Depressive and anxiety symptoms in patients with schizophrenia and schizophreniform disorder

Background: Symptoms of depression and anxiety are frequently encountered i n the course of schizophrenia and are of considerable clinical importance. They may compromise social and vocational functioning, and they are associa ted with an increased risk of relapse and suicide. Various treatment approa ches have been reported to be successful. Method: The sample comprised 177 patients with DSM-III-R or DSM-TV schizoph renia or schizophreniform disorder who were participants in multinational c linical drug trials at our academic psychiatric unit over a 7-year period a nd who were assessed by means of the Positive and Negative Syndrome Scale ( PANSS). Analysis was performed on baseline PANSS scores. The depression/anx iety score was compared in the men and women, first-episode and multiple-ep isode patients, and those with predominantly positive and negative syndrome s. Correlations were sought between depression/anxiety scores and age, tota l PANSS score, positive score, negative score, general psychopathology scor e, and treatment outcome. Multivariate analysis was applied to determine co ntributions of individual variables toward depression/anxiety and outcome s cores. Results: Depression and anxiety symptoms were more severe in women (p = .00 7), first-episode patients (p = .02), and those with predominantly positive symptoms (p < .0001). Depression/anxiety scores were significantly correla ted to age (r = -0.31, p < .0001), PANSS positive scores (r = 0.39, p < .00 01), and treatment outcome (r = 0.25, p = .006). Multivariate analysis bore out these results. with the exception that first episode was not a signifi cant predictor of depression and anxiety scores. Conclusion: PANSS depressive/anxiety scores were generally low in our sampl e, perhaps because patients with schizoaffective disorder were excluded. Th e finding that these symptoms were mon prominent in women and first-episode patients is in keeping with previous literature. The higher scores in firs t-episode patients are likely due to the higher positive symptom scores in these patients. The association between depressive/anxiety scores and posit ive symptoms but not with negative symptoms points to a specific relationsh ip between affective symptoms and the positive symptom domain of schizophre nia. The presence of depressive and anxiety symptoms may predict a more fav orable outcome to treatment, although this may only apply to the acute exac erbations of the illness.