Depression in schizophrenia
- Samuel G Siris, MD
Samuel G Siris, MD
- Professor Emeritus of Psychiatry
- Hofstra University/Northwell Health
- Raphael J Braga, MD
Raphael J Braga, MD
- Assistant Professor of Psychiatry
- Hofstra University/Northwell Health
- Center for Treatment and Research of Bipolar Disorder
- The Zucker Hillside Hospital
Depressive symptoms are frequent clinical features in patients with schizophrenia. Depression is associated with a less favorable patient course and poorer outcomes compared to patients with schizophrenia without depression.
The diagnosis of depression in schizophrenia is complicated by a differential diagnosis that includes depression-like extrapyramidal side effect symptoms of antipsychotic drugs, negative symptoms of schizophrenia, and organic conditions. In addition to thorough assessment, treatment trials can be used to differentiate these conditions.
The epidemiology, clinical manifestations, diagnosis, and treatment of depression in patients with schizophrenia are discussed here. Depression and schizophrenia as individual, non-comorbid disorders are discussed separately. Other common comorbidities of schizophrenia are also discussed separately. (See "Schizophrenia in adults: Clinical manifestations, course, assessment, and diagnosis" and "Pharmacotherapy for schizophrenia: Acute and maintenance phase treatment" and "Unipolar depression in adults: Epidemiology, pathogenesis, and neurobiology" and "Unipolar depression in adults: Assessment and diagnosis" and "Unipolar major depression in adults: Choosing initial treatment" and "Co-occurring schizophrenia and substance use disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment and diagnosis" and "Anxiety in schizophrenia" and "Unipolar depression in adults: Course of illness".)
Estimates of the lifetime prevalence of depression in schizophrenia vary widely – from 6 to 75 percent – based on differing study characteristics including varying definitions of depression, patient settings, and durations of observation [1-5]. Overall, studies have found a modal prevalence of approximately 25 percent, well above the rate of depression in the general population. (See "Unipolar depression in adults: Epidemiology, pathogenesis, and neurobiology".)
Risk factors for depression in schizophrenia include family history of depressive disorder , high levels of family and personal expectations for success in life, critical family attitudes, high levels of family expressed emotion, stigma, intelligence and insight, multiple hospitalizations, recent hospital discharge, and lack or loss of psychosocial support or support of self-esteem.
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- CLINICAL MANIFESTATIONS
- DIFFERENTIAL DIAGNOSIS
- Organic factors
- Antipsychotic drug-induced dysphoria
- Extrapyramidal side effects of antipsychotics
- Negative symptoms of schizophrenia
- Prodrome of a psychotic episode
- Disappointment reactions
- Depression in schizophrenia
- - Schizoaffective disorder
- ASSESSMENT AND MANAGEMENT
- Antipsychotic medication effects
- Pharmacotherapy for major depressive disorder
- - Other depressive disorders
- SUMMARY AND RECOMMENDATIONS