Depressive Syndromes in Schizophrenic Patients

Suicide is common in schizophrenia and may be due not only to the influence of audi­tory hallucinations, but also to depression. Depressive syndromes may occur in every phase of schizophrenic disease: in the foreground of acute psychosis, during in­patient treatment and in the post-remission phase. The origin of these syndromes is still unclear. The following hypotheses about their aetiology can be differentiated.

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Aspects of Bipolar Manic-Depressive, Schizo-Affective, and Schizophrenic Psychoses

Interest in the course of endogenous psychoses is traditional and has created numerous publications. For different reasons further research in this area is still highly desirable. Modern treatment, like lithium prophylaxis or long-term med­ication with neuroleptic drugs, can change the course of endogenous psychoses profoundly, thus raising the interest in the natural history of these disorders.

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DSM-III Paranoia

The term paranoia has a rather long and checkered history in psychiatry. Recently, Kendler and Tsuang (1981) reviewed the various clinical concepts histori­cally associated with paranoia from the point of view of the criteria that have been used to define them.

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The Undertreatment of Depression

Effective physical and psychological treatments of clini­cal depression have been developed, and in the case of physical treatments are widely available at relatively little cost in the developed countries. An important task for epidemiology is to ascertain whether treatments shown to be effective in controlled clinical trials are being developed fully and effectively (Alderson 1983).

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Variations of the Mood Disorders

The mood disorders, especially major depression, have many symp­toms besides change in mood. I’ve discussed many of these in the chapters on depression and bipolar disorder. Changes in appetite and sleep, energy, activity level, and concentration are some of these symptoms, and in some people they may dominate the clinical picture or at least be so prominent that other types of illnesses can be mistakenly diagnosed. This chapter will deal with some subtypes of affective disorder that are especially likely to be called something else, “explained away,” or missed altogether by the affected person, family members, and even doctors.

Mood disorders commonly fluctuate in relation to other biological events such as the menstrual cycle and childbirth, can be associated with cerebro­vascular accidents (commonly known as stroke), and can be affected by the change of the seasons. Mood disorders in young people and in the elderly have some special characteristics as well, and there are relationships between depression and chronic pain and between depression and panic attacks.