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Query: UMLS:C0036341 (schizophrenia)
 60,220 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Depressive symptoms are a common feature of schizophrenic disorders, a fact that has become increasingly apparent over the last two decades. Apparently the introduction of standardized rating scales in cross-sectional and longitudinal investigations played an important role in the recognition of the relevance of depressive symptoms. They can be interpreted as being cosyndromal or comorbid, depending on the conceptual perspective applied. This is not simply a difference in terminology but is of great aetiopathogenetic relevance. Of particular clinical relevance is the observation that schizophrenic patients with concomitant depressive symptoms have a greater risk of suicidality or an unfavourable disease course. For this reason it is important that sufficient attention is paid to the diagnosis and treatment of depressive symptoms occurring during schizophrenic psychoses. Besides treatment with antidepressants, modern neuroleptics are of great importance in this context as they are more efficacious than classical neuroleptics in treating depressive symptoms.
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PMID:Occurrence and treatment of depressive comorbidity/cosyndromality in schizophrenic psychoses: conceptual and treatment issues. 1627 80

The aim of the present study was to examine the relevance of depressive symptoms during an acute schizophrenic episode for the prediction of treatment response. Two hundred inpatients who fulfilled DSM-IV criteria for schizophrenia or schizophreniform disorders were assessed at hospital admission and after 6 weeks of inpatient treatment using the Positive and Negative Syndrome Scale (PANSS) and the Hamilton Rating Scale for Depression (HAM-D). Depressive symptoms showed positive correlations with both positive and negative symptoms at admission and after 6 weeks, and decreased during 6 weeks of treatment. Pronounced depressive symptoms (HAM-D score> or =16) were found in 28% of the sample at admission and in 9% after 6 weeks of treatment. Depressive symptoms at admission predicted a greater improvement of positive and negative symptoms over 6 weeks of treatment, but also more, rather than fewer remaining symptoms after 6 weeks. Both results, however, lost statistical significance when analyses were controlled for the influence of positive and negative symptoms at admission. Therefore, the hypothesis that depressive symptoms are predictive of a favorable treatment response was not supported by the present study.
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PMID:Depression during an acute episode of schizophrenia or schizophreniform disorder and its impact on treatment response. 1828 May 82

Clinicians treating older patients with schizophrenia are often challenged by patients presenting with both depressive and psychotic features. The presence of co-morbid depression impacts negatively on quality of life, functioning, overall psychopathology and the severity of co-morbid medical conditions. Depressive symptoms in patients with schizophrenia include major depressive episodes (MDEs) that do not meet criteria for schizoaffective disorder, MDEs that occur in the context of schizoaffective disorder and subthreshold depressive symptoms that do not meet criteria for MDE. Pharmacological treatment of patients with schizophrenia and depression involves augmenting antipsychotic medications with antidepressants. Recent surveys suggest that clinicians prescribe antidepressants to 30% of inpatients and 43% of outpatients with schizophrenia and depression at all ages. Recent trials addressing the efficacy of this practice have evaluated selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, sertraline, fluvoxamine and citalopram. These trials have included only a small number of subjects and few older subjects participated; furthermore, the efficacy results have been mixed. Although no published controlled psychotherapeutic studies have specifically targeted major depression or depressive symptoms in older patients with schizophrenia, psychosocial interventions likely play a role in any comprehensive management plan in this population of patients.Our recommendations for treating the older patient with schizophrenia and major depression involve a stepwise approach. First, a careful diagnostic assessment to rule out medical or medication causes is important as well as checking whether patients are adherent to treatments. Clinicians should also consider switching patients to an atypical antipsychotic if they are not taking one already. In addition, dose optimization needs to be targeted towards depressive as well as positive and negative psychotic symptoms. If major depression persists, adding an SSRI is a reasonable next step; one needs to start with a low dose and then cautiously titrate upward to reduce depressive symptoms. If remission is not achieved after an adequate treatment duration (8-12 weeks) or with an adequate dose (similar to that used for major depression without schizophrenia), switching to another agent or adding augmenting therapy is recommended.We recommend treating an acute first episode of depression for at least 6-9 months and consideration of longer treatment for patients with residual symptoms, very severe or highly co-morbid major depression, ongoing episodes or recurrent episodes. Psychosocial interventions aimed at improving adherence, quality of life and function are also recommended. For patients with schizophrenia and subsyndromal depression, a similar approach is recommended.Psychosis accompanying major depression in patients without schizophrenia is common in elderly patients and is considered a primary mood disorder; for these reasons, it is an important syndrome to consider in the differential diagnosis of older patients with mood and thought disturbance. Treatment for this condition has involved electroconvulsive therapy (ECT) as well as combinations of antidepressant and antipsychotic medications. Recent evidence suggests that combination treatment may not be any more effective than antidepressant treatment alone and ECT may be more efficacious overall.
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PMID:Co-occurring depressive symptoms in the older patient with schizophrenia. 1866 57

