Diagnosis of Secondary Depression in Schizophrenia: Implications for DSM-IV

Abstract

A substantial literature documents the existence of a secondary depression syndrome occurring in the course of schizophrenia. This review examines the relevance this syndrome may have in relation to demographic, symptomatic, biological, prognostic, and treatment issues. It explores the differential diagnosis of secondary depression in schizophrenia and considers the implications for the inclusion of such a diagnostic category DSM-IV.

Characterization of depressive syndrome in schizophrenic outpatients

“…There was no significant statistic difference in the average daily dose of the antipsychotic used by patients of both groups. Several studies in the area [10][11][12]21,25 presented similar results.…”

“…21 Other aspects also favor the disparity in results, such as the utilization of several definitions for depressive conditions, the use of different diagnostic criteria for schizophrenia and the assessment of patients in distinct phases of the schizophrenic disease, i.e., in its prodroms, the acute psychotic phase, the post psychotic period and the residual phase. 4 The 22,1% -frequency found for patients which had a major depressive episode15, necessarily including depressed mood, is therefore the Post Psychotic Depressive Disorder of Schizophrenia rate of the current research.…”

“…The Odds Ratio analysis shows, thus, a strong association of this characteristic to group A. Some researchers 14,15,21,33,40 reported a greater genetic predisposition and emphasize that among schizophrenic patients with depressive syndrome there are more first-degree relatives with unipolar depression. Others disagree with this statement.…”

“…The therapeutic approach here is different, and , according to Siris, does not require the use of antidepressants. 21,22 The authors believe, after having analyzed other studies, that the controversies related to this subject stem from the fact that many of these investigations focused on patients at different moments of the psychotic process. 8,9,23 Consequently, contradictions about the depressive syndrome prognostics arise.…”

“…The definition of a secondary depressive syndrome in schizophrenia allows the development of somatic and psychosocial interventions to improve the assistance and to decrease the patient's suffering. 21 We used the operative criteria of the DSM-IV, as they are better outlined. According to this classification, the essential characteristic of this clinical picture is the occurrence of a major overlapped depressive episode that occurs only in the disease's residual phase.…”