of this study was to investigate depressive symptomatology across distinct major psychiatric disorders. A total of 1351 subjects affected by major depressive disorder (MDD = 389), bipolar disorder (BP = 511), delusional disorder (DD = 93) and schizophrenia (SKZ = 358) were included in our study. Subjects were assessed using the Operational Criteria for Psychotic Illness checklist (OPCRIT). The most frequently represented depressive symptoms in MDD were Loss of energy/tiredness, Loss of pleasure, Poor concentration, and Sleep disorders. Compared with MDD, BP had higher occurrences of Agitated activity, Excessive sleep, and Increased appetite and/or Weight gain, as well as lower Loss of pleasure. In our sample, 32.3% and 26.8% of DD and SKZ, respectively, had quite consistent depressive symptomatology, with at least four or more depressive symptoms. The most common depressive symptoms were Sleep disorders, Poor concentration and Loss of energy/Tiredness, followed by Psychomotor symptoms in SKZ only. Excessive self-reproach, Suicidal ideation, and Appetite and/or Weight changes were more specific to mood disorders. Finally, compared with SKZ, DD suffered from more depressive symptoms and had more severe depressive symptomatology. A quite consistent level of depressive symptomatology is therefore present in subpopulations of delusional and schizophrenic subjects other than in affective subjects. We identified some symptoms that are common across all major psychoses and symptoms that are more specific to each group.
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Affiliation(s)
- Alessandro Serretti
- Department of Psychiatry, San Raffaele Institute, Vita-Salute University, School of Medicine, Via Luigi Prinetti 29, 20127 Milan, Italy.
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Kulhara P, Avasthi A. Influence of depressive symptoms and premorbid adjustment on factor structure of phenomenology of schizophrenia: a study from India. Eur Psychiatry 2003; 18:226-32. [PMID: 12927323 DOI: 10.1016/s0924-9338(03)00062-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
This study investigated the nature of factor structure of schizophrenia syndromes using a sample of 151 patients with schizophrenia according to DSM-IV. The patients were assessed on the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), Hamilton Depression Rating Scale (HDRS) and the Phillips Rating Scale of Premorbid Adjustment in schizophrenia. Three factors-negative syndrome, reality-distortion syndrome and disorganized syndrome were extracted when only SAPS and SANS were analysed. Addition of the Phillips Rating Scale scores to SAPS and SANS ratings in the factorial equation led to splitting of the negative syndrome though reality-distortion and disorganized syndromes remained stable. Factor analysis of the HDRS scores with SAPS and SANS ratings resulted in the HDRS loading highly on reality-distortion syndrome and splitting of negative syndrome. Factor analysis of all the variables taken together resulted in delineation of four factors. The study suggests a link between depression and reality distortion. Apathy and anhedonia seem to be linked to premorbid adjustment.
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Affiliation(s)
- Parmanand Kulhara
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160 023, India.
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Fitzgerald PB, Rolfe TJ, Brewer K, Filia K, Collins J, Filia S, Adams A, de Castella A, Davey P, Kulkarni J. Depressive, positive, negative and parkinsonian symptomsin schizophrenia. Aust N Z J Psychiatry 2002; 36:340-6. [PMID: 12060182 DOI: 10.1046/j.1440-1614.2001.01004.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Depressive symptoms are common in schizophrenia but their relationship to the positive and negative symptoms of the disorder and to extrapyramidal side-effects remains unclear. Considerable overlap exists between these symptom clusters when rated with traditional clinical rating scales. The aim of this study was to investigate the relationship of depressive to positive, negative and parkinsonian symptoms using the recent adaptation of the Positive and Negative Syndrome Scale (PANSS). METHOD The study involved the cross-sectional measurement of symptoms in a sample of community-treated and hospitalized patients with schizophrenia. Structured assessment included thePANSS, Montgomery-Asberg Depression Rating Scale (MADRS) and the Extrapyramidal Side Effects Rating Scale (ESRS). RESULTS Depressive symptoms were common and correlated with positive and negative symptoms. These correlations were of a similar magnitude using either the original PANSS factor structure or the newer pentagonal model. The overlap between depressive and negative symptoms was limited to certain items in the rating scales and there was a clear separation between these symptom clusters and the other items. Parkinsonian symptoms also correlated with negative symptoms rated with either PANSS model. CONCLUSION Use of the pentagonal PANSS model does not improve its capacity to distinguish between depressive and negative symptoms. Positive, negative, parkinsonian and depressive symptoms overlap using common rating scales but there appears to be some separation between these symptom domains when rated with individual scale items rather than total scale scores.
