Recognition and Treatment of Depression in Schizophrenia
Department of Psychiatry, University of Calgary
Educational Objectives: At the conclusion of this presentation, the participant should be:
1. Aware of an evidence based approach to assessing depression in schizophrenia.
2. Aware of current clinical practice guidelines for the treatment of schizophrenia
3. Aware of three key questions to screen for depression in schizophrenia
Depression as a symptom in schizophrenia has been recognized since the disorder was described by Emil Kraeplin. It is present at all stages of the disorder from the prodrome, the acute relapse phase and during remission. It is at its most severe in the acute relapse phase and has been associated with both suicide and attempted suicide, and poorer life satisfaction, quality of life and family relationships.
The assessment of depression is complicated by its overlap with anxiety and positive symptoms in the acute phase and with negative and extrapyramidal during remission. To address these problems with existing depression rating scales, the Calgary Depression Scale was developed using factor analysis of symptoms of schizophrenia. A number of symptoms related to anxiety and lack of energy and drive did not distinguish depressed from non depressed patients with schizophrenia resulting a parsimonious 9 item rating scale. The scale has been found to be reliable and valid and to compare favourably with other measures of depression. It has been used in major studies such as CATIE and CUTLASS. It has now been translated into 32 languages and validated in a number of languages including Japanese. It can be accessed on line at http://www.ucalgary.ca/cdss/.
Treatment of depression in schizophrenia depends on the stage of the disorder. In the acute phase the primary treatment is with antipsychotics, in remission, both antidepressants and cognitive therapy have been found to be helpful. For the treatment resistant patient or one with persisting suicidal ideation, clozapine has been found to be helpful.
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Kaneda Y, Ohmori T, Addington D. (2000) The Japanese version of the Calgary Depression Scale for Schizophrenics (JCDSS) No To Shinkei
Canadian Psychiatric Association Working Group Clinical Practice Guidelines: Treatment of Schizophrenia. Canadian Journal Psychiatry 2005;50(13)
Suppl 1:1S-56S https://ww1.cpa-apc.org/Publications/Clinical_Guidelines/schizophrenia/november2005/index.asp
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The burden of depressive symptoms in the long-term treatment of patients with schizophrenia. Schizophrenia Research 2007(2)90:186-197