Depression in schizophrenia

Depression can be observed at any stage in the development of schizophrenia: to precede the manifestation of an attack, complicating early diagnosis, to be included in the complex structure of the syndrome of an attack of psychosis, to appear as psychosis is relieved at the stage of formation of remission.After the first psychotic episode, in addition to endogenous and reactive personal mechanisms. And in this case, active psychological support of the patient is especially necessary (psychotherapy, psychosocial therapy), whose “targets” are individual personality traits – coping, psychological defense, perfectionism, and self-stigmatization. The study was conducted on the basis of the department of the first episode of psychosis (PPE) of the Orenburg Regional Clinical Psychiatric Hospital No. 1. A total of 238 schizophrenic patients with a disease duration of no more than 5 years and no more than 3 seizures at the stage of recovery from psychosis were examined. Taking into account the presence or absence of postpsychotic depression, patients were divided into PPD groups (presence of depression) – 118 patients and OD (no depression) – 120 patients. Depressive status, objectified, in addition to the clinical method, the Calgary Depression Rating Scale (CDRS) – 6 points or more. The clinical and psychopathological method is supplemented by the symptomatic questionnaire SCL-90-R, which is filled in by the patient. Patients with a disease duration of more than 5 years, with a history of more than 3 psychotic attacks, with a malignant course of schizophrenia, with somatoneurological pathology, accompanied by severe dysfunction of the affected system, concomitant alcohol and / or drug addiction were excluded from the study. To study individual personality traits, the methods of diagnosing perfectionism by Garanyan-Kholmogorova, coping by SVF and E. Heim, self-stigmatization – SS (Yastrebov V.S. et al., 2004), psychological defense – Kellerman-Plutchik were used. The indicators of the Calgary scale of the PPD group (7.63 + 1.59) significantly exceed the data for the OD group (1.73 + 1.67), and a more pronounced subjective experience of distress in patients with depression was also established. In the syndromic profile, according to the SCL-90-R results, the leading in patients with depression are anxiety-depressive disorders with interpersonal sensitivity and obsessive thoughts, primarily in relation to the return of the psychotic state, or in relation to the immediate future after discharge from the clinic. The anxiety-depressive status of patients can be explained by the “reactive” component of experiences, which determines the acquisition of criticality to the past psychosis, along with preserved evaluative resources of the personality at the early stage of schizophrenia. The indices of perfectionism in the PPD group for all the studied factors of the questionnaire significantly exceed those in patients without depression, which reflects the significance of this personality trait for the development of postpsychotic depression. Self-stigmatization is significantly expressed in the PPD group (general indicator. Among the forms of SS in the PPD group, the leading is socioreversive (40.69 + 21.94), then autopsychic and compensatory. PPD is followed by, almost in equal severity, compensatory (25.34 + 14.3) and autopsychic forms of SS. These data indicate a greater severity of experiences in relation to the consequences of the disease in patients with PPD. In the structure of psychological defense, the indicators in the group are significantly higher PPD (in descending order of severity) by regression, reactive formations, displacement, replacement, projection In the OA group, the leading in the profile and reliably exceeding in the PPD group, the denial indicator The data on the coping structure are somewhat contradictory. maladaptive coping in the behavioral sphere in the group of patients with depression, which may reflect, on the one hand, the preservation adaptive behavioral potential, on the other hand, some ambitiousness of the behavioral sphere, determining the “target” of psychotherapy. On the contrary, in the cognitive and emotional spheres in patients with PPD, the maladaptive orientation of coping is more pronounced. Coping structure is determined by the relationship with the depressive status using self-blame, humility, confusion, submissiveness, suppression of emotions, avoidance tendencies, social encapsulation, mental stuck – maladaptive options, and compensation, substitutionary satisfaction, self-compassion – relatively adaptive option. At the same time, according to SVF data, in the coping structure of patients with PPD, the need for social support is urgent, the search for alternative self-affirmation is resource coping. The study shows, along with the predominant maladaptive orientation of individual personality traits of patients with postpsychotic depression in the first episode of schizophrenia, in contrast to patients without depression, the presence of an adaptive personal resource in depressed patients, primarily in the coping structure. This indicates the need for active psychotherapeutic support of patients with postpsychotic depression with an emphasis in short-term treatment and rehabilitation programs on cognitive-behavioral methods. The predominant use of cognitive-behavioral therapy in the department of the first psychotic episode in Orenburg has already shown its effectiveness both in short-term therapy and in long-term follow-up (up to 10 years).

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