Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
duygudurum
merkezi
Depression in Schizophrenia:
Symptom, Syndrome or
Co-morbidity?
E. Timuçin Oral
Assoc Prof of Psychiatry
Outcome
~15% fully recovered
~ 85% have residual and/or active sx
90% or more are economically dependent
75% or more are unmarried
~ 10% die by suicide
Mortality 2x more than healthy controls
Simple Courses
38%
Undulating Courses
58%
Atypical Courses
4%
McKenna 2003
DSM-IV - Schizophrenia
Social/Occupational Dysfunction
Work
Interpersonal relationships
Self-care Mood Symptoms
Depression
Cognitive Deficits Anxiety
Attention Hopelessness
Memory Demoralization
Executive functions Stigmatization
(e.g., abstraction) Comorbid Substance Abuse Suicidality
Good Prognosis in Schizophrenia (?)
Depression
25% prevalence rate with Schizophrenia
Suicide
10% of patients commit suicide
Suicide attempts are 5 times higher than suicide rate
Lifetime Suicide Rates
UP (alone) 10,4%
Schizophrenia + UP 27,5%
BP (alone) 28,5%
Schizophrenia + BP 70.6%
37% at least one suicide attempt
7.9% in nonschizophrenic population (p<0.0001)
(Judd, 1996)
40% reported suicidal ideation
23% reported suicide attempts
6.4% died
Patients who died had lower negative
symptom severity
Suspiciousness and Delusions were more
severe among suicides
Paranoid subtype: elevated risk (12%)
Deficit subtype: reduced risk (1.5%)
(Judd, 1998)
Depression in Schizophrenia
Often been associated with
Worse outcome (Falloon et al 1978)
Impaired functioning
Personal suffering (Siris, 2000)
Higher rates of relapse, rehospitalization and
even suicide (10% of patients)
(Mandel et al 1982; Roy et al 1983; Birchwood et al 1993;
Caldwell-Gottesman 1990; Fenton et al 1997)
Literature on depression in schizophrenia is
imprecise whether the affect, symptom, or syndrome
of depression is involved.
Affect, Symptom, Syndrome?
Affect a mood state (happiness - sadness). Not
pathological as long as situationally appropriate
Inclusion Criteria
Receiving same medication >1 year
Exclusion Criteria
All other psychotic diagnoses,
All other medical and psychiatric diagnosis
Scales
Structured Clinical Interview for Diagnosis (SCID)
Hamilton Depression Rating Scale (HDRS)
Calgary Depression Scale for Schizophrenia (CDSS)
Positive and Negative Syndrome scale (PANSS)
Definitions
Dx of MD (SCID) = ‘co-morbidity group’
Scored > 8 (HDRS) + >12 (CDSS) = ‘syndrome group’
Scored < 8 (HDRS) / <12 (CDSS) = ‘symptom group’
Scored ≤ 2 (HDRS + CDSS) = ‘non-depression group’
Patient Characteristics
71,1% paranoid
16,5% undifferentiated
8,2% residual
4,1% disorganized
Treatment