A depression rating scale for schizophrenics

Psychiatric comorbidities are common among patients with schizophrenia. Substance abuse comorbidity predominates. Anxiety and depressive symptoms are also very common throughout the course of illness, with an estimated prevalence of 15% for panic disorder, 29% for posttraumatic stress disorder, and 23% for obsessive-compulsive disorder. It is estimated that comorbid depression occurs in 50% of patients, and perhaps (conservatively) 47% of patients also have a lifetime diagnosis of comorbid substance abuse. This article chronicles these associations, examining whether these comorbidities are "more than chance" and might represent (distinct) phenotypes of schizophrenia. Among the anxiety disorders, the evidence at present is most abundant for an association with obsessive-compulsive disorder. Additional studies in newly diagnosed antipsychotic-naive patients and their first-degree relatives and searches for genetic and environmental risk factors are needed to replicate preliminary findings and further investigate these associations.

Psychiatric Comorbidities and Schizophrenia

We performed a longitudinal study of chronic schizophrenic patients who were hospitalized for research purposes at the National Institute of Mental Health (NIMH) Intramural Program in the 1970s and early 1980s We assessed present course, outcome and predictor data from the initial cohort of 58 young chronic schizophrenic patients who were followed up for 2 to 12 years following their NIMH index hospitalization At follow-up, the sample showed substantial functional impairment and levels of symptoms with only about 20% of the sample demonstrating a good outcome In addition, strong intercorrelation was noted among the symptom and functioning indexes at follow-up Moreover, neuropsychologic tests of frontal cortical functioning were significantly correlated with outcome levels of negative symptoms and social functioning but not with levels of positive symptoms During the period from the index hospitalization to the follow-up assessment, 78% of the sample suffered a relapse, 38% attempted suicide and 24% had episodes of major affective illness Furthermore, levels of positive and negative symptoms ascertained when patients received optimal neuroleptic treatment during the index hospitalization significantly predicted outcome levels of symptoms and functioning and time spent hospitalized during the follow-up period In contrast, levels of index positive and negative symptoms ascertained during the drug-free state did not predict outcome symptoms or functioning These data suggest that treatment response is a critical predictor variable We examined the implication of these data for the course of illness in schizophrenics

National Institute of Mental Health Longitudinal Study of Chronic Schizophrenia: Prognosis and Predictors of Outcome

Reliability and validity of a depression rating scale for schizophrenics.

OBJECTIVE: The aim of this study was to investigate when social consequences in schizophrenia emerge, and what conditions give rise to the social disadvantage evident in people suffering from schizophrenia. METHOD: Early course in schizophrenia was studied in a population-based sample of 232 first illness-episode cases retrospectively from onset to first admission, and in a representative subsample of 115 patients prospectively at six cross-sections over a period of 5 years. Data on non-specific and negative symptomatology and social development was compared with data from an age- and sex-matched control group drawn from the normal population. RESULTS: In total, 73% of the patients showed a prodromal phase of several years. First signs were depressive and negative symptoms. In 57% of cases social disability emerged 2 to 4 years before first admission. Social consequences depended on the level of social development at onset. An early onset involved social stagnation, and a late onset was associated with social decline. Men's poorer social outcome was determined by their lower level of social development at onset and socially adverse illness behaviour. The 5-year symptom-related course showed no gender difference. At 81% the lifetime prevalence of depressive mood until first admission was several times higher in schizophrenics than in healthy controls. Early depression predicted a lower subsequent score for affective flattening. Suicide indicators were predicted by lack of self-confidence and feelings of guilt early in the illness. CONCLUSION: Taking into account a prodromal phase of several years on average before first hospital admission, early detection, case identification and intervention are urgently needed. The intervention must be targeted at syndromes such as early depression, negative symptoms and certain forms of cognitive and social impairment. Language: en

Depression, negative symptoms, social stagnation and social decline in the early course of schizophrenia.

• Symptoms of depression are common in patients who have been treated for schizophrenia. Various concepts have been proposed to explain the relationship between depression and schizophrenia. Data for schizophrenic patients in prospective studies and a comparison group of depressives show that depressive symptoms are more prevalent during the acute phase of the illness and that they decrease (rather than increase) in severity with effective neuroleptic treatment.

'Revealed' Depression and Drug Treatment for Schizophrenia

224 newly admitted inpatients were randomly allocated to two treatment groups: standard care (length of stay determined by the clinical team) and brief care (acute treatment aimed at effecting the patient's discharge after about a week). Using a new research instrument (the Patient Behaviour Assessment Schedule), information was gathered from the patient's closest relative or friend on a subsample of 99 patients (the "target group"), which actually showed shortened length of hospitalization for brief care patients. There were no significant differences between groups at the two follow-up evaluations on measures of behavioural disturbances and limited social functioning. Results for the whole "target" group reveal that although there was significant improvement in both behaviour and social functioning 2 weeks after admission, there was little subsequent change thereafter. Overall, individual patients demonstrated more improvement in behavioural disturbance than in social functioning at the follow-up interview.

Effects of brief hospitalization on psychiatric patients' behaviour and social functioning.

A randomized controlled trial of brief hospital admission failed to show any difference on clinical measures when compared with standard admission for all psychiatric patients admitted from a catchment area over one year. Psychotic and neurotic symptoms were examined separately and together, using the Present State Examination (PSE) a week after admission and three months later. Clinical outcome was not related to length of stay in hospital or psychiatric diagnosis. This study shows how the PSE can be used to measure change in clinical state for a heterogenous group of psychiatric patients.

Clinical change as a function of brief admission to hospital in a controlled study using the present state examination.

A randomized trial to evaluate day hospital care as an alternative to inpatient treatment in the acute phase of psychiatric illness was abandoned when too few patients were admitted to the trial to enable any valid generalization to be made concerning the total at-risk population In accounting for the failure of the experimental design, attention is drawn to the inability of the research team to influence either the organization of the unit, whereby junior staff had no contact with the day hospital, or the prevailing belief among senior staff that the two treatment settings serve distinctive, not alternative, functions The implications of our failure for the feasibility of conducting a successful and externally valid controlled trial in this research setting are explored

Angela C. Knights

Papers

'Revealed' Depression and Drug Treatment for Schizophrenia

Effects of brief hospitalization on psychiatric patients' behaviour and social functioning.

Clinical change as a function of brief admission to hospital in a controlled study using the present state examination.

Caution and conservatism in the use of a psychiatric day hospital: Evidence from a research project that failed