'Revealed' Depression and Drug Treatment for Schizophrenia
01 Jul 1981-Archives of General Psychiatry (American Medical Association)-Vol. 38, Iss: 7, pp 806-811
TL;DR: 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 they decrease (rather than increase) in severity with effective neuroleptic treatment.
Abstract: • 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.
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TL;DR: A new rating scale for the measurement of depression in schizophrenia is developed based on items selected from the Hamilton Depression Rating Scale and the Present State Examination based on a three stage procedure first factor analysis then measures of internal consistency and finally face validity.
1,160 citations
TL;DR: The evidence at present is most abundant for an association with obsessive-compulsive disorder among the anxiety disorders, and additional studies in newly diagnosed antipsychotic-naive patients and their first-degree relatives are needed.
Abstract: 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.
957 citations
Cites result from "'Revealed' Depression and Drug Trea..."
...’’(120) The relationship of PPD to the psychotic episode itself remains unclear, including the question of whether the depression is a reaction to psychosis, or represents an unmasking effect of the depression as the psychosis remits.(121) This latter view is supported by observations that depressive symptoms are often associated with positive symptom scores(122) and decrease with effective neuroleptic treatment....
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TL;DR: Level 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, suggesting that treatment response is a critical predictor variable for the course of illness in schizophrenics.
Abstract: 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
656 citations
TL;DR: Tests of the reliability and validity of the Calgary Depression Scale concluded that the CDS is a parsimonious reliable scale which is suitable for assessing depression across both the acute and residual stages of schizophrenia.
620 citations
TL;DR: Depression, negative symptoms, social stagnation and social decline in the early course of schizophrenia are studied.
Abstract: 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
437 citations
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TL;DR: This measurement and classification of psychiatric symptoms, it will really give you the good idea to be successful.
Abstract: By reading, you can know the knowledge and things more, not only about what you get from people to people. Book will be more trusted. As this measurement and classification of psychiatric symptoms, it will really give you the good idea to be successful. It is not only for you to be success in certain life you can be successful in everything. The success can be started by knowing the basic knowledge and do actions.
2,617 citations
TL;DR: A high association between akinesia and both objectively rated and subjectively experienced sedative effect indicates that an 'akinetic depression' is not likely if the patient does not look or feel drowsy.
Abstract: • It is possible that some "postpsychotic depressions" may be a toxic effect of antipsychotic drugs. Out of a total of 94 schizophrenic patients, 28 developed a mild akinesia and 32 never developed extrapyramidal symptoms. Those who developed akinesia became less psychotic, but they also experienced a significant, although modest, increase in depression ratings. Successful treatment of the akinesia resulted in significant improvements in depression, somatic concern, anxiety, emotional withdrawal, blunted affect, and motor retardation on both physicians' and nurses' ratings. A high association between akinesia and both objectively rated and subjectively experienced sedative effect indicates that an "akinetic depression" is not likely if the patient does not look or feel drowsy. The 32 nonakinetic patients also became less psychotic, but not more depressed.
364 citations
TL;DR: A review and reformulation of Postpsychotic depression is presented, finding that therapeutic perseverence purportedly can improve the patient's long-term prognosis, and the phenomenon itself may be favorable prognostic sign.
Abstract: • Several authors have described a severe depression in patients emerging from psychotic states. The clinical picture usually resembles that of a retarded depression with strong neurasthenic and schizoid components. It frequently emerges after a patient has been discharged from the hospital and may often go unnoticed. When manifest, the syndrome is usually stable phenomenologically, is often lengthy, and may be resistant to all modalities of treatment. Postpsychotic depression is a relatively neglected clinical area despite the risk of suicide and prolonged suffering. Therapeutic perseverence purportedly can improve the patient's long-term prognosis, and the phenomenon itself may be a favorable prognostic sign. We present here a review and reformulation of this syndrome.
284 citations
TL;DR: It is concluded that non-medical interviewers can obtain as high reproducibility as psychiatrists on most of the non-psychotic sections of the PSE if they have appropriate training.
Abstract: A random sample of 237 women in a south-east London area were seen by non-medical interviewers, trained to use a standard technique (the Present State Examination) to elicit and record psychiatric symptoms. Ninety-five were interviewed a second time by psychiatrists, who also rated audiotape recordings. The reproducibility of the techniques is adequate though not as high, in some respects, as that obtained from out-patient or in-patient samples. This is true at the level of symptom, syndrome, total score, and index of definition of psychiatric disorder. It is concluded that nonmedical interviewers can obtain as high reproducibility as psychiatrists on most of the non-psychotic sections of the PSE if they have appropriate training. Repeatability is lower than reproducibility, partly due to fluctuations in clinical condition, partly to environmental changes between interviews, and partly to differential responses to medical and non-medical interviewers. Over a short period of time, such as a week, repeatability is satisfactory.
257 citations
TL;DR: Results confirm the usefulness of long-acting fluphenazine in maintenance therapy of chronic schizophrenic outpatients already established on the drug and highlight the need for adequate community services to deal with the residual chronic disabilities characteristic of these patients.
Abstract: A double-blind placebo trial of fluphenazine decanoate, a long-acting phenothiazine, was carried out to determine its value in maintenance therapy of chronic schizophrenic outpatients already established on the drug for a minimum period of eight weeks. In low doses it was significantly more effective than placebo in preventing relapse and admission to hospital. Relapse was accompanied by a resurgence of specifically schizophrenic symptoms and by an increase in abnormalities described by the relatives. There was no difference between the experimental and control groups in the treatment required for depression. The group on active medication required more treatment for Parkinsonism, but this difference did not reach statistical significance.In the context of a well-run special clinic for outpatient follow-up of chronic schizophrenic patients these results confirm the usefulness of long-acting fluphenazine. By inference, the benefit of this treatment highlights the need for adequate community services to deal with the residual chronic disabilities which are characteristic of these patients.
229 citations