Patients with schizophrenia suffer frequently from comorbid depressive symptoms. However, there is a paucity of studies regarding prevalence, clinical diagnostic and treatment in the field. For this review, we performed a focused literature analysis to identify recommendation for the treatment and diagnosis of schizophrenia with comorbid depression. Furthermore, we searched different schizophrenia guidelines for specific treatment recommendations. Due to the complex and heterogeneous picture of depressive symptoms in schizophrenia, the application of standardized assessment tools is recommended. For these purposes, the CDSS (Calgary depression rating scale for Schizophrenia) is such an established tool. In summary, there is only limited evidence for specific treatment recommendations. A change in antipsychotic treatment should usually be preferred before an antidepressant is introduced. In the group of antidepressants, SSRI seem to have some advantages, but most clinical and scientific experience is available for tricyclic antidepressants. Due to the limited original contributions and studies with sufficient methodology, further interventional trials are needed to give specific recommendations with high evidence grades.
Schizophrenia ranges among the most debilitating psychiatric diseases. Physical activity is recommended as an add-on therapy to improve acute symptoms (especially negative symptoms and cognitive deficits) and to prevent the onset of the disease. But individuals with schizophrenia usually engage in less physical activity than the general population. This sedentary lifestyle is one of the reasons that lead to more somatic comorbidities and increased mortality in this cohort. In this narrative review we provide an overview of evidence for the beneficial effects of physical exercise on the central nervous system and symptom severity in individuals with schizophrenia. We discuss the findings in the context of their implementation in current treatment guidelines: The guidelines only provide general advice and no concrete statements regarding type, duration and intensity of exercise therapies, as the existing studies varied in their methodology. Future studies should therefore explore the possibility to transfer existing detailed recommendations for the general population on patients with schizophrenia to reduce sedentary behavior. Key Words: Aerobic, Add-on therapy, Resistance Training, Prevention
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