Clinical subtypes of postpsychotic depression in the first episode of schizophrenia: results of a cross-sectional observational study

Abstract

BACKGROUND: Clinical diagnosis of depression in schizophrenia is difficult because of the dimensional overlap of a number of affective symptoms with negative manifestations of schizophrenia spectrum disorders. In the very first attack of schizophrenia, when the negative symptom complex is not yet clear enough, the difficulties of differential diagnosis become even more relevant, especially when depression occurs in the post-attack stage during the formation of remission and the manifestation of postpsychotic depression. AIM: To establish a diagnostic approach based on a combination of clinical-psychopathological and psychometric methods for the assessment of postpsychotic depression in patients with a first episode of schizophrenia. MATERIAL AND METHODS: We are examined 1112 patients who had suffered a first psychotic episode. Аfter introducing inclusion/exclusion criteria, two groups were formed in the final design: 243 patients with postpsychotic depression (PPD) and 119 patients without depression in partial remission. Clinical-psychopathological, psychometric (PANSS, CDSS, SCL-90-R scales), and statistical (descriptive, non-parametric statistics — significance level p 0.05) methods were used. RESULTS: Based on the concept of positive-negative affectivity, three types of PPD have been identified: with signs of positive affectivity — anxious, sensitive-psychasthenic, depersonalisation-hypochondriacal and melancholic-anergic subtypes; with signs of negative affectivity anhedonic, dysthymic-apathetic and dysphoric subtypes; formed due to psychopathological manifestations of the non-affective register — obsessive-ruminative, agoraphobic, paranoid-symbolic subtypes. Patients who were diagnosed with PPD with positive affectivity after an attack were predominat (p 0.05): 46.91% of the total number of depressed patients. PPD formed due to non-affective spectrum disorders is accompanied by the strongest subjective severity of suffering in patients, compared to patients diagnosed with PPD with positive affectivity. Subjectively, the easiest for patients is PPD with negative affectivity, which, however, does not mean that it can be considered as favourable from the standpoint of therapy and rehabilitation. CONCLUSION: PPD is detected in a significant number of patients with a first psychotic episode, even after excluding the group with pharmacogenic depression, both due to subjective complaints, nosogenic depressive experiences, and as a result of a psychometric assessment of the patients’ condition. The concept of “dissociated post-attack depression” is substantiated.