Management of depression in patients with schizophrenia spectrum disorders: a critical review of international guidelines

Dondé, Clément; Vignaud, Philippe; Poulet, Emmanuel; Haesebaert, Frédéric

doi:10.1111/acps.12939

Cited by 20 publications

(23 citation statements)

References 46 publications

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“…The direction of the “expected” path was based on theoretical assumptions. Because antipsychotics affect insight [42], QoL [43,44], depression [45], and suicide [46], chlorpromazine equivalent doses were added as a covariate. Negative, positive and general schizophrenic symptomatology were added as covariates to control for their potential confounding effect in the relationships between insight, QoL, depression, and suicide [12,47,48].…”

Section: Methodsmentioning

confidence: 99%

Modeling the Longitudinal Effects of Insight on Depression, Quality of Life and Suicidality in Schizophrenia Spectrum Disorders: Results from the FACE-SZ Cohort

Ehrminger

Urbach

Passerieux

et al. 2019

JCM

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Background: Up to half of the patients with schizophrenia attempt suicide during their lifetime. Better insight is associated with better functioning but also with increased suicidality. The direction of the relationship between insight and suicidality is not clear, hence we aimed to provide new elements using structural equation modeling. Methods: Insight, quality of life (QoL), depression, and suicidality were measured at baseline and at 12 months in individuals with schizophrenia spectrum disorders. The relationships between these variables were investigated by latent difference score models, controlling for chlorpromazine doses, positive and negative symptoms, and general psychopathology. Results: 738 patients were included, and 370 completed the study. Baseline levels of insight predicted changes in suicidality, whereas baseline levels of suicidality did not predict changes in insight, suggesting that better insight underlies suicidality and predicts its worsening. Our results suggest this temporal sequence: better insight → worse QoL → increased depression → increased suicidality, while insight also affects the three variables in parallel. Conclusion: Better insight predicts a worsening of QoL, depression and suicidality. These findings contribute to our global understanding of the longitudinal influence of insight on suicidality. We advocate that insight-targeted interventions should not be proposed without the monitoring of depression and suicide prevention.

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Section: Methodsmentioning

confidence: 99%

Modeling the Longitudinal Effects of Insight on Depression, Quality of Life and Suicidality in Schizophrenia Spectrum Disorders: Results from the FACE-SZ Cohort

Ehrminger

Urbach

Passerieux

et al. 2019

JCM

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“…This study aimed to gauge the level of recognition and management approaches used by UK psychiatrists to manage and treat depression in psychosis. With depression in psychosis now being adopted in national and international clinical guidelines, 7 we wanted to explore whether any change in recognition has led to more effective management of depression in those with psychosis, particularly in the early stages of illness.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Since this publication in 2001, 9 depression as a common occurrence in psychosis has become more widely recognised. 11,12 Monitoring for depression in psychosis is featured more commonly in national and international guidelines, 7 and the recent British Association for Psychopharmacology updated consensus statement is the first UK guide to include specific pharmacological treatment recommendations. 13…”

mentioning

confidence: 99%

Recognition and management of depression in early psychosis

2021

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Aims and method Depression in first-episode psychosis (FEP) is highly prevalent and associated with poor outcomes; it has become increasingly recognised and adopted in national and international guidelines for psychosis. Using a 26-item questionnaire, this study aimed to explore if this shift has led to greater recognition among UK psychiatrists, and more effective management of depression in FEP. Results Of the 297 respondents, 54.4% observed depression occurring in chronic psychosis, with the least number of respondents (17.7%) identifying depression occurring frequently during FEP. Although there was reasonable agreement in the use of antidepressants as a first-line treatment for depression (70% prescribing antidepressants), there was uncertainty around assessing depression and delineating from psychosis symptoms, and particularly negative symptoms. Clinical implications Evidence-based treatments for comorbid depression in psychosis will lead to clearer national guidelines, allowing for optimal management of depression in early psychosis, potentially leading to improved outcomes for these individuals.

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“…Major recommendations for further studies conducted in order to assess the effects of NIBS on clinical insight in patients with schizophrenia included the standardization of multidimensional insight assessment along with long-term follow-up assessments. In case of an effect of NIBS on insight, the potential consequences of insight improvement should be carefully evaluated (especially on depressive symptoms, suicidal thoughts and quality of life) and adequately managed using appropriate therapeutic approaches [ 73 ].…”

Section: Discussionmentioning

confidence: 99%

Improvement of Insight with Non-Invasive Brain Stimulation in Patients with Schizophrenia: A Systematic Review

Blay

Adam

Bation

et al. 2021

JCM

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Patients with schizophrenia are often unaware of their condition and the consequences of their illness. This lack of insight results in impaired functioning, treatment non-adherence and poor prognosis. Here, we aimed to investigate the effects of non-invasive brain stimulation (NIBS) on two forms of insight, clinical and cognitive, in patients with schizophrenia. We conducted a systematic review of the literature registered in the PROSPERO database (CRD42020220323) according to PRISMA guidelines. The literature search was conducted in Medline and Web of Science databases based on studies published up until October 2020 that included pre-NIBS and post-NIBS measurements of clinical and/or cognitive insight in adults with schizophrenia. A total of 14 studies were finally included, and their methodological quality was assessed by using the QualSyst tool. Despite the lack of well-conducted large randomized-controlled studies using insight as the primary outcome, the available findings provide preliminary evidence that NIBS can improve clinical insight in patients with schizophrenia, with a majority of studies using transcranial direct current stimulation with a left frontotemporal montage. Further studies should investigate the effect of NIBS on insight as a primary outcome and how these effects on insight could translate into clinical and functional benefits in patients with schizophrenia.

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Management of depression in patients with schizophrenia spectrum disorders: a critical review of international guidelines

Abstract: Further studies are needed to strengthen the level of evidence for antidepressive approaches in PWS. The inclusion of PWS as stakeholders is also considered to be a major issue for future guideline development.

Cited by 20 publications

References 46 publications

Modeling the Longitudinal Effects of Insight on Depression, Quality of Life and Suicidality in Schizophrenia Spectrum Disorders: Results from the FACE-SZ Cohort

Modeling the Longitudinal Effects of Insight on Depression, Quality of Life and Suicidality in Schizophrenia Spectrum Disorders: Results from the FACE-SZ Cohort

Recognition and management of depression in early psychosis

Improvement of Insight with Non-Invasive Brain Stimulation in Patients with Schizophrenia: A Systematic Review

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