Depressive Symptoms as Prodromal Signs of Schizophrenia

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Several first-episode studies have consistently reported an extremely high frequency of depressive symptoms in the first psychotic episode: depressive mood or at least two depressive symptoms were found in 70-75% of cases [56,57,113-115].

As shown above, depressive symptoms frequently appear long before the first positive symptom [16,114,116]. In the ABC study cohort, the lifetime prevalence of depressive mood of a duration of two or more weeks -assessed until first admission - was 81%. In 39% of cases the symptom was continuously present, in 34% recurrent, and in 8% it occurred only once. Only 19% of the first-episode cases of schizophrenia reported not to have suffered from an episode of depressed mood [114].

A comparison of 57 first-episode patients with schizophrenia with 57 population controls matched by age, sex and place of residence showed that three out of four depressive symptoms were significantly more frequent in patients than in controls [114]. For depressive mood, the lifetime prevalence at first admission was 70.2% in patients versus 19.3% in controls, for feelings of guilt 33.3% versus 10.5%, and for poor self-confidence 59.4% versus 12.3%. The relative risks of these symptoms ranged from 3 to 5. The frequency of attempted suicide at the early illness stage showed a nonsignificant excess of some 40%. This result will probably attain significance in larger samples, thus indicating that early clinical intervention is needed here.

The depressive syndrome emerging at the early prodromal stage of schizophrenia is presumably for the most part a pattern of response of the brain to fairly mild degrees of dysfunction. It seems to be produced by the same neurobiological processes that bring forth psychotic symptoms at a later stage. In contrast, at the beginning of the prodromal stage, the distressing factors associated with the disorder - e.g. traumatic experiences of the psychosis, hallucinations in particular, and social consequences of schizophrenia - do not yet play a role.

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