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

6/Use of the Center for Epidemiological Studies-Depression Scale with Older Adults

OBJECTIVE The purpose of the study was to examine comorbidity in the context of child and adolescent depression. METHOD The authors reviewed recent epidemiological studies using standardized interviews and DSM-III or DSM-III-R criteria. RESULTS There was a high rate of comorbidity in children and adolescents with major depressive disorders or dysthymia. Comorbidity with conduct disorder/oppositional defiant disorder ranged from 21% to 83%; comorbidity with anxiety disorder ranged from 30% to 75%; and comorbidity with attention deficit disorder ranged from 0% to 57.1%. Rates of depressive comorbidity found in community studies were similar to the rates found in clinical studies. In almost all cases, the disorders were more common in depressed children than expected by chance, and the rates of other disorders in depressed children were higher than the rates of depression in those with depression. CONCLUSIONS The mechanisms by which comorbidity occurs are obscure at present. Several possibilities and their implications for nosology, epidemiology, and treatment research are discussed.

Depressive comorbidity in children and adolescents: empirical, theoretical, and methodological issues.

• The current point and lifetime prevalence rates of affective disorders, based on the application of Research Diagnostic Criteria to a US urban community sample, are reported. The affective disorders studied included major and minor depression, mania, hypomania, bipolar I and II, primary and secondary depression, schizo-affective disorder, depressive and cyclothymic personality, and grief reactions. Epidemiologic surveys that include treated and untreated persons to obtain rates of specific psychiatric disorders are needed for scientific purposes and health care planning.

Affective Disorders in a US Urban Community: The Use of Research Diagnostic Criteria in an Epidemiological Survey

• The primary-secondary distinction in affective disorders has been proposed to reduce the heterogeneity of depression. An investigation of the frequency of secondary depression and its nature in depressed opiate addicts, alcoholics, and schizophrenics was undertaken. Findings show that secondary depression in ambulatory patients with other psychiatric disorders is relatively common. The sociodemographic characteristics of the secondary depressives are consistent with the population from which they derive but differ from primary depressives. The symptom patterns of secondary depressives are similar to primary depressives but are overall less severe. These findings give further support to the value of separating out secondary from primary depression in future research studies.

Symptom patterns in primary and secondary depression. A comparison of primary depressives with depressed opiate addicts, alcoholics, and schizophrenics

The combination of antidepressants and neuroleptics has been widely recommended and commonly used clinically for the schizophrenic patient who becomes depressed. However, the value of the combination for these patients has not been clearly demonstrated. This report presents results of a double-blind, randomized, placebo-controlled clinical trial designed to evaluate the combination of perphenazine and amitriptyline hydrochloride with that of perphenazine alone in the treatment of 35 ambulatory chronic schizophrenic patients in whom depressive symptoms developed. Results showed that the addition of amitriptyline to perphenazine, when compared with perphenazine alone, was more effective in reducing symptoms of depression after four months of treatment, but less effective in reducing thought disorder. The study concludes that the value of adding an antidepressant to the usual neuroleptic in the treatment of secondary depression in schizophrenia should be reviewed.

Treatment of secondary depression in schizophrenia. A double-blind, placebo-controlled trial of amitriptyline added to perphenazine.

An examination of the relationship between symptoms and social adjustment among 98 chronic schizophrenic outpatients revealed that depressive mood contributed most to overall social dysfunction. Correlational patterns between depressive mood and factors of social dysfunction among these patients were found to be similar to those found among acutely depressed outpatients.

Depression and social adjustment among chronic schizophrenic outpatients.

Fifty-six chronic schizophrenic outpatients and their significant others were interviewed separately and given the Social Adjustment Scale II. Intraclass correlations revealed a statistically significant level of agreement between the patients' and the significant others' reports of social adjustment. The mean scores for different areas of social adjustment showed considerable variation, and there were interesting differences between the raters' and significant others' judgments of the social adjustment of the patient.

Assessment of Social Adjustment in Chronic Ambulatory Schizophrenics

The influence of social and economic forces on the placement and treatment of the chronically mentally ill is traced historically. This review suggests that minorities and the poor, who have in the past suffered the worst institutional care, will be most at risk in the community during the present era of cutbacks in social services. Deinstitutionalization, in making claims on resources that the larger community is reluctant to grant, is seen as jeopardizing needed incremental reforms.

Donald H. Williams

Papers

Symptom patterns in primary and secondary depression. A comparison of primary depressives with depressed opiate addicts, alcoholics, and schizophrenics

Treatment of secondary depression in schizophrenia. A double-blind, placebo-controlled trial of amitriptyline added to perphenazine.

Depression and social adjustment among chronic schizophrenic outpatients.

Assessment of Social Adjustment in Chronic Ambulatory Schizophrenics

Deinstitutionalization and social policy: historical perspectives and present dilemmas.