Tunay KARLIDERE, ÖZCAN UZUN, Adem BALIKÇI

Tedavi altındaki ilk atak şizofreni olgularında depresif belirtiler: Bir yıllık izlemede klasik ve atipik antipsikotiklerin karşılaştırılması

Amaç: Depresyon şizofreninin gidişi sırasında sıklıkla ortaya çıkan önemli bir sendromdur. Şizofreninin tedavisinde atipik antipsikotik kullanan olgularda depresif belirtilerin daha düşük oranda gözlenmesi beklenmektedir. Geriye dönük bu çalışmada, bir yıl süreyle izlenen atipik veya klasik antipsikotik tedavi kullanan ilk atak şizofreni olgularındaki depresif belirtilerin değerlendirilmesi amaçlanmıştır. Yöntem: Çalışma, 93 ilk atak şizofreni olgusunun kayıtlarının incelenmesi ile gerçekleştirilmiştir. Değerlendirme için Kısa Psikiyatrik Derecelendirme Ölçeği, Pozitif Belirtileri Değerlendirme Ölçeği, Negatif Belirtileri Değerlendirme Ölçeği, Hamilton Depresyon Ölçeği (HAM-D), Calgary Depresyon Ölçeği verileri kullanılmıştır. Olguların tedavisinde klasik antipsikotik (s=21), olanzapin (s=28), risperidon (s=25) veya ketiyapin (s=19) kullanıldığı saptanmıştır. Olgular, klinik durumlarına göre iki aydan uzun olmayan aralıklarla kontrollere çağrılmıştır. Depresif belirtilerin ölçülmesi ve bunların klinik değişkenlerle ilişkisinin saptanması için yukarıdaki ölçekler olgulara her kontrolde uygulanmıştır. Bulgular: Klasik antipsikotik grubunda (%57.1) atipik antipsikotik grubuna (%31.9) göre daha fazla anlamlı şiddette depresif belirtiler (HAM-D puanı>=17) saptanmıştır. Depresyon ve depresif belirtiler oranı atipik antipsikotik kullanan olgular arasında benzer bulunmuştur. Tartışma: Olasılıkla etki düzeneklerine ve negatif belirtiler üzerindeki etkilerine bağlı olarak atipik antipsikotik kullanan şizofreni olgularında, klasik antipsikotik kullananlara göre daha düşük oranda depresyon tablosu gelişmektedir.

Depressive symptoms in first episode schizophrenia patients under treatment: one-year follow-up comparison of classical and atypical antipsychotics

Objective: Depression is an important syndrome occuring frequently during the course of schizophrenia. In patients using atypical antipsychotics in the treatment of schizophrenia, depressive symptoms are expected at a lower rate. In this retrospective study, evaluation of depressive symptoms in patients who were monitored for one year with first-episode schizophrenia using atypical or conventional antipsychotic treatment was intended. Methods: The study was carried out by examining the records of 93 patients with first-episode schizophrenia. The data of the Brief Psychiatric Rating Scale, Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, Hamilton Depression Rating Scale (HDRS) and the Calgary Depression Scale were used for evaluation. Classical antipsychotics (n=21), olanzapine (n=28), risperidone (n=25) or quetia-pine (n=19) were found to be used in the treatment of subjects. According to clinical status, the subjects were invited to the controls at intervals not longer than two months. The above scales were applied to subjects at each control to measure the depressive symptoms and to determine the relationship of those with clinical variables. Results: The classic antipsychotic group (57.1%) showed more significantly severe depressive symptoms (HDRS score>=17) than the atypical antipsychotic group (31.9%). The rate of depression and depressive symptoms were similar among the subjects used atypical antipsychotic agents. Conclusion: Possibly depending on their mechanism of action and the effects on negative symptoms of patients with schizophrenia, the atypical antipsychotic drugs showed lower rate of depression compared to conventional antipsychotics.