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Affiliation(s)
- Paul B Fitzgerald
- Dandenong Psychiatry Research Centre, Monash University, Department of Psychosocial Medicine, Victoria 3175, Australia.
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Abstract
OBJECTIVE Previous studies suggest suspiciousness is associated with an increased risk of major depressive episodes in psychotic patients. We tested the hypothesis that this relationship would extend to nonpsychotic groups. METHOD Data came from the Epidemiological Catchment Area (ECA) study, a longitudinal population-based study conducted at five sites in the United States. Baseline clinical and demographic features were used to predict the onset of episodes of depression at 1-year follow-up in subjects without psychotic symptoms. RESULTS Subclinical suspiciousness was associated with an increased risk of new episodes of depression after accounting for demographic variables. However, three of six subclinical delusion-like experiences were also associated with an increased risk of depressive episodes. None of the subclinical hallucination-like experiences predicted subsequent risk. CONCLUSION Subclinical suspiciousness appears to increase the risk of depression in the general population. Some other delusion-like experiences may do the same.
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Affiliation(s)
- E Messias
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland, Baltimore, Maryland 21228, USA
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Messias E, Kirkpatrick B, Ram R, Tien AY. Suspiciousness as a specific risk factor for major depressive episodes in schizophrenia. Schizophr Res 2001; 47:159-65. [PMID: 11278133 DOI: 10.1016/s0920-9964(00)00030-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Serious depression is a common and important complication of schizophrenia. In a prospective, population-based study, we tested the hypothesis that suspiciousness increases the risk for the later development of depression in schizophrenia. METHOD Data came from the Epidemiological Catchment Area (ECA) study. Baseline clinical and demographic features were used to predict the onset of new episodes of depression at 1 year follow-up. As ECA diagnoses were based on lay interviews, which may have low sensitivity compared with clinical diagnoses, two overlapping groups of putative schizophrenia patients were defined. RESULTS Suspiciousness was associated with an increased risk of new episodes of depression in both patient groups, after accounting for demographic variables. There was no association between an increased risk of depression and either disorganization or hallucinations and delusions. CONCLUSIONS Suspiciousness appears to be a specific risk factor for depression in psychotic groups. Interventions that decrease suspiciousness, or mitigate its isolating effects, might decrease the risk of serious depression and suicide.
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Affiliation(s)
- E Messias
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland, Baltimore, MD, USA
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Lançon C, Auquier P, Reine G, Bernard D, Addington D. Relationships between depression and psychotic symptoms of schizophrenia during an acute episode and stable period. Schizophr Res 2001; 47:135-40. [PMID: 11278130 DOI: 10.1016/s0920-9964(00)00002-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of the present study is to explore the relationship between depression and psychotic symptoms of schizophrenia over the course of illness. Sixty-eight patients meeting DSM-IV criteria for schizophrenia were enrolled, 27 in an acute episode, 41 when stable. Assessments were performed using the Calgary Depression Scale for Schizophrenia (CDSS) for depression and the Positive and Negative Syndrome Scale (PANSS) for psychotic symptoms. When considering patients in an acute episode (52% depressed), the CDSS score was correlated only with the PANSS positive sub-scale score. For patients in the stable period (38% depressed), the CDSS score was correlated with positive as well as negative and general psychopathology sub-scale scores. Hence, the relationship between depression and other symptoms of schizophrenia appear to differ during different stages of illness.
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Affiliation(s)
- C Lançon
- Department of Psychiatry, CHU Sainte Marguerite, 270 Bd de Sainte Marguerite, 13274 Marseille Cedex 09, France.
