The relationships between depression and remission in first-episode psychosis

This study assessed changes in depressive symptoms over time in 57 patients with first-episode psychosis, and investigated the relationships of these symptoms during the acute psychotic episode and the post-psychotic period with treatment outcome. Assessment instruments included the Calgary Depression Scale (CDS) and the Positive and Negative Syndrome Scale (PANSS). For the evaluation of treatment outcome, recently proposed operational remission criteria were used. PANSS factor analysis identified a depression/anxiety factor (PANSSD/ A) at baseline, which separated into "pure" depression (PANSS-D) and anxiety (PANSS-A) factors at 24 months. There were strong correlations between the CDS and the PANSS-D/A, PANSS-D and PANSS-A scores at baseline, but at 24 months significance was lost between CDS and PANSS-A. Compared to non-remitters, patients who achieved remission had significantly higher baseline CDS scores, but depressive symptoms resolved with antipsychotic treatment. Non-remitting patients had relatively low baseline CDS scores, but their depressive symptoms persisted throughout the study. These findings suggest that depressive symptoms in the acute psychotic episode differ from those in the post-psychotic period in terms of their phenomenology, temporal relationship to psychosis, and treatment response.