Depressive symptoms among patients with schizophrenia in acute and remission phases

Amir Peljto; Danilo Pešić; Nikos G Christodoulou; Dušica Lečić Toševski

doi:10.2298/VSP160311004P

Amir Peljto Institute of Mental Health, Belgrade, Serbia
Danilo Pešić Institute of Mental Health, Belgrade, Serbia
Nikos G Christodoulou
Dušica Lečić Toševski Institute of Mental Health, Belgrade, Serbia; Serbian Academy of Sciences and Arts, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP160311004P

Keywords: depression;, schizophrenia;, prevalence;, acute disease;, remission induction.

Abstract

Bacground/Aim. Researchers suggest that among people with schizophrenia, the prevalence of depressive symptoms ranges from 7% to 80%. The rate of depressive symptoms among people with schizophrenia varies widely because of the phase of the disease, type of study applied, rating scale for depressive symptoms and diagnostic criteria. The aim of this research was to determine the prevalence of depressive symptoms and the clinical correlation of depressive symptoms with other clinical parameters (type and severity of psychotic symptoms, severity of illness, insight and global functioning) among patients with schizophrenia in acute and remission phases. Methods. This prospective clinical study enrolled 100 consecutive patients with schizophrenia both in acute and remission phases. Psychometric assessments were made using the Positive and Negative Syndrome Scale (PANSS) for rating the symptoms of schizophrenia, Scale to Assess the Unawareness of Mental Disorder (SUMD), Calgary Depression Scale for Schizophrenia (CDSS), and Global Assessment of Functioning Scale. Results. The prevalence of depressive symptoms among patients with schizophrenia in the acute phase was 23% at the study group, while in the remission phase it was 13%. In the acute phase, the CDSS scale correlated with a depressive and positive subscale of the PANSS scale as well as SUMD scale. In the remission phase, the CDSS scale correlated only with a depressive subscale of the PANSS scale. The CDSS scale did not correlate with the negative subscale of the PANSS scale. The subjective nature of depressive symptoms is more pronounced in the remission phase. Conclusion. Our findings showed that depressive symptoms were more pronounced in the acute psychotic phase than in the remission phase of schizophrenia. Targeted, patient oriented, and algorithm-based approach for treatment management, with taking into account different phenotypic expressions of the disorder (patients with and without affective symptoms) is warranted in patients with schizophrenia.

References

REFERENCES

Krabbendam L, van Os J. Affective processes in the onset and persistence of psychosis. Eur Arch Psychiatry Clin Neurosci 2005; 255(3): 185‒9.

Gaebel W, Wölwer W. Facial expressivity in the course of schizophrenia and depression. Eur Arch Psychiatry Clin Neu-rosci 2004; 254(5): 335‒42.

Peralta V, Cuesta MJ. Negative parkinsonian, depressive and catatonic symptoms in schizophrenia: a conflict of paradigms revisited. Schizophr Res 1999; 40(3): 245‒53.

Cheniaux E, Landeira-Fernandez J, Lessa Telles L, Lessa JL, Di-as A, Duncan T, et al. Does schizoaffective disorder really ex-ist? A systematic review of the studies that com¬pared schizoaf-fective disorder with schizophrenia or mood disorders. J Af-fect Disord 2008; 106(3): 209‒17.

Skodlar B. Three different meanings of depression in schizo-phrenia. A phenomenological perspective. Psychiatr Danub 2009; 21 Suppl 1: 88‒92.

Kantrowitz JT, Citrome L. Schizoaffective disorder: a re¬view of current research themes and pharmacological management. CNS Drugs 2011; 25(4): 317‒31.

Siris SG, Bench C. Depression and schizophrenia. In: Hirsch SR, Weinberger D, editors. Schizophrenia. 2nd ed. Oxford, UK: Blackwell Publishing Ltd; 2003.

Conley RR, Ascher-Svanum H, Zhu B, Faries D, Kinon BJ. The burden of depressive symptoms in the long-term treatment of patients with schizophrenia. Schizophr Res 2007; 90(1‒3): 186–97.

Heald A, Morris J, Soni SD. Characterisation of depression in patients with schizophrenia. Indian J Med Res 2008; 127(6): 544‒50.

Morrissette DA, Stahl SM. Affective symptoms in schizophre-nia. Drug Discovery Today: Therapeutic Strategies 2011; 8 (1–2): 3–9.

Pruß L, Wiedl KH, Waldorf M. Stigma as a predictor of in¬sight in schizophrenia. Psychiatry Res 2012; 198(2): 187‒93.

Staring AB, Van der Gaag M, Van den Berge M, Duivenvoor¬den HJ, Mulder CL. Stigma moderates the associations of insight with depressed mood, low self-esteem, and low quality of life in patients with schizophrenia spectrum dis¬orders. Schizophr Res 2009; 115(2‒3): 363–9.

First MB, Spitzer RL, Gibbon M, Williams JB. Structured Clini-cal Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV). Washington, D.C.: American Psychi¬atric Press, Inc.; 1996.

Andreasen NC, Carpenter WT Jr, Kane JM, Lasser RA, Marder SR, Weinberger DR. Remission in schizophrenia: proposed cri-teria and rationale for consensus. Am J Psy¬chiatry 2005; 162(3): 441‒9.

