[Clinical aspects of depression in the psychotic patient]

In order to study clinical aspects of depression in psychotic patients, it is necessary to first differentiate between the following states, as a function of the currently accepted international classification of mental disorders: 1) depressions correlated with psychotic symptomatology (delirium, hallucinations); 2) psychotic disorders with depressive symptomatology; 3) schizo-affective disorders. The greatest interest is currently in the assessment of the second category, in particular study of depression in schizophrenics. This is due to a number of factors, including the relatively great frequency of the disorder, its differential significance as a function of the time in the natural history of the disease, as well as prognostic and therapeutic implications. Proper clinical evaluation is thus important. Until the last few years, this evaluation was based primarily upon use of depression scales or factorial scores, either from general psychopathology scales or specific schizophrenia scales. A number of empirical studies have recently cast some doubt upon validity of these scales for evaluation of depression in psychotic patients, and more specific instruments such as the Calgary Depression Scale (CDS) and the Psychotic Depression Scale (PDS) have been developed. The first validation studies with these scales open up an interesting perspective, in particular for the evaluation of the effects of neuroleptics.