Comparison of Prodromal Symptoms in Schizophrenia and Depression

We compared a representative subsample of 130 first admissions for schizophrenia from the ABC study with 130 age- and sex-matched ''healthy'' controls from the general population and 130 first admissions because of a depressive episode. Of the latter group, 70% suffered from a severe depressive episode. All these samples went through IRAOS interviews. Preliminary results show that DUI was significantly longer in depression (7.2 years) than in schizophrenia (5.3 years) (p<0.05). Equal proportions of both samples had received psychotropic medication before first admission: 19% of the patients with schizophrenia and 20% of the depressed patients.

As shown in Table 1.5, the two disorders share eight of their ten most frequent initial symptoms. These shared symptoms are primarily core depressive symptoms and indicators of functional impairment. In the further course of the prodromal stage, cognitive and social functioning deteriorate in depressive illness, too, but less markedly than in schizophrenia. This result is also reflected in a comparison of the cumulative prevalence rates of the ten most frequent symptoms in the early course of schizophrenia and depression (Table 1.6). Towards the end of the prodromal stage, the two disorders become clearly distinguishable, as psychotic symptoms appear and functional impairment clearly increases in schizophrenia and the depressive symptom dimension becomes predominant in depression.

Table 1.5 The ten most frequent initial symptoms (IRAOS items) in schizophrenia and in depression

Schizophrenic Depressive patients patients

Schizophrenic Depressive patients patients

Table 1.5 The ten most frequent initial symptoms (IRAOS items) in schizophrenia and in depression

Symptom

%

Rank

%

Rank

p

Worrying

19.2

4

14.1

5

n.s.

Headaches, other aches and pains

10.3

-

13.2

S

n.s.

Nervousness, restlessness

21.9

2

6.2

-

< 0.001

Anxiety

23.2

1

15.4

4

n.s

Difficulties of thinking, concentration

17.1

5

16.5

3

n.s.

Depressed mood

20.6

3

34.9

1

< 0.05

Loss of self-confidence

11.9

S

14.0

6

n.s.

Social withdrawal

11.6

9

13.3

7

n.s.

Disturbed sleep and/or appetite

15.0

6

21.9

2

n.s.

Loss of energy, slowness

13.5

7

S.5

10

n.s.

Loss of libido

4.1

-

S.5

10

n.s.

Oversensitivity

3.3

-

9.3

9

n.s.

Other changes in affect (blunted etc.)

11.1

10

0.S

-

< 0.001

Table 1.6 The ten most frequent symptoms (IRAOS items) in the early course of schizophrenia and depression (period prevalence)

Period prevalence from symptom onset until first hospital admission

Table 1.6 The ten most frequent symptoms (IRAOS items) in the early course of schizophrenia and depression (period prevalence)

Period prevalence from symptom onset until first hospital admission

Schizophrenic

Depressive

patients

patients

Symptom

%

Rank

%

Rank

p

Worrying

74.6

9

94.6

4

< 0.001

Nervousness, restlessness

SS.3

3

S1.5

10

n.s.

Anxiety

SS.1

4

S1.5

10

n.s.

Difficulties of thinking, concentration

93.S

1

96.9

3

n.s.

Depressed mood

S4.9

5

100.0

1

< 0.001

Loss of self-confidence

6S.3

10

S9.2

7

< 0.001

Social withdrawal

79.S

S

90.S

6

< 0.05

Disturbed sleep and/or appetite

93.S

1

9S.5

2

n.s.

Loss of energy, slowness

S2.5

6

93.S

5

< 0.05

Delusional mood

6S.3

10

4.6

-

< 0.001

Delusional misinterpretations;

S0.3

7

6.2

-

< 0.001

delusions of reference

Reduced spare time activities

63.5

-

S9.1

S

< 0.001

Reduced interests, citizen role

33.9

-

S7.7

9

< 0.001

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