Postpsychotic depression in schizophrenics

Seventeen patients suffering acute schizophrenic decompensations were followed longitudinally for up to six months in order to study the incidence and quality of postpsychotic depression. Only two of these patients developed a moderately severe and prolonged depression following a relatively symptom free period. Six other patients evidenced mild to moderate depression for short periods of time either during or immediately following their acute psychoses.     

Postpsychotic depression in schizophrenia patients

Depression is a frequent comorbidity in the course of schizophrenia and is associated with increased mortality from suicide. Postpsychotic depression is defined as the syndrome of major depression occurring following remission of psychotic symptoms in a person with schizophrenia. Various proposed causes, differential diagnosis, and issues regarding management of postpsychotic depression are discussed.     

Postpsychotic depression and negative symptoms: an investigation of syndromal overlap

The authors studied 46 patients with the operationally defined syndrome of postpsychotic depression following episodes of schizophrenia or schizoaffective disorder. Half of these patients were also found to satisfy criteria for negative symptoms. The patients with negative symptoms were rated as more severely ill on global measures, but there was only limited evidence that they were more depressed. Nevertheless, in a randomized double-blind trial of imipramine versus placebo as an adjunct to the fluphenazine decanoate and benztropine regimens of the patients with negative symptoms, the patients who received imipramine seemed to show more improvement.     

"Postpsychotic depression" and residual schizophrenia in a mental health hospital

Forty three patients, mean age 55.20 +/- 9.27 SD, affected by Schizophrenia Residual Type (DSM IV, RDC criteria) and treated with neuroleptic drugs for a mean of 25.42 years (+/- 4.12 SD) were included into the study. Clinical evaluation was cross-sectional assessed by BPRScale, SAPS, SANS, HRS-D, EPSE. ACS and MMSE. Seventy percent of patients presented a "postpsychotic depression" (42%, mild; 16%, moderate and 12% serious). "Postpsychotic depression" does not seem to be influenced by neuroleptics, but it seems to be a component of residual schizophrenia in patients with a long lasting permanence in a mental hospital.     

Postpsychotic collapse in schizophrenia

The hospital records of 46 schizophrenic patients were studied retrospectively for postpsychotic collapse (PPC), defined in terms of underactivity. PPC was observed in 38 (83%) patients. The duration of PPC was strongly correlated with the duration of the acute psychotic phase after therapy started, and weakly correlated with the mean dose of antipsychotics per day in the acute psychotic phase, and with age of onset. The authors discuss PPC in terms of the effect of antipsychotics, of psychological reaction, and of understimulation in the hospital setting.     

Comparison of depression symptoms between primary depression and secondary-to-schizophrenia depression

Objectives: This study exclusively aimed to clinically assess which symptom pattern discriminates primary depression from depression-secondary to-schizophrenia.

Methods: A total of 98 patients with primary depression and 71 patients with secondary-to-schizophrenia depression were assessed for identifying the clinical phenomena of depression. Diagnosis of schizophrenia was confirmed by Mini International Neuropsychiatric Interview. Each participant was, however, assessed by Patient Health Questionnaire-9 as well as Calgary Depression Scale for Schizophrenia (CDSS) for possible concurrent depressive symptoms.

Results: Depressed mood, loss of interest, reduced energy and pathological guilt were more common in primary depression, whereas sleep disturbance and guilty ideas of reference were more amounting towards the diagnosis of depression secondary-to-schizophrenia.

Conclusions: It is clinically hard to differentiate primary from secondary-to-schizophrenia depression, especially in the absence of obvious psychotic symptoms. However, the classical symptoms of depression like subjective depressed mood, anhedonia, reduced energy and pathological guilt are more prominent in the primary depression.     

Cerebrovascular disease basis of depression: post-stroke depression and vascular depression

The close association between cerebrovascular disease and depression has been known for more than a century, yet much of the progress in understanding the cerebrovascular basis of depression in late life has been spurred by development of two concepts: 'post-stroke depression' and 'vascular depression'. The purpose of this review is to examine the epidemiology, diagnostic features, course, pathophysiology and prognosis of post-stroke depression and vascular depression, to highlight their common features, and to contrast the distinct aspects of these two subtypes of geriatric depression.     

Atypical bipolar II depression compared with atypical unipolar depression and nonatypical bipolar II depression

Aim of the study was to find out whether atypical bipolar II depression was distinct from both atypical unipolar depression and nonatypical bipolar II depression. Seventy-nine consecutive atypical bipolar II depressed outpatients were compared with 42 consecutive atypical unipolar depressed outpatients and with 53 consecutive nonatypical bipolar II depressed outpatients. Among the variables studied (age at intake, age at onset, female gender, duration of illness, psychosis, comorbidity, chronicity, recurrences, severity), age at intake and onset were significantly lower in the atypical bipolar II group than in the other groups. The other variables, apart from psychosis, were not significantly different. Findings suggest that atypical bipolar II depression may have an age at onset different from that of atypical unipolar depression and nonatypical bipolar II depression. As different ages at onset may identify distinct subtypes of depression, this finding might suggest that atypical bipolar II depression may be distinct from both atypical unipolar depression and nonatypical bipolar II depression.     

Phenomenological comparison of poststroke depression and functional depression

The authors used structured clinical interviews to compare depressive symptoms in 43 patients with poststroke major depression and 43 patients with major depression without a known medical cause. The depressive syndrome profiles in the two patient groups were highly similar.     

Atypical depression

Atypical depressions are those characterized by high levels of phobic anxiety or by reversed vegetative symptoms such as hypersomnia and hyperphagia. Patients with such depressions may present overtly for treatment. However, they may also present within other diagnostic categories such as personality disorder or somatic complaints. The comparative roles of monoamine oxidase inhibitors, heterocyclic antidepressants, and other biologic treatments for atypical depressions are discussed.     

Post-stroke depression

Post-stroke depression (PSD) is among the most common emotional disorders afflicting stroke sufferers. Approximately one third of stroke survivors experience an early or later onset of depression. PSD impedes the rehabilitation and recovery process, jeopardizes quality of life and increases mortality. Diagnosis of PSD is challenging in the acute and chronic aftermath. Therefore, it often remains unrecognized and/or undertreated. The interaction between depression and stroke is very complex and the pathophysiological mechanisms have not as yet been fully elucidated, although an interaction between anatomical and psychosocial factors may be important in PSD development. Neurochemical changes and clinical findings are similar to endogenous depression. PSD is potentially treatable, although no conclusive benefits of antidepressant agents and nonpharmacological interventions have been observed. The efficacy of preventive strategies in PSD remains essentially undetermined.