Antidepressants for the treatment of depression in people with schizophrenia: a systematic review

Whitehead, Caroline; Moss, Susanna; Cardno, A. G.; Lewis, Glyn

doi:10.1017/s0033291703007645

Cited by 87 publications

(47 citation statements)

References 26 publications

(51 reference statements)

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“…For example, if seen as an inherent part of the psychosis symptom profile, depression might be expected to respond to antipsychotic drugs, whereas if the clinician perceives a 'superimposed' depressive episode, antidepressants might appear appropriate. The most common treatment approach reported by respondents of the survey was augmenting neuroleptics with antidepressant medications, a practice for which empirical support is weak (Whitehead, Moss, Cardno, & Lewis, 2003;Micallef, Fakra, & Blin, 2006).…”

Section: Discussionmentioning

confidence: 99%

Cognitive factors maintaining persecutory delusions in psychosis: The contribution of depression.

Vorontsova¹,

Garety²,

Freeman³

2013

Journal of Abnormal Psychology

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Depression is common in people with schizophrenia, but how it might directly contribute to the persistence of psychotic symptoms has rarely been tested. The key aim of the present study was to test whether depression and associated cognitive processes predict the maintenance of persecutory delusions. Three groups of participants were tested at baseline: 60 patients with persecutory delusions in the context of a schizophrenia spectrum diagnosis, 30 patients with depression, and 30 nonclinical controls. They completed interviewer and self-report assessments of depression and paranoia, and measures of six cognitive factors (schematic beliefs, experiential avoidance, autobiographical memory, problem solving, rumination, worry style). The patients with persecutory delusions were then assessed again, six months later. It was found that 50% of the patients with persecutory delusions met diagnostic criteria for major depression. Cognitive processes found to be associated with depression across the groups were negative schematic beliefs about the self, experiential avoidance and rumination, but not autobiographical memory or problem solving. The severity of initial depression in patients with persecutory delusions predicted the persistence of paranoia over six months. A number of cognitive factors also predicted the persistence of persecutory delusions, including negative schematic beliefs about the self, worry, and problem-solving difficulties. In conclusion, depression is common in patients with current persecutory delusions, and it shows similar cognitive features to major depressive disorder. The results of this study indicate that depression and related processes may contribute to the maintenance of paranoia. Trials are warranted of depression-related therapeutic techniques for people with persecutory delusions.

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Section: Discussionmentioning

confidence: 99%

Cognitive factors maintaining persecutory delusions in psychosis: The contribution of depression.

Vorontsova¹,

Garety²,

Freeman³

2013

Journal of Abnormal Psychology

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“…Bu bilgilere rağmen, şizofreni hastalarında depresyon ihmal edilerek yeterli biçimde tedavi edilmemekte ve bu da özkıyım davranışına yol açmaktadır. Psikotik semptomları artırmadan antidepresanların etkin bir şekilde kullanılabileceği gösterilmişse de, hâlâ şizofreni hastalarında kullanımları beklenenin altındadır (57). Depresyon sıklıkla ilaç yan etkileri ve negatif semptomlarla maskelenir ve karışırken, dikkatli bir klinisyen belirli hedef sorularla depresyonu saptayabilir.…”

Section: Discussionunclassified

The correlation of suicide attempt and suicidal ideation with insight, depression and severity of illness in schizophrenic patients

