Post-Psychotic Depression in Schizophrenia

Abstract
Although a depressive state is known to occur following the
resolution of an acute psychotic episode, little research has
investigated its etiology, course, prognosis and treatment.
Very often the depression is mistaken for an extrapyramidal-
like syndrome ± the secondary effect of antipsychotic medica-
tion ± as a sense of inevitability assails both the patient and
therapist. Post-psychotic depression, far from being an
obscure and undefined clinical picture, has the characteristics
of a clear-cut syndrome. Nevertheless, it was only recently
referred to as a distinct entity in psychiatric classification
systems. As a result, different researchers used varying
criteria for the definition of the phenomenon, and the data
collected in the different studies are therefore difficult to
compare. We present a critical review of the data published to
date, with emphasis on the importance of early recognition and
treatment of post-psychotic depression.

Depressive complaints are a well-known complication of a
psychotic episode [1]. Patients usually experience a strong sense
of anhedonia (apathy and lack of interest in everything) and
depressed mood. They also complain of insomnia and lack of or
diminished appetite or libido.
The main clinical signs of post-psychotic depression are a
depressed affect and a generalized psychomotor slowness. It
should be stressed that PPD, according to its present DSM
definition, is the occurrence of these symptoms during the
residual phase of schizophrenia, i.e., following the disappear-
ance of the symptoms meeting criterion A for schizophrenia.
Although not included in the definition of PPD, Cutler and Siris
[2] reported that approximately one-quarter of schizophrenic
and schizoaffective patients with PPD experienced panic
attacks, indicating that symptoms of anxiety may be part of the clinical picture of PPD in patients with schizophrenia. Many
cases are also associated with suicidal ideation with or without
guilt feelings. Shuwall and Siris [3] investigated the relationship
of suicidal ideation, anxiety and psychosis in a group of
schizophrenic and schizoaffective patients with PPD. Their
findings suggest that in these patients the presence of psychosis
and/or anxiety is associated with higher levels of suicidal
ideation independent of the level of depression.

I don’t know if this was mentioned, but going from acutely I’ll to medicated and stable also can be depressing as it reminds one just how I’ll one truly is.

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I’m still reading it. They mention despair.

This sounds like you, Minnster. I wanna give you a hug.

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I knoooow, it does. They say it differs from the negative symptoms, but I didn’t really understand how. I will come back to this in the morning tomorrow.

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Any post psychotic depression I’ve had I always attributed to side effects from typical antipsychotics. I hate typical antipsychotics. I can’t recall any depression I’ve had that was post psychotic depression. I guess if they say it exists it probably does, but I’ve never experienced it.

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