Depression in Schizophrenics

258 Pages·1989·8.03 MB·English

by  Ian F. Brockington (auth.)

Depression in
Schizophrenics
Springer-sbm Archive Dordrecht
Depression in
Schizophrenics
Edited by
Richard Williams and
]. Thomas Dalby
Calgary General Hospital
and University of Calgary
Calgary, Alberta, Canada
Springer Science+Business Media, LLC
Library of Congress Cataloging in Publication Data
World Psychiatric Association Symposium on Depression in Schizophrenics (1988: Calgary, Alta.)
Depression in schizophrenics 1 edited by Richard Williams and J. Thomas Dalby.
p. cm.
"Proceedings of a World Psychiatric Association Symposium on Depression in Schizophrenics,
held July 6-7, 1988, in Calgary, Alberta, Canada"-T.p. verso.
Includes bibliographical references and index.
ISBN 978-1-4757-9980-4 ISBN 978-1-4757-9978-1 (eBook)
DOI 10.1007/978-1-4757-9978-1
l. Schizophrenia-Congresses. 2. Depression, Mental-Congresses. I. Williams, Richard,
1950- II. Dalby, J. Thomas. III. Title.
[DNLM: l. Depressive Disorder-congresses. 2. Schizophrenia-congresses. QM 203 W92763d
1988)
RC514.W68 1988
616.89'82-dc20
DNLC/DLC 89-16146
for Library of Congress CIP
Proceedings of a World Psychiatric Association Symposium on
Depression in Schizophrenics, held July 6-7, 1988,
in Ca!gary, Alberta, Canada
© 1989 Springer Science+Business MediaNe w York
Originally published by P1enum Press, New York in 1989
Softcover reprint of the hardcover 1s t edition 1989
AII rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
PREFACE
The chapters of this volume were originally presented
at a symposium on "Depression in Schizophrenics" held at the
University of Calgary, Health Sciences Centre on July 06 and
07, 1988. It was the intent of the organizers to draw
together leading international researchers to address, in a
comprehensive fashion, the persisting problem of depression
in schizophrenic individuals.
As many of the authors point out, depression was
clearly identified as a central problem in schizophrenia by
the pioneers of psychiatry. Their wisdom and clinical
acumen was lost for a time to be only recently re
discovered. Their insights must now be integrated with
modern taxonomic systems, evolving etiological models and
methods of assessment. With increased recognition of the
problem of depression in this population we must also
examine appropriate methods of ameliorating the suffering of
those afflicted.
The conference was divided into sections (theoretical
aspects, phenomenology, suicide and treatment) and the
chairmen of these sections have given brief introductions.
Necessary overlap of topics and methods provided a
convergent and validating examination of empirical results
which may serve to direct continuing studies. As well we
hope that thoughtful review may directly influence clinical
practice and thereby improve the quality of life for
schizophrenic patients.
R. Williams
J.T Dalby
v
ACKNOWLEDGEMENTS
The symposium on which this book is based was co
sponsored by a number of organizations including the
Department of Psychiatry, University of Calgary; the World
Psychiatric Association; the World Psychiatric Section on
Psychiatric Rehabilitation; the Alberta Psychiatric
Association and the Alberta Friends of Schizophrenics. A
special note of thanks is extended to Merrell Dow
Pharmaceuticals (Canada) Inc. who provided a grant in aid of
continuing medical education.
The impetus and organization for the conference was
directed by the Schizophrenia Research Interest Group at the
University of Calgary including: Don and Jean Addington,
Mary Anne Beyfus, Tom Dalby, Gerry McDougall, David Romney,
Di Vosburgh and Richard Williams
Ms. Jocelyn Lockyer of the Office of Continuing Medical
Education at the University of Calgary provided invaluable
assistance in the arrangements for the symposium. Ms.
Caroline Collins of the same office contributed her patient
aid by typing and proofreading the entire text.
Finally we offer our sincere appreciation to each of
the programme participants.
vi
CONTENTS
Part I THEORETICAL ASPECTS
Introduction
Richard Williams 3
A Critical View of the Concept of Schizophrenia...... 5
Ian F. Brockington
Genetics and Affective Changes in Schizophrenia..... 13
Peter McGuffin, Anne E. Farmer, Ian harvey and
Maureen Williams
Interhemispheric Relations and Depression in........ 29
Schizophrenia in the Perspective of Cerebral
Laterality
Pierre Flor-Henry
Part II PHENOMENOLOGY
Introduction........................................ 49
Donald Addington
Negative Symptoms in Schizophrenia: Depressive or
