Research report
Negative symptoms, depression and parkinsonian symptoms in chronic, hospitalised schizophrenic patients

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Abstract

Background: Negative symptoms of schizophrenia are often confounded by overlapping depressive and parkinsonian symptoms. The role of medication as an aetiological factor in the development of these symptoms is an important issue for prevention and treatment. Methods: A total of 45 inpatients in chronic wards who met RDC criteria for schizophrenia were assessed with the Hamilton depression rating scale (HDRS) and negative symptom rating scale (NSRS) and the targeting abnormal kinetic effect scale (TAKE). Results: No significant correlation was found between the total scores on the vegetative superfactor of the HDRS and the NSRS. Duration of neuroleptic treatment was positively correlated with depressive symptoms (r=0.299, P<0.05) and negative symptoms (r=0.443, P<0.001). Dose of antipsychotic was also correlated positively with negative symptoms (r=0.260, P<0.05). Age was negatively correlated with depressive symptoms as assessed by the HDRS (r=0.306, P<0.05). Conclusion: The data suggest that depressive and negative symptoms can be separated in chronic schizophrenia, while pointing to a possible role of antipsychotic medication in the aetiology. Limitations: The study was conducted in a small chronically hospitalised population treated with relatively high doses of antipsychotics. It is not clear that the results obtained here would be applicable to an acute patient population.

Introduction

Negative symptoms (NS) of schizophrenia, such as flat affect, psychomotor retardation, lack of gestures, social withdrawal can be confounded by overlapping depressive symptoms (DS) and parkinsonian symptoms (PS). This problem may cause difficulties in the everyday practice, since DS can be treated with antidepressants (Siris, 1991), PS can be treated with antiparkinsonian drugs and now even NS can be treated with new generation of antipsychotics, such as clozapine (Kane et al., 1988). Therefore, for the proper treatment of the symptoms of anhedonia, flat affect, psychomotor retardation, bradykinesia we have to make a proper diagnosis. The controversial data about the role of antipsychotic treatment in the development of DS and NS, respectively may make the treatment even more difficult. According to some data antipsychotics may cause depression (DeAlarcon and Carney, 1969, Floru et al., 1975, Galdi, 1983, Galdi et al., 1981, Johnson, 1981), some other data do not support this opinion (Barnes et al., 1989, Knights and Hirsch, 1981, Roy, 1984). According to some studies traditional neuroleptics may improve NS (Cole et al., 1964Goldberg et al., 1965Breier et al., 1987) but according to Carpenter et al. (1985)these drugs may rather cause NS. We would like to mention that since in the present study we assessed the patients with rating scales we did not diagnose them suffering from syndromes, therefore we used the term symptom, e.g. DS. Prosser et al. (1987)found a correlation between NS and some PS and vegetative features of depression, respectively, but they could not find any correlation between NS and cognitive symptoms of depression. Barnes et al. (1989)found no association between cognitive symptoms of depression and NS. Kibel et al. (1993)found that some cognitive symptoms of depression correlated with NS, some did not.

The role of drug factors in the development of NS, DS and PS is also an important issue in point of view of both, prevention and treatment of these syndromes.

We undertook the present study to re-examine in which way these syndromes and/or side effects correlate and do not correlate with each other, to find data to distinguish them in the everyday practice and in this way, make it easier to find the proper treatment for them. Moreover, we wished to find correlation between drug factors and these symptoms and side effects, respectively.

Section snippets

Material and methods

A total of 45 patients suffering from chronic schizophrenia according to the Research Diagnostic Criteria (Spitzer et al., 1977) were included into the study. All were inpatients on chronic wards of three mental hospitals and were able and willing to give informed consent. Patients suffering from organic brain disorder, severe physical illness, drug and alcohol addiction were not included into the study. Sixteen of the patients were females. The mean age of the patients (± S.D.) was 34.93±9.91

Results

The patients received the following antipsychotics alone or in combination: chlorpromazine, thioridazine, trifluoperazine, pimozide, haloperidol, haloperidol decanoate, fluphenazine decanoate. We converted the doses of the neuroleptics into chlorpromazine equivalents using the data of Norman et al., 1986. Only one antiparkinsonian agent, benztropine mesylate was used and 13 patients were on this medication.

Table 1 shows the average total scores (±) on the HDS, NSRS, TAKE, HDSV, HDSC, on the

Discussion

In our study we found, like others (Barnes et al., 1989Prosser et al., 1987Kibel et al., 1993, that it is possible to distinguish NS from DS. But while Barnes et al. (1989)and Prosser et al. (1987)found that there was no correlation between cognitive symptoms of depression and NS we found the opposite, namely that while there was a significant correlation between cognitive symptoms of depression and NS, the vegetative symptoms of depression did not correlate significantly with NS, the presence

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