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Post-schizophrenic Depression In common with the other disorders, brain disorders are often referred to as dynamic formation stipulated by a great diversity of factors. Therefore, the process of so-called general morphological pathologies of schizophrenic disorder is a natural phenomenon. This process may be characterized by decline in gradual progression forms of schizophrenia, general depressive- apathetic shift in clinical findings (Johnson, 1988) as well as by the tendency to phase flow of the process (Becker et al, 1985). In addition to that, therapeutic patho morphosis, residing in stratification of the symptomatology, appeared as a fundamentally) new factor in the modern psychiatry. Therefore, the changes that occur during the course of schizophrenic disorder naturally lead to separation and examination of new and altered symptoms and symptom complexes. Post-schizophrenic Depression is one of such symptom complexes.
The term post-schizophrenic depression was firstly introduced by scholars in the mid- 1970 s; however, it was officially acknowledged only after the 10 th revision of the ICD (The International Classification of Diseases). Post Schizophrenic Depression is a distinct subtype of schizophrenia (F 20. 4 F 2). It is defined as mild or moderate episode of disease with 2 week 2 years length occurring in result of reduction of the paranoid symptomatology. The disease requires the presence of several schizophrenic symptoms, both positive and negative. Diagnostic decision foresees indeterminate genesis of post-schizophrenic depressions.
American classification DSM-IV (Johnson, 1988) also has the classification of the disease under the heading 311. 4 (post psychotic depression). In contrast to classification provided by the International Classification of Diseases, this heading belongs to the cluster mood disorders. According to the diagnostic reference, post psychotic depression is classified as a large-scale depressive disorder that develops in residual stage of schizophrenia with preservation of the number of positive and negative symptoms. In addition to that, the research character of the given reference is particularly emphasized. The problem of depressions occurring in result of the reduction of the general paranoid symptomatology during the course of schizophrenia came into being during the mid- 1950 s, after the adoption of amina zine into psychiatric practice. Post-schizophrenic depression in the capacity of a separate poly etiologic syndrome was examined under the name post-remission syndrome of the nervous exhaustion (Heinrich, 1969).
In 1970 B. Guse's and E. Robins (S. B. Guse et al. , 1970) determined the secondary depressions during the course of schizophrenia. In 1973 P.
Kielholz in the light of his new concept of continual classification of depressions marked out endogenous schizophrenic depressions. Finally, in 1975 S. Fda described post-schizophrenic depression, and, later on, in 1976, T. McGlashan and W. T. Carpenter (Johnson, 1988) described post-psychotic depression.
In such a way, by the early 1980 s post-schizophrenic depression was singled out as a separate syndrome and a wide range of questions was outlined concerning the genesis, the symptoms and its correlation with the clinical course of schizophrenia. The Genesis of Post-Schizophrenic Depressions The researchers acknowledge poly etiologic nature of post-schizophrenic depressions, and put forward different hypotheses. According to our literature review, the emphasis was on the problem of genesis of the post-schizophrenic depression. On this basis, four main approaches to the genesis may be singled out.
Morbogenous hypothesis of post-schizophrenic depression clinical behavior is the most influential. However, it is heterogeneous in its structure, while presenting the diverse view points. Thus, post-schizophrenic depression may occur as biological reaction on psychosis (Becker et al, 1985), as cyclic ity display during the course of schizophrenia (Johnson, 1988), as a separate phase or stage taking place during the clinical course of schizophrenia with the following transition of the symptomatology into the milder register (Becker et al, 1985; S. B. Guse et al. , 1970). It may also occur as the integral part of the clinical course of schizophrenia in capacity of schizophrenic syndrome that occurs under the influence of a certain cryptogenic factor and reflects the definite type of clinical course of schizophrenia (Johnson, 1988; Becker et al, 1985).
The hypothesis of pharmacogenous character of the post-schizophrenic depressions is no more dominating one; however, the proponents of this approach advance different suppositions. Thus, post-schizophrenic depression may be pharmacogenous in its structure of the therapeutic patho morphosis leading to paranoid syndrome breakdown with posterior formation of depressive tails (Becker et al, 1985), complex schizo-affective syndromes [ 4 ] and mixed residual processes (S. B. Guse et al. , 1970).
Post-schizophrenic depression may also be examined as a peculiar depressive version of the neuroleptic syndrome interchangeably with sedative and extra pyramidal syndrome [ 56 ]. Post-schizophrenic depression may also occur as a symptom of delayed dyskinesia (Johnson, 1988; S. B. Guse et al. , 1970). The sequent hypothesis examines post- schizophrenic depression as a manifestation of deficient symptomatology, being the outcome of the negative schizophrenia, or the mixed symptom (Andreasen, 1985; Bucci, 1987).
Besides, post- schizophrenic depression may occur as the secondary negative symptom (Carpenter et al, 1988) in terms of G. Huber's schizophrenic defect conception. The personality-reactive hypothesis examines post- schizophrenic depression as a personal response on the very fact of psychical disorder (S. B. Guse et al. , 1970), pathological defense reaction (Becker et al, 1985), and a personal response on social deprivation, to mention a few.