PDF

___

Mulholland C, Cooper S. The symptom of de- pression in schizophrenia and its management. Adv Psychiatr Treat 2000; 6:169-177.
Kendler KS, Gallagher TJ, Abelson JM, Kessler RC. Lifetime prevalence, demographic risk factors, and diagnostic validity of nonaffective psychosis as assessed in a US community sample: the National Comorbidity Survey. Arch Gen Psychiatry 1996; 53:1022-1031.
Sands JR, Harrow M. Depression during the longitudinal course of schizophrenia. Schizophr Bull 1999; 25:157-171.
Shanfield S, Tucker G, Harrow M, Detre T. The schizophrenic patient and depressive symptoma- tology. J Nerv Ment Dis 1970; 151:203-210.
Knights A, Hirsch SR: 'Revealed' depression and drug treatment for schizophrenia. Arch Gen Psychiatry 1981; 38:806-811.
De Alarcon R, Carney MWP. Severe depressive mood changes following slow-release intra- muscular fluphenazine injection. Br Med J 1969; 3:564-567.
Johnson DAW. Depressions in schizophrenia: Some observations on prevalence, aetiology and treatment. Acta Psychiatr Scand 1981; 63(Suppl.291):137-144.
Van Putten T, May PRA. 'Akinetic depression' in schizophrenia. Arch Gen Psychiatry 1978; 35: 1101-1107.
Siris SG. Depression in schizophrenia: perspec- tive in the era of ''Atypical'' antipsychotic agents. Am J Psychiatry 2000; 157:1379-1389.
Parker G, Malhi G. Are the atypical antipsychotic drugs also atypical antidepressants? Aust N Z J Psychiatry 2001; 35:631-638.
Harrow M, Yonan CA, Sands JR, Marengo J. Depression in schizophrenia: are neuroleptics, akinesia, or anhedonia involved? Schizophr Bull 1994; 20:327-338.
Kapur S, Mann JJ. Role of the dopaminergic sys- tem in depression. Biol Psychiatry 1992; 32:1-17.
Pierre JM. Extrapyramidal symptoms with atypi- cal antipsychotics: incidence, prevention and management. Drug Saf 2005; 28:191-208.
Ghaemi SN, Cherry EL, Katzow JA, Goodwin FK. Does olanzapine have antidepressant proper- ties? A retrospective preliminary study. Bipolar Disord. 2000; 2:196-199.
Glazer W, Prusoff B, John K, Williams D. Depression and social adjustment among chronic schizophrenic outpatients. J Nerv Ment Dis 1981; 169:712-717.
Dario Bagaric, Petrana Brecic, Drazenka Ostojic, Vlado Jukic, Ana Goles. The relationship be- tween depressive syndrome and suicidal risk in patients with acute schizophrenia. Croat Med J 2013; 54:436-443.
Hor K, Taylor M. Review: Suicide and schizo- phrenia: a systematic review of rates and risk factors. J Psychopharmacol 2010; 24(Suppl.4): 81-90.
First MB, Spitzer RL, Williams JBW. Structured Clinical Interview for DSM-IV (SCID). Washing- ton, DC: APA, 1997.
Corapcioglu A, Aydemir O, Yildiz M, Esen A, Koroglu E. Structured Clinical Interview for DSM- IV (SCID), Turkish Version. Ankara: Hekimler Yayin Birligi, 1999.
Overall JE, Gorham DR. The Brief Psychiatric Rating Scale. Psychol Rep 1962; 10:799-812.
Soykan C. Institutional Differences and Case Typicality as Related to Diagnosis System Sever- ity, Prognosis and Treatment. Unpublished Master Thesis, Middle East Technical University, Ankara, 1989.
Andreasen NC. The Scale for the Assessment of Positive Symptoms (SAPS). University of Iowa, Iowa City, 1984.
Erkoç Ş, Arkonaç O, Ataklı C. Pozitif Semptom- ları Değerlendirme Ölçeğinin güvenilirliği ve geçerliliği. Düşünen Adam. 1991; 4:20-24.
Andreasen NC. The Scale for the Assessment of Negative Symptoms (SANS). University of Iowa, Iowa City, 1984.
Erkoç Ş, Arkonaç O, Ataklı C. Negatif Semptom- ları Değerlendirme Ölçeğinin güvenilirliği ve geçerliliği. Düşünen Adam 1991; 4:14-15.
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960; 23:56-62.
Akdemir A, Dönbak S, Dağ İ, İşcan N, Özbay H. Hamilton depresyon derecelendirme ölceği (HDDÖ)'nin geçerliği, güvenirliği ve klinikte kulla- nımı. 3P Dergisi 1996; 4:251-259.
Addington DE, Addington JM, Tyndale E.