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Dollfus S, Ribeyre JM, Petit M. Objective and subjective extrapyramidal side effects in schizophrenia: their relationships with negative and depressive symptoms. Psychopathology 2000; 33:125-30. [PMID: 10773770 DOI: 10.1159/000029133] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The aim of this study was to show that objective extrapyramidal symptoms (O-EPS) were strongly correlated to negative and depressive symptoms while subjective extrapyramidal symptoms (S-EPS) were not. Ninety-one schizophrenic patients were evaluated by the Extrapyramidal Symptoms Rating Scale (ESRS), Montgomery and Asberg Depression Rating Scale (MADRS) and Scale for the Assessment of Negative Symptoms (SANS). While significant correlations were found between O-EPS and SANS (r = 0.51; p < 0.001) and between O-EPS and MADRS (r = 0.26; p < 0.01), no significant relationship existed between S-EPS and SANS (r = 0.19) or MADRS (r = 0.19). Similar results regarding the relationships between EPS and SANS were found in stabilized and acute subgroups and in deficit and nondeficit subgroups. A stepwise multiple regression showed that 41% of the variance of the SANS scores was due to facial mask and bradykinesia, and that 17% of the variance of the MADRS scores was due to facial mask and akathisia. This study shows the interest of evaluating subjective parkinsonism symptoms over objective ones since they are less interrelated to other symptoms, in particular to negatives ones.
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Affiliation(s)
- S Dollfus
- Groupe de recherche Caen-Rouen, Centre Esquirol, CHU Côte de Nacre, France.
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Ventura J, Nuechterlein KH, Subotnik KL, Hardesty JP, Mintz J. Life events can trigger depressive exacerbation in the early course of schizophrenia. JOURNAL OF ABNORMAL PSYCHOLOGY 2000. [DOI: 10.1037/0021-843x.109.1.139] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lançon C, Auquier P, Reine G, Toumi M, Addington D. Evaluation of depression in schizophrenia: psychometric properties of a French version of the Calgary Depression Scale. Psychiatry Res 1999; 89:123-32. [PMID: 10646831 DOI: 10.1016/s0165-1781(99)00097-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to determine the psychometric properties (especially validity and reliability) of the French language version of the Calgary Depression Scale for Schizophrenia (CDSS) in schizophrenic patients. Ninety-five subjects who met DSM-IV criteria for schizophrenia were enrolled. The studies of the internal structural validity and of the reliability (internal consistency) showed that some items from the CDSS (early awakening and guilty ideas of reference) must be discussed in the constitution of this scale. The total score of the CDSS was significantly correlated with the MADRS total score, the HDRS total score, and the depression item (G6) on the PANSS, which suggests that the CDSS is a valid instrument for the assessment of depression in schizophrenia. The existence of a significant correlation between the CDSS total score and the PANSS positive sub-scale suggests a possible relationship between positive and depressive symptoms in schizophrenia.
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Affiliation(s)
- C Lançon
- Department of Psychiatry, CHU Sainte Marguerite, Marseille, France.
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Hori A, Tsunashima K, Watanabe K, Takekawa Y, Ishihara I, Terada T, Uno M. Symptom classification of schizophrenia changes with the duration of illness. Acta Psychiatr Scand 1999; 99:447-52. [PMID: 10408267 DOI: 10.1111/j.1600-0447.1999.tb00991.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Our starting hypothesis was that schizophrenic symptomatology changes over time. This hypothesis explains conflicting reports on schizophrenic symptom structures as a consequence of different durations of illness in the samples studied to date. Therefore a sample of 258 schizophrenic in-patients (with ICD-10 diagnoses F20) was categorized according to illness duration. A factor analysis was performed on the 8 items of the Manchester Scale for three subgroups (duration < 10 years, 10> or =20 years and > or = 20 years). For those patients whose illness duration was less than 10 years, 'formal thought disorder' was not related to any other mental state, whereas for those whose duration was 10 years or longer, it was correlated with 'negative symptoms'. In the < 10 years group, 'anxiety and depression syndrome' and 'positive symptoms' formed one complex, but these symptoms were separated into two distinct syndromes in the > or = 20 years group. Thus we were able to demonstrate that the classification of symptoms changes with increasing duration of illness.
