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Negative and depressive symptoms in suicidal schizophrenics
J S Jones1, D J Stein, B Stanley
1Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York.
Acta Psychiatrica Scandinavica
|February 1, 1994
Summary
Depressive symptoms and dexamethasone suppression test (DST) results significantly differentiate schizophrenic patients with a history of suicide attempts from those without. These findings highlight the importance of assessing depression and the hypothalamic-pituitary-adrenal axis in schizophrenia.
Area of Science:
- Psychiatry
- Neuroscience
- Clinical Psychology
Background:
- Schizophrenia is a complex mental disorder often associated with comorbid depressive symptoms.
- A history of suicide attempts is a significant concern in patients with schizophrenia.
- The dexamethasone suppression test (DST) has been explored as a biological marker in various psychiatric conditions.
Purpose of the Study:
- To evaluate the utility of positive, negative, and depressive symptoms in distinguishing schizophrenic patients with and without a history of suicide attempts.
- To assess the role of the dexamethasone suppression test (DST) in differentiating these patient groups.
- To explore the relationship between depressive symptoms, suicide history, and hypothalamic-pituitary-adrenal (HPA) axis function in schizophrenia.
Main Methods:
- Fifty-seven hospitalized schizophrenia patients were assessed after a neuroleptic-free interval.
- Evaluations included the Brief Psychiatric Rating Scale (BPRS) for positive and negative symptoms and the Hamilton Rating Scale for Depression (HRSD).
- A dexamethasone challenge was administered, with morning and evening cortisol levels measured.
Main Results:
- Patients with a history of suicide attempts were more likely to meet criteria for major depression compared to non-attempters.
- Hamilton Rating Scale for Depression (HRSD) scores effectively differentiated between suicide attempters and non-attempters.
- Dexamethasone suppression test (DST) cortisol levels (a.m. and p.m.) also differentiated the groups, and HRSD scores correlated with cortisol levels.
- Positive and negative symptom scores from the Brief Psychiatric Rating Scale (BPRS) did not differentiate the groups.
Conclusions:
- Depressive symptoms are crucial indicators in schizophrenic patients with a history of suicide.
- The dexamethasone suppression test (DST) and assessment of the hypothalamic-pituitary-adrenal (HPA) axis may offer valuable insights into suicide risk in schizophrenia.
- Further investigation into HPA axis function in schizophrenia is warranted to understand its role in suicidality.