Deficit Syndrome.............................. 53
Jacqueline A. Samson, Alexander Young and
Ming T. Tsuang
The Assessment of Depression in Schizophrenia....... 67
Donald Addington and Jean Addington
Depression in Functional Psychosis.................. 77
David G.C. Owens and Eve c. Johnstone
Depression and Paranoid Schizophrenia.............. 101
David M. Romney
The Development of Methods to Assess the
Temporal Relationship of Depressive and
Psychotic Symptoms in Schizophrenia.......... 109
Michael Foster Green, Keith H. Nuechterlein,
and Joseph Ventura
Negative Symptoms and Depression in Schizophrenia.. 121
Michael Pogue-Geile
vii
Part III SUICIDE AND PROGNOSIS IN SCHIZOPHRENICS
WITH DEPRESSION
Introduction. . . . • . • • • • . . • . • . . . • . • • • • • . . . . . . • • • . . . . . 13 3
Bryan Tanney
Suicidal Behavior in Schizophrenics................ 137
Alec Roy
Early Phases of Schizophrenia and Depression:
Prediction of Suicide........................ 153
Jerry F. Westermeyer and Martin Harrow
Suicide in Schizophrenia: Clinical Approaches..... 171
Robert E. Drake, Stephen J. Bartels
and William c. Torrey
Part IV TREATMENT APPROACHES TO DEPRESSION IN
SCHIZOPHRENICS
Introduction. • . • • . • • . • . . • . . . . . . . . . • • • . • • • . . • . . . . . . . 189
Gerald McDougal and Di Vosburgh
The Complex Problem of Treatment................... 193
Donald A.W. Johnson
Long-Term Neuroleptic Toxicity and Mood:
Blurring of Diagnostic Boundaries............ 203
Barry D. Jones
Antidepressants in "Depressed" Schizophrenics...... 215
Samuel G. Siris
The Neuroleptic Dysphoria Syndrome................. 233
Theodore Van Putten, Stephen R. Marder
and Nicole Chabert
Drug and Subject Influences on Measures of
Depression and Negative Symptoms in
Schizophrenic Patients....................... 245
Richard Williams and J. Thomas Dalby
CONTRIBUTORS. . . . . . . . . . . . . . . . . . . . • . • . . . . . . . . • . . . . . . . 2 55
INDEX. . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . 2 61
viii
Section 1
THEORETICAL ASPECTS
INTRODUCTION
Richard Williams
Man has always classified his external and internal
worlds in an attempt to understand each to a greater degree.
In the 1800s classification systems for animal and plant
species were refined to an extreme degree such that the
system has persisted even when new evidence suggested change
in subgrouping for some animals. Classifying the internal
world of mental processes has proved less easy; the early
organic/functional dichotomy was found to be unhelpful, for
as mental disorders become better understood they tended to
shift from the functional to the organic group. For example,
epilepsy, G. P. I. and now even schizophrenia and affective
disorders are being shown to be associated with organic
changes. Whether these biological changes are the cause of,
or result from, the disorder, has still to be elucidated.
Dr. Brockington's chapter is a provocative challenge to
psychiatric investigators to move outside of the restricting
and constricting confines of ICD-9 and DSM-III-R categories
to look at major psychiatric disorders along dimensions.
Walton and Presly (1) have shown that personality types do
not fit neatly into categories but can be understood on a
multidimensional model; perhaps it is now time for other
mental disorders to be viewed in a similar way. Dr.
Brockington discusses two phenomenological dimensions (one
being delusions or autism; the second verbal hallucinosis and
passivity) and a third behavioral dimension (negative
symptoms or defect state) and it is Dr. Flor-Henry who
introduces the fourth dimension of organic changes. It is
clear that central laterality is an important element in
understanding the pathophysiology of individual patients, as
it can be related to treatment responsiveness (demonstrated
in his case example). The introduction of Nuclear Magnetic
Resonance Imaging (NMRI) techniques has indicated that
apparently different types of abnormality (hypo- and hyper
frontality) (2) within patients diagnosed according to strict
research criteria as having schizophrenia; whilst Dr. Flor
Henry attempts to explain all this within a unitary theory,
one must consider the possibility of different contributing
factors producing different organic changes although sharing
a final common phenomenological pathway.
The genetic component to mental illness is clearly
reviewed by Dr. McGuffin and colleagues. Tim Crow (3) has
long postulated the inner-relatedness of affective illness
and schizophrenia, and whilst not originating the "continuum
3