Depression in the Early Illness Course as a Prognostic Indicator of the Later Course

We studied the further illness course and the predictive efficiency of prodromal symptoms in 115 first illness episodes from the representative subsample of 130 first admissions at six cross-sections over five years after first admission [114]. Patients with schizophrenia who suffered from depressive mood (> 14 days) in the early illness course were compared with age- and gender-matched patients without depressive episodes. The group with depression in the early course of schizophrenia showed significantly higher scores of depressive, but also of positive, negative and nonspecific symptoms in the first episode than did nondepressed patients. With remission of the episode, the mean score for depressive symptoms fell with psychotic symptoms without any indication of a ''wave'' of postpsychotic depression and remained more or less stable until five years after first admission. The presence of depressive symptoms in the early illness course predicted the occurrence of neither positive nor depressive or nonspecific symptoms after remission of the psychotic episode. In contrast, the absence of depressive symptoms in the early course was significantly correlated with affective flattening in the five years following first admission. The implication of this finding is that prodromal depression predicts a severe first psychotic episode, whereas a low score of prodromal depressive symptoms predicts more affective flattening after the remission of the episode.

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