Depression, demoralization and control over psychotic illness: a comparison of depressed and non-depressed patients with a chronic psychosis

Abstract

SynopsisThis paper explores the hypothesis that depression in chronic schizophrenia is in part a psychological response to an apparently uncontrollable life-event, namely the illness and its long-term disabilities. It is suggested that depression is linked to patients' perception of controllability of their illness and absorption of cultural stereotypes of mental illness. Clinically and operationally diagnosed schizophrenic and manic-depressive patients receiving long-term maintenance treatment were studied. The cross-sectional prevalence of depression in schizophrenics was 29% and 11% for patients with bipolar affective illness. The hypothesis was supported. Multivariate analyses revealed that patients' perception of controllability of their illness powerfully discriminated depressed from non-depressed psychotic patients. Although those patients who accepted their diagnosis reported a lower perceived control over illness and an external locus of control, label acceptance was not associated with lowered depression, self-esteem or unemployment. The cross-sectional nature of the study makes the direction of causality and the role of intrinsic illness variables difficult to ascertain; however, the results set the scene for prospective and intervention studies and the various possibilities are discussed.

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

“…Among people with psychosis, those with concurrent depression respond less well to neuroleptic treatment (Gasquet et al, 2005;Himmelhoch, Fuchs, May, Symons, & Neil, 1981;Lerner, Mintzer, & Schestatzky, 1988) and experience more relapses (Birchwood, Mason, MacMillan, & Healy, 1993;Mandel, Severe, & Schooler, 1982;Roy, Thompson, & Kennedy, 1983) and more functional impairment (Birchwood et al, 1993;Sands & Harrow, 1999;Conley, Ascher-Svanum, Zhu, Faries, & Kinon, 2007) than those who are not depressed.…”

“…Max Birchwood and colleagues emphasised that the experience of having a psychotic episode can cause depression, particularly when the illness is experienced as uncontrollable (Birchwood et al, 1993) and when the experience embodies loss, shame and/or entrapment . A prospective study following 102…”

“…Several other conceptualisations of the relationship between delusions and depression were outlined in Chapter 2, notably Birchwood and colleagues' social ranking theory account of post-psychotic depression (Birchwood et al, 1993;Birchwood et al, 2000) and Bentall and colleagues' attribution-focused defence model of persecutory delusions (Bentall et al, 1994;Bentall et al, 2001). The present study was not designed to test specific predictions arising from either of these accounts, but results regarding schematic beliefs and avoidance have some relevance.…”

Reducing relapse in psychosis through medication management

“…In addition, strategies to help the person to recognise and manage precipitating factors that lead to relapse such as stress are developed using a biopsychosocial approach. The importance of relapse prevention can perhaps be summarised by Birchwood et al (1993) who argued that many clients feel trapped by their illnesses, which may make them more prone to depression. Subsequently they have a strong interest in learning to recognise and avoid the re emergence of symptoms and possible re hospitalisation (Birchwood et al 1993).…”

“…The importance of relapse prevention can perhaps be summarised by Birchwood et al (1993) who argued that many clients feel trapped by their illnesses, which may make them more prone to depression. Subsequently they have a strong interest in learning to recognise and avoid the re emergence of symptoms and possible re hospitalisation (Birchwood et al 1993). Relapse prevention consists of multiple individualised approaches that are tailored to meet the diverse needs of clients who are attempting to manage their symptoms.…”