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Affiliation(s)
- A Hori
- Department of Psychiatry, National Center Hospital for Mental, Nervous and Muscular Disorders, National Center of Neurology and Psychiatry, Tokyo, Japan
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Mauri MC, Bitetto A, Fabiano L, Laini V, Steinhilber C, Fornier M, Rafique F. Depressive symptoms and schizophrenic relapses: the effect of four neuroleptic drugs. Prog Neuropsychopharmacol Biol Psychiatry 1999; 23:43-54. [PMID: 10368855 DOI: 10.1016/s0278-5846(98)00090-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
1. A prevalence of depressive symptomatology, ranging from 25% to 80% has been reported during the course of schizophrenia. 2. Depressive symptoms were assessed in 144 schizophrenic patients (DSM IV) during an acute exacerbation phase. 3. Depressive symptoms showed a prevalence ranging from 5.5% (severe clinical pictures) to 54.8 (mild clinical pictures). 4. The authors did not find a correlation between depressive symptoms per se and the presence of negative psychotic symptoms. Depression may be linked not so much to negative symptoms but to the psychotic state itself. 5. Depressive symptomatology concurrently occurred with schizophrenic relapses and improved together with the psychotic clinical picture, independently of the neuroleptic drug employed. Haloperidol, haloperidol decanoate and fluphenazine decanoate all showed a similar improvement of depressive symptoms. 6. L-sulpiride showed a trend to be most effective on depressive symptomatology in comparison to the other neuroleptics.
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Affiliation(s)
- M C Mauri
- Department of Clinical Psychiatry, University of Milan.
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Zorrilla EP, Cannon TD, Kessler J, Gur RE. Leukocyte differentials predict short-term clinical outcome following antipsychotic treatment in schizophrenia. Biol Psychiatry 1998; 43:887-96. [PMID: 9627743 DOI: 10.1016/s0006-3223(97)00358-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The majority of patients with schizophrenia and many of their unaffected siblings exhibit a relative granulocytosis and lymphopenia. To characterize these abnormalities better, we examined leukocyte differentials and organ nonspecific autoantibodies in relationship to intake phenomenology and short-term clinical outcome. METHODS We studied patients with schizophrenia (n = 81) and their siblings (n = 18). At intake assessment, about one-half of the probands (n = 38) were neurolepticnaive first-episode patients; the remainder were medication-free for at least 2 weeks. Hematologic indices were obtained at intake assessment, and psychiatric symptomatology was assessed at baseline and following 6 months of clinically determined treatment. RESULTS A relative granulocytosis and lymphopenia prospectively predicted poorer recovery in positive, but not negative, symptoms after 6 months of antipsychotic treatment. Abnormal leukocyte proportions were specific to patients who presented with clinically significant positive symptomatology at intake. In contrast, clinically significant negative symptoms were only evident in a small subgroup of patients who were positive for antinuclear autoantibodies and/or rheumatoid factor. CONCLUSIONS Future research should further test the hypothesis that a relative granulocytosis and lymphopenia reflect genetic loading for the pathophysiologic determinants of positive symptoms. Future research also should determine the etiologic significance of organ nonspecific autoimmunity in predominantly negative symptom schizophrenia.
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Affiliation(s)
- E P Zorrilla
- Department of Psychology, University of Pennsylvania, Philadelphia, USA
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Lam RW, Peters R, Sladen-Dew N, Altman S. A community-based clinic survey of antidepressant use in persons with schizophrenia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1998; 43:513-6. [PMID: 9653537 DOI: 10.1177/070674379804300511] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the rates of antidepressant and antipsychotic use in the treatment of schizophrenia. METHOD The primary therapists at 8 community mental health centres in a metropolitan Canadian city completed a survey questionnaire for all of their active clients. Information was collected about diagnoses, medication treatments, and clinical variables. RESULTS There were 3555 clients, 1552 (43.7%) of which had a diagnosis of schizophrenia. Of clients with schizophrenia, 94% were prescribed antipsychotic medications, and 11.6% of these were also prescribed antidepressant medications. There were differences between the combination-treatment group and the antipsychotic-alone group in gender ratio, rates of concurrent diagnoses of mood disorder, level of current functioning, and total number of hospitalizations. CONCLUSION In this community-based sample of clients with schizophrenia, antidepressants and antipsychotics are commonly prescribed in combination, even though the rate of concurrent mood disorders diagnoses is low. Further studies should clarify the efficacy and indications for antidepressant use in this population.
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Affiliation(s)
- R W Lam
- Department of Psychiatry, University of British Columbia, Vancouver.