Kay SR, Fiszbein A, Opler LA. The positive and negative syn-drome scale (PANSS) for schizophrenia. Schizophr Bull 1987: 13(2): 261‒76.

Amador XF, Strauss DH, Yale SA, Flaum MM, Endicott J, Gor-man JM. Assessment of insight in psychosis. Am J Psy¬chiatry 1993; 150(6): 873‒9.

Addington D, Addington J, Maticka-Tyndale E. Specificity of the Calgary Depression Scale for schizophrenics. Schizophr Res 1994; 11(3): 239‒44.

Jones SH, Thornicroft G, Coffey M, Dunn G. A brief mental health outcome scale-reliability and validity of the Global As-sessment of Functioning (GAF). Br J Psychiatry 1995; 166(5): 654‒9.

El Yazaji M, Battas O, Agoub M, Moussaoui D, Gutknecht C, Dalery J, et al. Validity of the depressive dimension ex¬tracted from principal component analysis of the PANSS in drug-free patients with schizophrenia. Schizophr Res 2002; 56(1‒2): 121‒7.

Baynes D, Mulholland C, Cooper SJ, Montgomery RC, MacFlynn G, Lynch G, et al. Depressive symptoms in stable chronic schizo-phrenia: prevalence and relationship to psy¬chopathology and treatment. Schizophr Res 2000; 45(1‒2): 47‒56.

Lançon C, Auquier P, Reine G, Bernard D, Addington D. Re-lationships between depression and psychotic symp¬toms of schizophrenia during an acute episode and stable period. Schizophr Res 2001; 47(2‒3): 135‒40.

Hausmann A, Fleischhacker WW. Differential diagnosis of de-pressed mood in patients with schizophrenia: a diagnos¬tic al-gorithm based on a review. Acta Psychiatr Scand 2002; 106(2): 83–96.

Ramirez N, Sarro S, Arranz B, Sanchez J, Gonzalez J, San L. In-struments of depression assessment in schizophrenia. Actas Esp Psiquiatr 2001; 29(4): 259–68. (Spanish)

Schennach-Wolff R, Obermeier M, Seemuller F, Jager M, Messer T, Laux G, et al. Evaluating depressive symptoms and their im-pact on outcome in schizophrenia applying the Calgary De-pression Scale. Acta Psychiatr Scand 2011; 123(3): 228‒38.

Maggini C, Raballo A. Exploring depression in schizophre¬nia. Eur Psychiatry 2006; 21(4): 227–32.

Majadas S, Olivares J, Galan J, Diez T. Prevalence of depres¬sion and its relationship with other clinical characteristics in a sam-ple of patients with stable schizophrenia. Compr Psychiatry 2012; 53(2): 145–51.

Gorna K, Jaracz K, Wrzyszczynska L, Rybakowski F. Qual¬ity of life and depression in schizophrenic patients. Adv Med Sci 2007; 52(Suppl 1): 108–11.

Roche E, Clarke M, Browne S, Turner N, McTuige O, Kamali M, et al. Prevalence and clinical correlates of depression in acute phase of first episode schizophrenia. Irish J Psych Med 2010; 27(1): 15‒8.

Arranz B, San L, Ramírez N, Dueñas RM, Perez V, Salavert J, et al. Clinical and serotonergic predictors of non-affec¬tive acute remitting psychosis in patients with a first-epi¬sode psychosis. Acta Psychiatr Scand 2009; 119(1): 71–7.

Möller HJ, von Zerssen DV. Depressive states during the clinical treatment of 280 schizophrenic inpatients (au¬thor's transl). Pharmacopsychiatria 1981; 14(5): 172‒9. (German)

Reine G, Lançon C, Di Tucci S, Sapin C, Auquier P. Depres¬sion and subjective quality of life in chronic phase schizo¬phrenic patients. Acta Psychiatr Scand 2003; 108(4): 297‒303.

Sarro S, Dueñas RM, Ramírez N, Arranz B, Martínez R, Sánchez JM, et al. Cross cultural adaptation and validation of the Spanish version of the Calgary Depression Scale for Schizo-phrenia. Schizophr Res 2004; 68(2‒3): 349‒56.

Müller MJ, Szegedi A, Wetzel H, Benkert O. Depressive fac¬tors and their relationships with other symptom domains in schiz-ophrenia, schizoaffective disorder, and psychotic depression. Schizophr Bull 2001; 27(1): 19‒28.

Bottlender R, Strauss A, Möller HJ. Prevalence and back¬ground factors of depression in first admitted schizo¬phrenic patients. Acta Psychiatr Scand 2000; 101(2): 153‒60.

Rocca P, Bellino S, Calvarese P, Marchiaro L, Patria L, Rasetti R, et al. Depressive and negative symptoms in schizophrenia: dif-ferent effects on clinical features. Compr Psychiatry 2005; 46(4): 304‒10.

Sim K, Mahendran R, Siris SG, Heckers S, Chong SA. Subjec¬tive quality of life in first episode schizophrenia spectrum disorders with comorbid depression. Psychiatry Res 2004; 129(2): 141‒7.