Koreen A R, Siris S G, Chakos M, Alvir J, Mayerhoff D, Lieberman J
Hillside Hospital, Long Island Jewish Medical Center, Albert Einstein College of Medicine, Glen Oaks, NY 11004.
Am J Psychiatry. 1993 Nov;150(11):1643-8. doi: 10.1176/ajp.150.11.1643.
Because findings regarding the prognostic significance of depressive symptoms in schizophrenia and their effect on the course and treatment of schizophrenia have been limited by the effects of previous treatment, retrospective evaluations, and differing definitions and criteria, the authors sought to determine the prevalence and prognostic significance of depressive symptoms in first-episode schizophrenia.
Thirty-nine men and 31 women experiencing their first episode of schizophrenia were evaluated with behavioral and extra-pyramidal symptom scales before treatment (baseline), biweekly during acute treatment, and then monthly. Extracted scores on the Hamilton Rating Scale for Depression and a "syndromal" definition of depression based on Research Diagnostic Criteria were obtained. Patients were followed prospectively for up to 5 years and received open standardized treatment.
The prevalence of depressive symptoms at baseline ranged from 75% (patients who met extracted Hamilton and/or syndromal criteria) to 22% (patients who met both criteria). Of 808 psychotic ratings given to the 70 patients over a 5-year follow-up period, 210 (26%) were concurrently rated as depressed; of the 1,754 nonpsychotic ratings, only 70 (4%) were concurrently rated as depressed. Of the 210 depressive symptoms that occurred concurrently with psychosis, 206 (98%) resolved as the psychosis remitted. Depressive symptoms were prodromal to a psychotic relapse in only two (7%) of 27 patients who relapsed. Depressive symptoms correlated more with positive and negative symptoms than with extrapyramidal symptoms.
These findings suggest that depressive symptoms in patients experiencing their first episode of schizophrenia may represent a core part of the acute illness or may occur as a subjective reaction to the experience of psychotic decompensation. Since most of the depressive symptoms resolved as the psychosis remitted, antidepressant therapy should be limited to patients in whom the depression persists.
由于先前治疗的影响、回顾性评估以及不同的定义和标准，关于精神分裂症中抑郁症状的预后意义及其对精神分裂症病程和治疗的影响的研究结果受到限制，作者试图确定首发精神分裂症中抑郁症状的患病率及其预后意义。
对39名男性和31名女性首发精神分裂症患者在治疗前（基线）、急性治疗期间每两周以及之后每月进行行为和锥体外系症状量表评估。获取汉密尔顿抑郁量表的提取分数以及基于研究诊断标准的抑郁“综合征”定义。对患者进行长达5年的前瞻性随访，并接受开放标准化治疗。
基线时抑郁症状的患病率从75%（符合提取的汉密尔顿和/或综合征标准的患者）到22%（符合两项标准的患者）不等。在对70名患者进行的5年随访期间的808次精神病性评定中，有210次（26%）同时被评定为抑郁；在1754次非精神病性评定中，只有70次（4%）同时被评定为抑郁。在与精神病同时出现的210例抑郁症状中，206例（98%）随着精神病的缓解而缓解。在27例复发患者中，只有2例（7%）的抑郁症状先于精神病复发出现。抑郁症状与阳性和阴性症状的相关性比与锥体外系症状的相关性更强。
这些发现表明，首发精神分裂症患者的抑郁症状可能代表急性疾病的核心部分，或者可能是对精神病性失代偿体验的主观反应。由于大多数抑郁症状随着精神病的缓解而缓解，抗抑郁治疗应仅限于抑郁持续存在的患者。