Assessing depression in schizophrenia: The Calgary Depression Scale. Br J Psychiatry 1993; 163(Suppl.22):39-44.
Aydemir Ö, Danacı AE, Deveci A, İçelli İ. Calgary Şizofrenide Depresyon Ölçeği Türkçe versiyonu- nun özgüllüğü ve duyarlılığı. Nöropsikiyatri Arşivi 2000; 37:82-86.
Möller HJ. Antidepressive effects of traditional and second generation antipsychotics: a review of the clinical data. Eur Arch Psychiatry Clin Neurosci 2005; 255:83-93.
Krakowski M, Czobor P, Volavka J. Effect of neuroleptic treatment on depressive symptoms in acute schizophrenic episodes. Psychiatry Res 1997; 71:19-26.
Meltzer HY. The role of serotonin in antipsychotic drug action. Neuropsychopharmacology 1999; 21:106-115.
McGlashan TH, Carpenter WT Jr. An investi- gation of the postpsychotic depressive synd-rome. Am J Psychiatry. 1976; 133:14-19.
Johnson DA. The significance of depression in the prediction of relapse in chronic schizophre-nia. Br J Psychiatry 1988; 152:320-323.
Summers F, Harrow M, Westermeyer J. Neurotic symptoms in the postacute phase of schizophre- nia. J Nerv Ment Dis 1983; 171:216-221.
Leucht S, Pitschel-Walz G, Abraham D, Kissling W. Efficacy and extrapyramidal side-effects of the new antipsychotics olanzapine, quetiapine, rispe- ridone, and sertindole compared to conventional antipsychotics and placebo. A meta-analysis of randomized controlled trials. Schizophr Res 1999; 35:51-68.
Daniel DG, Zimbroff DL, Potkin SG, Reeves KR, Harrigan EP, Lakshminarayanan M. Ziprasidone 80 mg/day and 160 mg/day in the acute exacer- bation of schizophrenia and schizoaffective disor- der: a 6-week placebo-controlled trial. Ziprasi- done Study Group. Neuropsychopharmacology 1999; 20:491-505.
Keck PE Jr, Strakowski SM, McElroy SL. The efficacy of atypical antipsychotics in the treat-ment of depressive symptoms, hostility, and suicidality in patients with schizophrenia. J Clin Psychiatry 2000; 61(Suppl.3):4-9.
Dollfus S, Olivier V, Chabot B, Deal C, Perrin E. Olanzapine versus risperidone in the treatment of post-psychotic depression in schizophrenic pa- tients. Schizophr Res 2005; 78:157-159.
Tollefson GD, Sanger TM, Lu Y, Thieme ME. Depressive signs and symptoms in schizophre- nia: a prospective blinded trial of olanzapine and haloperidol. Arch Gen Psychiatry 1998; 55:250- 258.
Marder SR, Davis JM, Chouinard G. The effects of risperidone on the five dimensions of schizo- phrenia derived by factor analysis: combined results of the North American trials. J Clin Psychiatry 1997; 58:538-546
Emsley RA, Buckley P, Jones AM, Greenwood MR. Differential effect of quetiapine on depres- sive symptoms in patients with partially respon- sive schizophrenia. J Psychopharmacol 2003; 17:210-215.
Baynes D, Mulholland C, Cooper SJ, Montgo- mery RC, MacFlynn G, Lynch G, et al. Depres- sive symptoms in stable chronic schizophrenia: prevalence and relationship to psychopathology and treatment. Schizophr Res 2000; 45:47-56.
Addington DD, Azorin JM, Falloon IR, Gerlach J, Hirsch SR, Siris SG. Clinical issues related to depression in schizophrenia: an international survey of psychiatrists. Acta Psychiatr Scand 2002; 105:189-195.
Lindenmayer JP, Grochowski S, Kay SR. Schizo- phrenic patients with depression: psychopatholo- gical profiles and relationship with negative symptoms. Compr Psychiatry 1991; 32:528-533.
Kay SR, Fiszbein A, Opler LA. The Positive and Negative Syndrome Scale (PANSS) for schizo- phrenia. Schizophr Bull 1987; 13:261-276.
Goldman RS, Tandon R, Liberzon I, Greden JF. Measurement of depression and negative symp- toms in schizophrenia. Psychopathology 1992; 25:49-56.
Lako IM, Bruggeman R, Knegtering H, Wiersma D, Schoevers RA, Slooff CJ, et al. A systematic review of instruments to measure depressive symptoms in patients with schizophrenia. J Affect Disord 2012; 140:38-47.