Umut¹,

Altun²,

Danışmant³

et al. 2013

Dusunen Adam

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ÖZETŞizofreni hastalarında özkıyım girişimi ve özkıyım düşüncesinin, hastalık şiddeti, depresyon ve içgörü ile ilişkisi Amaç: Bu çalışmada şizofreni hastalarında özkıyım girişimi ve özkıyım düşüncesinin hastalık şiddeti, depresyon ve içgörü ile ilişkisi araştırılarak, şizofreni hastalarında özkıyım riskini yordayabilecek ölçütlerin gelişmesine katkı sağlanması amaçlanmıştır. Yöntem: Bakırköy Prof. Dr. Mazhar Osman Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi psikiyatri servislerinde DSM-IV-TR ölçütlerine göre şizofreni tanısı ile yatarak tedavi gören, 20-65 yaş arasındaki 104 hasta rastgele seçilmiş, hastalar hastaneye yattıktan sonraki 72 saat içinde değerlendirilmiştir. Olgular, İçgörünün Üç Bileşenini Değerlendirme Ölçeği (İÜBDÖ), Pozitif ve Negatif Sendrom Ölçeği (PANSS) ve Calgary Şizofrenide Depresyon Ölçeği (CŞDÖ) kullanılarak değerlendirilmiştir. Bulgular: Özkıyım girişimi öyküsü olan hastalarda depresyon puanları, özkıyım girişimi öyküsü olmayan hastalara göre daha yüksek bulunmuştur. Özkıyım düşüncesi olanların içgörü ve depresyon puanları, özkıyım düşüncesi olmayanlara göre daha yüksek bulunmuştur. Lojistik regresyon analizinde CŞDÖ özkıyım girişimi ve özkıyım düşüncesini, PANSS negatif toplam puanı özkıyım düşüncesini, kendine zarar veren davranış ise özkıyım girişimi öyküsünü belirleyen değişken olmuştur. Sonuç: Özkıyım girişimi ve özkıyım düşüncesini belirleyen ortak etken depresyon olduğundan, şizofreni hastalarında depresif belirtiler varlığında özkıyım düşüncesinin daha dikkatli ve ayrıntılı sorgulanması gerekmektedir. Kolaylıkla uygulanabilecek CŞDÖ'nün, şizofreni hastalarındaki depresyonu kolaylıkla saptayabileceğini, uygun tedavi yöntemleri ile depresyonun tedavisinin özkıyım riskini azaltabileceğini düşünmekteyiz. Anahtar kelimeler: Depresyon, içgörü, özkıyım, PANSS, şizofreni ABSTRACTThe correlation of suicide attempt and suicidal ideation with insight, depression and severity of illness in schizophrenic patients Objective: At this study, it is aimed to determine criteria to predict the suicidal risks of schizophrenic patients and to explore the correlation of suicide attempt and suicidal ideation with insight, depression and severity of illness as well. Method: Randomly selected 104 inpatients between 20 and 65 years of age, treated with a diagnosis of schizophrenia according to DSM-IV-TR criteria at Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery were included, and patients were examined at the period of first 72 hours of admission. The patients were evaluated with Schedule for Assessing the Three Components of Insight (SAI), Positive and Negative Syndrome Scale (PANSS), and Calgary Depression Scale for Schizophrenia (CDSS). Results: Depression scores were higher in the patients who had suicide attempt compared to those without suicide attempt. Depression and insight scores of the patients who had suicidal ideation were found to be higher compared to those without suicidal ideation. In the logistic regression analysis, CDSS was found t...

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“…Our data suggest that the use of concomitant medications, including antipsychotic polypharmacy, occurs even in the earliest stages of the disease. However, to date, there is only insufficient evidence supporting the use of concomitant medications with antipsychotics, except for the treatment of comorbid major depression (40), and one study found that in most cases non-antipsychotic concomitant medications could be discontinued without any worsening in mental state (41). On the other hand, one meta-analysis found that antidepressants might reduce negative symptoms (42), and an earlier study suggested that antidepressant treatment added to antipsychotics in schizophrenia might reduce relapse rates into psychosis in addition to reducing recurrence of postpsychotic depression (43).…”

Section: Discussionmentioning

confidence: 99%

10‐Year trends in the treatment and outcomes of patients with first‐episode schizophrenia

Nielsen

Quach

Emborg

et al. 2010

Acta Psychiatr Scand

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Nielsen J, le Quach P, Emborg C, Foldager L, Correll CU. 10‐Year trends in the treatment and outcomes of patients with first‐episode schizophrenia. Objective: The first episode of schizophrenia is a critical period for illness course and outcomes. We aimed to investigate treatments and outcomes during the first year after the diagnosis of schizophrenia. Method: Pharmacoepidemiologic inception cohort study of all newly diagnosed patients with schizophrenia in Denmark (n = 13 600) 1996–2005. Results: From 1996 to 2005, the mean age at first diagnosis decreased significantly (29.2–26.1 years), more patients received antipsychotics (67.2–80.7%, annual OR = 1.07, CI: 1.06–1.09, P < 0.001) and antipsychotic polypharmacy for >4 months (16.7–37.1%, OR = 1.14, CI: 1.12–1.57, P < 0.001). The antipsychotic defined daily dosage (DDD) doubled (150–332 DDD, P < 0.001), use of antidepressants (24.3–40.6%, P < 0.001). Bed days [89.9 days (CI: 81.8–98.8) to 71.8 days, CI: 63.7–80.8, P < 0.0001] decreased, whereas outpatient contacts [10.2 (CI: 9.5–11.0) to 21.4 (CI: 19.9–21.0), P < 0.0001] doubled. Conclusion: Between 1996 and 2005, there was an earlier recognition of schizophrenia, intensified outpatient treatment, increased use and dosing of antipsychotics and antidepressants, but also more antipsychotic polypharmacy.

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Antidepressants for the treatment of depression in people with schizophrenia: a systematic review

Cited by 87 publications

References 26 publications

Cognitive factors maintaining persecutory delusions in psychosis: The contribution of depression.

Cognitive factors maintaining persecutory delusions in psychosis: The contribution of depression.

The correlation of suicide attempt and suicidal ideation with insight, depression and severity of illness in schizophrenic patients

10‐Year trends in the treatment and outcomes of patients with first‐episode schizophrenia

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