Depression in Kraepelinian Schizophrenia

H Naudé ,Renata Du Preez ,Michael J Van Der Linde ,R N Sykes ,H.w Pretorius ,Joke De Pauw

doi:10.4102/sajpsychiatry.v15i4.194

Abstract

Objective. Depressive symptoms are prevalent, under- recognised and clinically important in patients suffering from schizophrenia. Depressive symptoms in schizophrenia patients are associated with distinct morbidity and mortality. The objective of this study was to investigate the prevalence of depressive symptoms in a subgroup of chronic schizophrenia, Kraepelinian schizophrenia, and the association with severity of illness. Kraepelinian schizophrenia is characterised by a chronic, unremitting, severe course of illness and severe deterioration of functioning in social, work and self-care domains. Method. The Calgary Depression Scale for Schizophrenia (CDSS) and the Clinical Global Impression Severity (CGI-S) scale were administered to 113 patients who fulfilled the criteria of Kraepelinian schizophrenia. Results. Sixty-eight males and 45 females participated in the study. Of this group, 17.7% scored 5 or more on the CDSS. The CGI-S scores indicated that almost half of the patients were moderately ill (i.e. a score of 4 on the CGI-S scale). Of the patients, 94 were receiving first-generation antipsychotic medication and 19 second- generation antipsychotic medication. Thirteen patients were also receiving antidepressant medication. Conclusion. The findings of this study are consistent with current reports in the literature that depressive symptoms are not common in Kraepelinian schizophrenia, even though patients are moderately to severely ill in both symptom and functional domains.

Highlights

The Calgary Depression Scale for Schizophrenia (CDSS) and the Clinical Global Impression Severity (CGI-S) scale were administered to 113 patients who fulfilled the criteria of Kraepelinian schizophrenia
The findings of this study are consistent with current reports in the literature that depressive symptoms are not common in Kraepelinian schizophrenia, even though patients are moderately to severely ill in both symptom and functional domains
Siris3) studied depressive phenomenona in schizophrenia as early as 1908. He suggested that the disease process might trigger mood symptoms in schizophrenia, while in other cases mood symptoms take the role of secondary symptoms

Summary

Methods

The Calgary Depression Scale for Schizophrenia (CDSS) and the Clinical Global Impression Severity (CGI-S) scale were administered to 113 patients who fulfilled the criteria of Kraepelinian schizophrenia. All hospitalised patients in the long-term wards of Weskoppies Hospital, Pretoria, who had a psychotic disorder were approached for recruitment. Two of the authors (H E N, R S) had administered the CDSS and CGI-S scale after appropriate training in the use of these instruments. Eligible patients for this study had to have met the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR)[15] criteria for residual schizophrenia. Further inclusion criteria were that patients had to have been continuously hospitalised and totally dependent on the institution for the provision of necessities such as food, shelter and clothing for the past 5 years. The following were exclusion criteria: (i) patients younger than 18 years; (ii) patients with a history of alcohol or other substance abuse or dependence in the preceding 6 months; (iii) evidence of a psychiatric disorder due to a general medical condition (iv) an unstable medical condition; and (v) DSM-IV-TR diagnosis of schizo-affective disorder.[15]

Results

Discussion

Conclusion