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Davidson L, McGlashan TH. The varied outcomes of schizophrenia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1997; 42:34-43. [PMID: 9040921 DOI: 10.1177/070674379704200105] [Citation(s) in RCA: 176] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To review variations in outcomes in schizophrenia across individual, historical, and cross-cultural boundaries, as well as within specific domains of functioning. METHOD Research literature on the outcomes of schizophrenia appearing within the last 8 years was reviewed. RESULTS First, a review of follow-up studies published in the developed world suggests that heterogeneity in outcome across individuals with schizophrenia remains the rule, with affective symptoms, later and acute onset, and responsiveness to biological treatments predictive of good outcome. Negative symptoms are associated with poor outcome, cognitive impairments, and incapacity in social and work domains. Deterioration appears to occur within the first few months of onset if not already in the prodrome, with recent early-course studies finding longer duration of untreated psychosis associated with insidious onset, negative symptoms, social and work incapacity, and poor outcome. Second, a review of recent cross-cultural and historical studies provides evidence that outcome varies across time and place, schizophrenia having a more favourable outcome in the developing world and becoming a more benign disorder over the course of this century. Third, a review of studies of the domains of functioning within individuals identifies 4 relatively independent dimensions of depression and negative, psychotic, and disorganized symptoms. Cognitive deficits, which are associated with negative symptoms, also constitute a relatively stable dimension over time, showing neither marked deterioration nor improvement once established early in the course of disorder. CONCLUSIONS The early appearance and stability over time of negative symptoms and cognitive impairments call for assertive intervention efforts early in the course of disorder to prevent chronicity and prolonged disability.
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Affiliation(s)
- L Davidson
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA
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Abstract
OBJECTIVE To assess the level of depressive symptomatology among a group of patients with schizophrenia, both inpatients and outpatients, and speculate as to the reasons why differences among the groups may be occurring. METHOD Fifty inpatients of Baillie Henderson Hospital, a chronic stay psychiatric hospital in Queensland, and 44 outpatients of this hospital were assessed on a number of measures including the Positive and Negative Syndrome Scale for Schizophrenia, Abnormal Involuntary Movements Scale, Hamilton Rating Scale for Depression and Beck Depression Inventory. All patients were assessed in a structured interview for 35-40 minutes by the same clinician. A chart review also occurred. The chief outcome variable was a Hamilton Depression Rating Scale of 17 or greater. RESULTS Clinically significant depression, as defined by a Hamilton Depression score of 17 or greater, was found in 10% (n = 5) of the inpatient sample. Of the outpatient sample, 4.5% (n = 2) showed a clinically significant depression, which was not significantly different to the inpatient group. The prevalence of mild to moderate depression, as defined by a Hamilton Depression score of between 10 and 17, was 42% in the inpatient group and 47.7% in the outpatient group. There was no significant difference between the two groups on the mean Hamilton Depression scores. CONCLUSIONS The results suggest a high level of depressive symptomatology in patients with schizophrenia. As suicide is common in this group, this finding is important. Self-reporting of this problem by patients with schizophrenia, by means of questionnaire, is feasible and provides comparable results to objective clinician ratings.
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Affiliation(s)
- P Markou
- Royal Brisbane Hospital, Herston, Queensland, Australia
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Sax KW, Strakowski SM, Keck PE, Upadhyaya VH, West SA, McElroy SL. Relationships among negative, positive, and depressive symptoms in schizophrenia and psychotic depression. Br J Psychiatry 1996; 168:68-71. [PMID: 8770431 DOI: 10.1192/bjp.168.1.68] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND We examined relationships among positive, negative, and depressive symptoms in schizophrenia and major depression with psychosis. METHOD Patients with schizophrenia (n = 17) and major depression and psychotic features (n = 25), with no prior psychopharmacologic treatment were assessed on scales measuring positive psychotic, negative, and depressive symptoms. RESULTS Analyses revealed the depressive symptoms positively correlated with anhedonia/asociality and avolition/apathy in both patient groups. Positive psychotic symptoms significantly correlated with depressive symptoms in the schizophrenic group. CONCLUSIONS Several specific symptoms used in defining both depressive and negative syndrome constructs appear to be shared. The relationship between positive symptoms and depression in schizophrenia and not psychotic depression suggests the severity of depression may be involved in this relationship.
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Affiliation(s)
- K W Sax
- Department of Psychiatry, University of Cincinnati College of Medicine, Ohio 45267-0559, USA
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