PDF
ePub
Citation
Print
Abstract
Objectives
To identify recent prescription patterns, as well as the demographic and clinical correlates of antidepressants (ADs) usage in schizophrenic patients.
Methods
A total of 297 patients diagnosed with schizophrenia enrolled at Seoul National Hospital in 2013. Brief Psychiatric Rating Scale (BPRS) was used to evaluate current psychiatric symptoms. Bivariate comparisons were used to assess the usage of concomitant psychotropics, demographic and clinical characteristics of ADs users compared with non-users. Multivariate analysis of covariance was performed consecutively.
Results
The rate of ADs usage was 26.3% and the most commonly used ADs were selective serotonin reuptake inhibitors. ADs users more often took benzodiazepine than ADs non-users (p=0.005), whereas there were no significant demographic and other clinical difference between the two groups. Regarding BPRS, somatic concern (p=0.022), anxiety (p=0.001) and depressive mood (p=0.009) scores were higher, and excitement (p=0.006) and hostility (p=0.04) scores were lower among ADs users compared to non-users, although there was no significant difference in the other scores of BPRS between the two groups. Moreover, among 5 components of BPRS, scores of affective symptoms (p < 0.001) were significantly higher, and scores of activation symptoms (p=0.014) were significantly lower in ADs users compared to non-users.
Conclusion
This study suggests that the usage of ADs could be related to affective symptoms regardless of positive and negative symptoms of schizophrenia. Further studies are required in order to confirm the clinical correlates of ADs usage and the interactions between affective symptoms and psychotic symptoms.
Figures and Tables
Table 1
Demographics and illness characteristics of a total of 297 schizophrenia patients with versus without current antidepressant use
Table 2
Comparisons of BPRS scores between AD users and nonusers in schizophrenia
Positive symptom score including conceptual disorganization, grandiosity, hallucinatory behavior and unusual thought content ; Negative symptom score including emotional withdrawal, motor retardation and blunted affect ; Affective symptoms score including somatic concern, anxiety, guilty feeling and depressive mood ; Resistance symptom score including hostility, suspiciousness and uncooperativeness ; Activation symptom score including tension, mannerisms and posturing and excitement. Mean±SD of BPRS scores were compared using multivariate analysis of covariance. * : p<0.05, ** : p<0.01, *** : p<0.001 vs. antidepressant nonuser. BPRS : Brief Psychiatric Rating Scale, AD : Antidepressant, SD : Standard deviation
References
1. Buckley PF, Miller BJ, Lehrer DS, Castle DJ. Psychiatric comorbidities and schizophrenia. Schizophr Bull. 2009; 35:383–402.
2. Hausmann A, Fleischhacker WW. Differential diagnosis of depressed mood in patients with schizophrenia: a diagnostic algorithm based on a review. Acta Psychiatr Scand. 2002; 106:83–96.
3. Mao YM, Zhang MD. Augmentation with antidepressants in schizophrenia treatment: benefit or risk. Neuropsychiatr Dis Treat. 2015; 11:701–713.
4. Hirsch SR, Jolley AG, Barnes TR, Liddle PF, Curson DA, Patel A, et al. Dysphoric and depressive symptoms in chronic schizophrenia. Schizophr Res. 1989; 2:259–264.
5. Koreen AR, Siris SG, Chakos M, Alvir J, Mayerhoff D, Lieberman J. Depression in first-episode schizophrenia. Am J Psychiatry. 1993; 150:1643–1648.
6. Ritsner M, Kurs R, Gibel A, Hirschmann S, Shinkarenko E, Ratner Y. Predictors of quality of life in major psychoses: a naturalistic follow-up study. J Clin Psychiatry. 2003; 64:308–315.
7. Jeong J, Won S, Chang S. Prevalence and predictors of depressive symptoms among the inpatients with schizophrenia. J Korean Soc Biol Ther Psychiatry. 2011; 17:121–130.
8. Jeon MS, KIm YS. A study of depressive symptoms in schizophrenia. J Korean Neuropsychiatr Assoc. 1981; 20:84–93.
9. Häfner H, Löffler W, Maurer K, Hambrecht M, an der Heiden W. Depression, negative symptoms, social stagnation and social decline in the early course of schizophrenia. Acta Psychiatr Scand. 1999; 100:105–118.
10. Birchwood M, Iqbal Z, Upthegrove R. Psychological pathways to depression in schizophrenia: studies in acute psychosis, post psychotic depression and auditory hallucinations. Eur Arch Psychiatry Clin Neurosci. 2005; 255:202–212.
11. Micallef J, Fakra E, Blin O. [Use of antidepressant drugs in schizophrenic patients with depression]. Encephale. 2006; 32(2 Pt 1):263–269.