Obsessive-compulsive symptoms (OCS) are clinically important phenomena in schizophrenia patients. Lamotrigine has a modulating effect on glutamatergic neurotransmission relevant to pathophysiology of both schizophrenia and OCD. Efficacy and tolerability of lamotrigine in schizophrenia and schizoaffective patients with comorbid OCS were evaluated. In an 8-week, open-label trial, lamotrigine (25 mg/day for 1 week, 50 mg for 2 weeks, 100 mg for 2 weeks, 200 mg for 3 weeks) was added to ongoing psychotropic drug regimens in schizophrenia (N = 5) and schizoaffective disorder (N = 6) patients with clinically significant OCS [Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score > 16]. The Y-BOCS score for nine completers decreased significantly from baseline to week 8 (22.9 +/- 6.1 vs 17.4 +/- 3.6; t = 2.33, df = 1, P = 0.033). Five patients, all with schizoaffective disorder, were responders (>or=35% decrease in Y-BOCS score). No significant changes were detected in schizophrenia symptom severity. Depressive symptoms, assessed with the Calgary Depression Rating Scale, improved significantly (6.4 +/- 1.5 vs 4.0 +/- 2.5; t = 3.19, df = 1, P = 0.013); this change positively correlated with OCS improvement (r = 0.69, P = 0.04). Lamotrigine was safe and well tolerated. Explicit evaluation of therapeutic efficacy of adjunctive lamotrigine in schizoaffective disorder patients with comorbid OCS merits further investigation.
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PMID:Lamotrigine augmentation in schizophrenia and schizoaffective patients with obsessive-compulsive symptoms. 1907 41

AIM: Depressive symptoms are common in the early prodromal phase of schizophrenia and other psychotic disorders. The objectives of the present study were to retrospectively examine the severity of depressive symptoms and their relationship to positive symptoms over the developmental course of adolescent-onset psychosis (AO-PSY). METHODS: The subjects were 62 unmedicated adolescents with DSM-IV psychosis and 104 normal controls from a Pacific island isolate with an elevated prevalence of schizophrenia. We used a modified K-SADS-PL to assess adolescents for a full range of Axis I psychopathology and quantified severity of depressive and positive symptoms over the adolescent's lifespan. RESULTS: Among AO-PSY subjects, 84% reported abnormal levels of depressive symptoms with mean onset 1.3 years prior to transition to psychosis. In 60% of the AO-PSY subjects with depressive symptoms, positive symptoms began first. A continuous linear increase in depressive symptom severity over the developmental course of illness mirrored the steady rise in positive symptom severity as psychosis emerged. CONCLUSIONS: We found that it is typically a combination of positive symptoms and depressive symptoms building in parallel that leads from the prodrome to frank psychosis. These results suggest that depressive symptoms represent more of an integral component of disease progression than an independent risk factor that predicts transition to early onset psychosis.
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PMID:Comorbid depressive symptoms in the developmental course of adolescent-onset psychosis. 1907 63

The study of depressions in 183 schizophrenic patients after the management of acute psychosis included evaluation of depressive symptoms, their relation to other psychopathologic syndromes, and the efficiency of drug therapy. The Calgary scale (CDSS) was used to assess severity of depression in schizophrenia along with other standardized psychometric scales to characterize general psychopathologic, positive, and negative symptoms, locomotor disturbances, other concomitant disorders, and general clinical picture. The predominance of depressive conditions with adynamic symptoms was documented. The majority of depressions occurred after the first attack. Those developing in the early post-attack period differed from depressions within a few months after the reduction of psychosis. Syndromic nature of depressions was evident from the number of psychotic episodes experienced by the patients. Depressive symptoms that developed after the management of the acute psychotic state could be efficiently and safely relieved by additional differential treatment with antidepressants. Depressive symptoms in schizophrenia are not predictors of poor prognosis provided the patient receives adequate therapy. More attention is needed to identification and adequate treatment of depression in schizophrenia. Optimized therapy of affective disorders in schizophrenic patients permits to improve prognosis of the disease.
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PMID:[Depressions in schizophrenic patients after the management of acute psychosis]. 1917 96

