Depression increases negative symptom burden in schizophrenia patients
MedWire News: Schizophrenia patients with depression should be monitored closely, say researchers who found that they have a significantly higher burden of negative symptoms and are more likely to attempt suicide than schizophrenia patients without depression.
Writing in the journal Acta Psychiatrica Scandinavica, Rebecca Schennach-Wolff (Ludwig-Maximilians-University, Munich, Germany) and team explain: "Despite the plenitude of published studies examining the rate and dimension of depression in patients with schizophrenia, these trials vary considerably in terms of the definition employed for depression, the methodology of assessment, the observed interval, and the patient status."
They add: "These differences might explain why current literature results are not yet giving clear guidance in terms of the frequency of depressive states during clinical treatment, the reasons for the occurrence of such symptoms as well as the impact of depressive symptoms on outcome."
To address these issues, the researchers studied 249 schizophrenia patients, aged an average of 34.1 years, who were admitted to one of 11 hospitals between 2001 and 2004.
All of the patients were assessed using the Calgary Depression Scale for Schizophrenia (CDSS), the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), the Global Assessment of Functioning Scale (GAF), and the Social Occupational Functioning Scale (SOFAS).
Overall, 90 (36%) patients were depressed at admission, as indicated by a score of 6 points or higher on the CDSS, of whom 21 (23%) were still depressed at discharge after a mean hospital stay of 69.17 days.
The researchers found that a significantly greater proportion of depressed than non-depressed patients were suffering from suicidality at admission, at 36.7% versus 18.4%.
Depressed patients also scored significantly higher on the PANSS negative symptom scale than non-depressed patients at admission (21.18 vs 16.95) and at discharge (16.21 vs 13.94).
Furthermore, depressed patients had poorer functioning and subjective well-being at admission and discharge than non-depressed patients, but greater levels of insight.
There were no significant differences between depressed and non-depressed patients, however, regarding early response (within 2 weeks) and response to treatment, at 61.11% versus 53.64%, and 77.78% versus 81.13%, respectively, or in remission rates, at 48.24% versus 54.74%.
"Even though we were not able to find a significant difference regarding specific predefined outcome criteria, patients with depressive symptoms suffered from significantly more negative and depressive symptoms at discharge, they had impairments in their subjective well-being and functioning and were in danger of suicidal tendencies," the researchers comment.
They conclude: "This highlights the importance of recognizing depressive symptoms in patients with schizophrenia underlining the need for specific treatment strategies."
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By Mark Cowen