12. Jin H, Zisook S, Palmer BW, Patterson TL, Heaton RK, Jeste DV. Association of depressive symptoms with worse functioning in schizophrenia: a study in older outpatients. J Clin Psychiatry. 2001; 62:797–803.
13. Conley RR, Ascher-Svanum H, Zhu B, Faries DE, Kinon BJ. The burden of depressive symptoms in the long-term treatment of patients with schizophrenia. Schizophr Res. 2007; 90:186–197.
14. Kay SR, Sevy S. Pyramidical model of schizophrenia. Schizophr Bull. 1990; 16:537–545.
15. Siris SG. Treating ‘depression’ in patients with schizophrenia: a thorough differential diagnosis determines the best treatment approach. Current Psychiatry. 2012; 11:35–39.
16. Lehman AF, Lieberman JA, Dixon LB, McGlashan TH, Miller AL, Perkins DO, et al. Practice guideline for the treatment of patients with schizophrenia, second edition. Am J Psychiatry. 2004; 161:2 Suppl. 1–56.
17. Whitehead C, Moss S, Cardno A, Lewis G. Antidepressants for the treatment of depression in people with schizophrenia: a systematic review. Psychol Med. 2003; 33:589–599.
18. Farahani A, Correll CU. Are antipsychotics or antidepressants needed for psychotic depression? A systematic review and meta-analysis of trials comparing antidepressant or antipsychotic monotherapy with combination treatment. J Clin Psychiatry. 2012; 73:486–496.
19. Buchanan RW, Kreyenbuhl J, Zito JM, Lehman A. Relationship of the use of adjunctive pharmacological agents to symptoms and level of function in schizophrenia. Am J Psychiatry. 2002; 159:1035–1043.
20. Lehman AF, Steinwachs DM. Patterns of usual care for schizophrenia: initial results from the Schizophrenia Patient Outcomes Research Team (PORT) Client Survey. Schizophr Bull. 1998; 24:11–20. discussion 20-32.
21. Xiang YT, Ungvari GS, Wang CY, Si TM, Lee EH, Chiu HF, et al. Adjunctive antidepressant prescriptions for hospitalized patients with schizophrenia in Asia (2001-2009). Asia Pac Psychiatry. 2013; 5:E81–E87.
22. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. 4th ed. text revision. Washington, DC: American Psychiatric Association;2000.
23. Guy W. ECDEU assessment manual for psychopharmacology. Rockville, MD: NIMH Psychopharmacology Research Branch;1976.
24. Overall JE, Beller SA. The Brief Psychiatric Rating Scale (BPRS) in geropsychiatric research: I. Factor structure on an inpatient unit. J Gerontol. 1984; 39:187–193.
25. Shafer A. Meta-analysis of the brief psychiatric rating scale factor structure. Psychol Assess. 2005; 17:324–335.
26. Simpson GM, Angus JW. A rating scale for extrapyramidal side effects. Acta Psychiatr Scand Suppl. 1970; 212:11–19.
27. Munetz MR, Benjamin S. How to examine patients using the Abnormal Involuntary Movement Scale. Hosp Community Psychiatry. 1988; 39:1172–1177.
28. Bianchi S, Bianchini E, Scanavacca P. Use of antipsychotic and antidepressant within the Psychiatric Disease Centre, Regional Health Service of Ferrara. BMC Clin Pharmacol. 2011; 11:21.
29. Chakos MH, Glick ID, Miller AL, Hamner MB, Miller DD, Patel JK, et al. Special section on CATIE baseline data: baseline use of concomitant psychotropic medications to treat schizophrenia in the CATIE trial. Psychiatr Serv. 2006; 57:1094–1101.
30. Siris SG, Addington D, Azorin JM, Falloon IR, Gerlach J, Hirsch SR. Depression in schizophrenia: recognition and management in the USA. Schizophr Res. 2001; 47:185–197.
31. Englisch S, Morgen K, Meyer-Lindenberg A, Zink M. Risks and benefits of bupropion treatment in schizophrenia: a systematic review of the current literature. Clin Neuropharmacol. 2013; 36:203–215.
32. Stahl SM. Stahl's essential psychopharmacology: neuroscientific basis and practical applications. 4th ed. New York, NY: Cambridge University Press;2013.
33. Goldman RS, Tandon R, Liberzon I, Greden JF. Measurement of depression and negative symptoms in schizophrenia. Psychopathology. 1992; 25:49–56.
34. Addington D, Addington J, Maticka-Tyndale E. Specificity of the Calgary Depression Scale for schizophrenics. Schizophr Res. 1994; 11:239–244.
35. Reine G, Lançon C, Di Tucci S, Sapin C, Auquier P. Depression and subjective quality of life in chronic phase schizophrenic patients. Acta Psychiatr Scand. 2003; 108:297–303.
XML Download