Smokers may use nicotine to self-medicate for situation-specific or person-specific cognitive or affective deficits. Although evidence suggests that nicotine replacement therapy (NRT), relative to placebo, enhances spatial working memory (SWM) in smoking-abstinent smokers with schizophrenia, the extent to which NRT may be helpful in attenuating abstinence-related SWM in other groups with deficits in SWM is unknown. Depressive symptoms are associated with both tobacco smoking and deficits in SWM. Previous studies have found that smoking abstinence increases depressive affect and depression-related hemispheric asymmetries in brain activation. Although the serotonin neurotransmitter system is closely associated with depression and the effects of nicotine, the authors are not aware of any studies that have evaluated the possible role of individual differences in serotonin transporter (5-HTT) genotype and depressive symptoms as moderators of the effects of NRT on SWM. Thus, the current study assessed the effects of NRT (nicotine patch) on SWM in relation to: (1) depressive traits and (2) 5-HTT genotype. Smoking-deprived habitual smokers (N = 64) completed the dot recall test of SWM during counterbalanced and double-blind nicotine and placebo testing sessions. There was a marginal overall effect of NRT on SWM. More importantly, NRT enhanced SWM in 5-HTT short allele carriers, relative to those with two long alleles, and this enhancement in short-allele carriers was greater for individuals with higher levels of depressive symptoms.
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PMID:Serotonin transporter genotype and depressive symptoms moderate effects of nicotine on spatial working memory. 1958 32

Depressive symptoms are a frequent component of schizophrenia and other psychotic illnesses. The treatment of psychoses with conventional (typical) antipsychotic agents may worsen depressive symptoms and many patients only partially respond to treatment. Typical antipsychotics are also associated with serious side effects, such as extrapyramidal symptoms, and sexual and menstrual dysfunction. Many of these pitfalls, however, can be avoided with atypical antipsychotics. Quetiapine, an atypical antipsychotic with proven efficacy in the treatment of psychotic symptoms in schizophrenia, also has efficacy for treating depressive symptoms in patients with schizophrenia and other psychiatric disorders. This suggests that quetiapine may also be effective in treating and preventing depressive symptoms in patients with affective disorders, such as bipolar disorder. A review of the evidence base supports the hypothesis that quetiapine does not cause treatment-emergent depression and may even be useful in the treatment and prevention of depressive symptoms in patients with bipolar disorder.
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PMID:Treatment of depressive symptoms with quetiapine. 1981 Sep 26

This study examined 'Theory of Mind' (ToM) functioning, its association with psychometric schizotypy and with self-reported psychotic-like experiences (PLEs) and depressive symptoms, in a community sample of adolescents. Seventy-two adolescents (mean age 14.51years) from Barcelona, Spain, completed questionnaires assessing PLEs, depressive symptoms, and schizotypy. A verbal ToM task and a vocabulary test were administered. The effect of symptomatology, vocabulary ability, age, and gender on task performance was explored. Neither total score on schizotypy nor PLEs were associated with ToM performance. A significant effect of vocabulary on adolescent's performance of both ToM and control stories was found. ToM showed significant negative associations with positive schizotypy, and with one cluster of positive PLEs: first-rank experiences. Positive significant associations between ToM and persecutory delusions and the impulsive aspects of schizotypy were found. Depressive symptoms did not affect ToM performance. Positive schizotypal traits and first-rank symptoms are associated with ToM deficits in adolescents. Results support the trait-(versus state-) dependent notion of ToM impairments in schizophrenia. ToM may be a developmental impairment associated with positive schizotypy and PLEs.
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PMID:'Theory of Mind', psychotic-like experiences and psychometric schizotypy in adolescents from the general population. 2072 45

The relationship between depressive symptoms and other symptom categories in schizophrenia have been studied by many authors. According to the existing studies depression in schizophrenic patients is related to the presense of positive symptoms, especifically delusions and hallucinations.As far as negative symptoms concerns it seems that there coexist with the depressive symptoms in any phase of the disease at least in a subgroup of schizophrenic patients. In addition, according to the pyramidal model of Kay, when positive and depressive symptoms coexist, they create theclinical picture of the paranoid subtype of schizophrenia. The same holds for the combination of negative and depressive symptoms, which most frequently describe the residual subtype of the disease. Extrapyramidal symptoms are side effects of antipsychotic drugs (especially the classicalones). According to the existing literature it seems that antipyramidal side effects appear more often in schizophrenic patients with depressive symptoms. The differential diagnosis of depressive symptoms in schizophrenic patients should start with the evaluation of possible presence of organiccauses like somatic disease, medication induced extrapyramidal symptoms, substance abuse. Yet, symptoms of depression need to be differentiated from the negative symptoms of schizophrenia. Psychiatric syndromes like schizoaffective disorder, bipolar disorder and depression with psychotic features need to be also considered. In this case is very important to identify accurately the duration of depressive symptoms as well as the succession of appearance of the depressive vs. psychotic symptoms. Depressive symptoms appear to be bad prognostic sign for the long-term outcome of schizophrenia, because of the increased risk for suicide but also because of the worsening of the quality of life and the general wellbeing of the schizophrenic patient. Depressive symptoms during the acute phase of the disease usually respond to antipsychotic therapy, but in some cases the treating physician may consider the use of atypical antipsychotics. In the case of post psychotic depression the concurrent administration of antidepressants is indicated.
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PMID:[Depression in schizophrenia: Relationship with other symptoms, differential diagnosis, prognosis,treatment]. 2221 20


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