Concomitant Medications May Not Improve Outcome of Antipsychotic Monotherapy for Stabilized Patients With Nonacute Schizophrenia

Glick, Ira D.; Pham, Diana; Davis, John M.

doi:10.4088/jcp.v67n0813

Cited by 41 publications

(17 citation statements)

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“…This complicated vicious circle might prolong the recovery from the other disorder, having probably created, in the case of schizophrenia, years ago, in Gruenberg's time, a type of chronic demoralization he had called "social breakdown syndrome" 12 . It has been observed that tapering of antidepressant medications in patients with stabilized non-acute schizophrenia may not improve the outcome of antipsychotic monotherapy; such patients were probably demoralized and psychotherapy might have been more useful 63 . In a study of patients with major depressive disorder, after controlling for depression severity at baseline, a greater degree of hopelessness was found to significantly increase the risk for non-response to fluoxetine as well as the risk of greater endpoint depression severity 64 .…”

Section: Discussionmentioning

confidence: 99%

Distress, demoralization and psychopathology: Diagnostic boundaries

Figueiredo

2013

Eur. J. Psychiat.

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-Background and Objectives:The objectives of the manuscript are: (a) to review the understanding of demoralization and its assessment; (b) to describe its clinical progression; (c) to explain the differences between demoralization and other form of psychological distress; (d) to propose a set of criteria for future research on demoralization.Methods: A MEDLINE search using the keywords distress, subjective incompetence, depression, demoralization, helplessness, hopelessness and psychopathology was conducted. This was supplemented by a manual search of the literature.Results: Demoralization can be distinguished from passing or transient distress, nonspecific distress, sub-threshold depression or anxiety, and certain mental disorders. Demoralization can be a risk factor for the manifestation of psychopathology, the prodromal phase of a mental disorder, or a trigger for exacerbation or recurrence of psychiatric distress symptoms. The domains of distress and demoralization are described and research diagnostic criteria for demoralization are presented.Conclusions: The scales discussed in this article differ in their time frames and have not yet been applied to the same population at the same time. The role of demoralization as a risk factor for mental disorders is just beginning to be understood. The domains and the diagnostic criteria for demoralization presented in this article need to be confirmed by epidemiological and empirical studies. Future research should continue to clarify its role in the pathogenesis of both mental disorders and physical illnesses and identify appropriate interventions for its arrest or prevention. ObjectivesThis article has the following objectives: (a) to review the evolving understanding of demoralization and the methods proposed for its assessment; (b) to describe the clinical progression of demoralization; (c) to explain the differences between demoralization and passing or transient distress, non-specific distress and sub-threshold depression or anxiety, as well as the differences between demoralization and mental disorders such as major depressive disorder, dysthymic disorder, acute stress disorder, posttraumatic stress disorder, and adjustment disorder; and (d) to propose a set of criteria that may be considered for future research on demoralization. Understanding demoralizationAs defined by Frank, demoralization is the state of mind of a person deprived of spirit or courage, disheartened, bewildered, and thrown into disorder or confusion. He proposed that this state of mind occurs in many persons who seek psychotherapy, whatever their diagnostic label 1,2 . Demoralization always takes place within the context of a past, present, anticipated or imagined stressful situation. To further characterize the concept of demoralization, it has been proposed that the clinical hallmark of demoralization is "subjective incompetence" (SI) and that demoralization involves both SI and symptoms of distress, such as depression, anxiety, resentment, anger, or combinations thereof 3,4 . S...

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Section: Discussionmentioning

confidence: 99%

Distress, demoralization and psychopathology: Diagnostic boundaries

Figueiredo

2013

Eur. J. Psychiat.

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“…11 Many patients in routine care settings continue to experience significant symptoms while following usual treatment regimens. 42 In other cases, antipsychotic polypharmacy may be the result of "getting stuck" in switching from 1 antipsychotic medi-*References 8, 9,11,12,17,21,26,40,41. Abbreviations: AOR, adjusted odds ratio; CI, confidence interval.…”

Section: Commentmentioning

confidence: 99%

National Trends in Psychotropic Medication Polypharmacy in Office-Based Psychiatry

Mojtabai¹,

Olfson²

2010

Arch Gen Psychiatry

407

272

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“…Current antidepressant use was also associated with substantially decreased suicide deaths, whereas current benzodiazepine use was associated with marked increased risk for suicide. Because depressed, suicidal, and anxious patients are more likely than other patients to receive both antidepressants and benzodiazepines, the observed effect from these 2 classes of drugs may differ considerably in that antidepressant use may be beneficial and benzodiazepine use may be harmful in the treatment of patients with schizophrenia after their first hospitalization (but not necessarily among stabilized long-term patients 22 ). Moreover, catatonia and sleeping problems are 2 symptoms that might be more common among patients who receive benzodiazepines than among patients who receive antidepressants.…”

Section: Commentmentioning

confidence: 99%

Polypharmacy With Antipsychotics, Antidepressants, or Benzodiazepines and Mortality in Schizophrenia

Tiihonen¹

2012

Arch Gen Psychiatry

211

140

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Benzodiazepine use was associated with a marked increase in mortality among patients with schizophrenia, whereas the use of an antidepressant or several concomitant antipsychotics was not. Antidepressant use was associated with decreased suicide deaths. The literature indicates that long-term use of benzodiazepines among patients with schizophrenia is more prevalent in other countries (eg, the United States) compared with Finland, which suggests that benzodiazepine use may contribute to mortality among this patient population worldwide.

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Concomitant Medications May Not Improve Outcome of Antipsychotic Monotherapy for Stabilized Patients With Nonacute Schizophrenia

Cited by 41 publications

References 0 publications

Distress, demoralization and psychopathology: Diagnostic boundaries

Distress, demoralization and psychopathology: Diagnostic boundaries

National Trends in Psychotropic Medication Polypharmacy in Office-Based Psychiatry

Polypharmacy With Antipsychotics, Antidepressants, or Benzodiazepines and Mortality in Schizophrenia

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