In addition to that, post- schizophrenic depression is examined as sharpening of the pre morbid personal peculiarities [ 58 ], or within the context of childhood conflicts (Johnson, 1988; S. B. Guse et al. , 1970). The Symptomatology of Post- schizophrenic Depressions The researchers virtually ignored the symptomatology of post- schizophrenic depressions, while describing the symptoms with no detailed syndromic classification. Post- schizophrenic depression was classified by melancholy affect, idea toric deferred response, feeling of guilt, suicide thoughts, anxiety, insomnia disorders, fatigue, and anhedonia (Becker et al, 1985; Johnson, 1988; S.
B. Guse et al. , 1970). According to the researchers (Becker et al, 1985; Johnson, 1988), the depth of depressive affect makes up no less than 12 - 18 -point by the Hamilton's scale. Some authors (Becker et al, 1985; Johnson, 1988; Heinrich, 1969) report dismal mood, and D. P. Yan Karen (1964) adds apathy.
Moreover, a number of authors (Becker et al, 1985; Johnson, 1988) accentuate on the presence of somatic disorders in post- schizophrenic depression structure, while J. P. Lindenvayer (1947) dwells on the presence of other positive symptoms, along with persecution ideas. Although post- schizophrenic depression is traditionally considered the monotonous symptom complex, some authors (Carpenter et al, 1988; Johnson, 1988) indicate of the positive effect of comminatory therapy in 50 per cent of cases. Correlation of the post- schizophrenic depression with the general clinical course of schizophrenia The vast majority of researchers (Becker et al, 1985; Heinrich, 1969; S. B.
Guse et al. , 1970) indicate of the fact that post- schizophrenic depression develops either in about 25 - 30 per cent of patients immediately after the reduction of paranoid symptomatology, or within the next six months after discharge from the hospital. Such demographic factors like age, sex, social status (Heinrich, 1969; S. B. Guse et al. , 1970) have no impact on post- schizophrenic depression frequency. Subject to the clinical course of schizophrenia determines that post- schizophrenic depression occurs primarily with the availability of the following factors: the occurrence of the depressive episodes in pre morbid (S.
B. Guse et al. , 1970), tardy process manifestation (Becker et al, 1985), weak clinically apparent symptoms under condition of favorable clinical course of the disease [Johnson, 1988; Heinrich, 1969; S. B. Guse et al. , 1970), and prevailing of the paranoid types of schizophrenia with frequent and short-term hospitalizations [ 24, 49 ]. Furthermore, there was demonstrated that the duration of post- schizophrenic depression at least twice as much longer as the duration of the paranoid symptomatology (Johnson, 1988). In addition to that, it was found out that the intensity of deficient symptomatology has no significant impact on the intensity of the post- schizophrenic depression (Becker et al, 1985).
By this means, by 1990 s the psychiatrists defined the circle of issues relating to the post- schizophrenic depression. The vast majority of psychiatrists [ (Heinrich, 1969; S. B. Guse et al. , 1970) explored the post- schizophrenic depression phenomenon as a poly etiological complex symptom with the dominating morbogenous factor. The subsequent researches were aimed to separate the positive, negative and neuroleptic components in the post- schizophrenic depression structure (Becker et al, 1985; Heinrich, 1969; S. B.
Guse et al. , 1970). The issues of typological versions of the post- schizophrenic depressions were virtually ignored, with the exception of R. E. Becker (Becker et al, 1985), who distinguished of melancholic and endo reactive (dysthymia) depressions.
M. C. Mauri (1951) describes remittent clinical course of the post- schizophrenic depressions. In general, the psychiatrists adhered to the following standpoint: the post- schizophrenic depression should be examined as a separate stage in a clinical remission (S. B. Guse et al. , 1970), reflecting the continuous sluggish process during the intercourse (Heinrich, 1969), in the capacity of the slow episode of disease with regression of symptomatology for the affective register (Becker et al, 1985), or the autochthonous endomorphic affective stages (Johnson, 1988).
The vast majority of psychiatrists, while examining the post- schizophrenic depressions, consider depressive disorders as structurally complex and productive symptoms that should be examined in combination with diverse symptoms of other registers, such as neurosis-like (cenestopathy, phobia, hypochondriacal depression), symptoms of depersonalization (Johnson, 1988; Becker et al, 1985), along with the symptoms of delusion-like register (psychic automatism, psychotic microeposides, and deliriums closely approximating those of obsessive-compulsive neurosis). References Becker R. E. , Collier J. A. , Verhulst S. J. (1985). Diagnosis of secondary depression in schizophrenia.
Journal of Clinical Psychiatry, 6 (11), 48. Carpenter W. T, Heinrich's D. W. , Woman A.
M. (1988). Deficit and non deficit form of schizophrenia. American Journal of Psychiatry, 145 (5), 578583. Heinrich, K. (1969, May 31). Atiopogische Gesichtspunkte in der Schizophrenic for shung. Hippokrates, 6768.
Johnson, D. (1988). A studies of depressive symptoms in schizophrenia. British Journal of Psychiatry, 154 (2), 207211. L. , B. (1987). The negative symptoms of schizophrenia and monoamine oxidase inhibitors. Psychopharmacology, 91 (1), 104108.
N. , A. (1985). Positive vs. negative schizophrenia. Sch. Bull. , 11 (3), 380389. S.
B. Guse, E. Robins. (1970). Guse S. B. , Robins E.
Suicide and primary affective disorders. British Journal of Psychiatry, 117, 437448.
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