Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-25T18:35:59.173Z Has data issue: false hasContentIssue false

1.05 - Approach to Depressed or Suicidal Schizophrenia Spectrum Patients

from Part I - Treatment Strategies

Published online by Cambridge University Press:  19 October 2021

Edited by
Michael Cummings  and
Stephen Stahl
Michael Cummings
Affiliation:
University of California, Los Angeles
Stephen Stahl
Affiliation:
University of California, San Diego
Get access

Summary

Negative symptoms and cognitive deficits are major barriers to employment, stable interpersonal relationships, and independent living for persons afflicted with schizophrenia in the community [1]. Negative symptoms, such as blunting of affect, impaired behavioral initiation, decreased motivation, ambivalence, and social withdrawal, interact on a continuum with illness features such as impaired executive functions, decreased verbal fluency, and emotional dyscontrol [2, 3]. Moreover, deficits in emotional control coupled with deficits in impulse control place the schizophrenic individual at elevated risk for suicide. The overall suicide rate in schizophrenia has been estimated to be circa 10%, with suicide being a primary factor involved in shortening the expected life span of schizophrenic patients [4]. Thus, negative symptoms, dysphoric mood states, and suicidality should be considered major treatment targets among complex treatment-resistant patients with schizophrenia.

Type
Chapter
Information
Management of Complex Treatment-resistant Psychotic Disorders , pp. 34 - 37
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Kaneko, K. (2018). Negative symptoms and cognitive impairments in schizophrenia: two key symptoms negatively influencing social functioning. Yonago Acta Med, 61, 91–102.CrossRefGoogle ScholarPubMed
Liu, J., Chan, T. C. T., Chong, S. A., et al. (2019). Impact of emotion dysregulation and cognitive insight on psychotic and depressive symptoms during the early course of schizophrenia spectrum disorders. Early Interv Psychiatry, 14(6), 691–697.Google Scholar
Barch, D. M., Pagliaccio, D., Luking, K. (2016). Mechanisms underlying motivational deficits in psychopathology: similarities and differences in depression and schizophrenia. Curr Top Behav Neurosci, 27, 411–449.CrossRefGoogle ScholarPubMed
Sher, L., Kahn, R. S. (2019). Suicide in schizophrenia: an educational overview. Medicina (Kaunas), 55(7), 361.CrossRefGoogle ScholarPubMed
Pompili, M., Orsolini, L., Lamis, D. A., et al. (2017). Suicide prevention in schizophrenia: do long-acting injectable antipsychotics (LAIs) have a role? CNS Neurol Disord Drug Targets, 16, 454–462.Google Scholar
Taipale, H., Mittendorfer-Rutz, E., Alexanderson, K., et al. (2018). Antipsychotics and mortality in a nationwide cohort of 29,823 patients with schizophrenia. Schizophr Res, 197, 274–280.CrossRefGoogle Scholar
Ertugrul, A. (2002). Clozapine and suicide. Am J Psychiatry, 159, 323; author reply 324.Google Scholar
Kane, J. M. (2017). Clozapine reduces all-cause mortality. Am J Psychiatry, 174, 920–921.CrossRefGoogle ScholarPubMed
Roberts, E., Cipriani, A., Geddes, J. R., et al. (2017). The evidence for lithium in suicide prevention. Br J Psychiatry, 211, 396.Google Scholar
Kanehisa, M., Terao, T., Shiotsuki, I., et al. (2017). Serum lithium levels and suicide attempts: a case-controlled comparison in lithium therapy-naive individuals. Psychopharmacology (Berl), 234, 3335–3342.Google Scholar
Deslauriers, J., Belleville, K., Beaudet, N., et al. (2016). A two-hit model of suicide-trait-related behaviors in the context of a schizophrenia-like phenotype: distinct effects of lithium chloride and clozapine. Physiol Behav, 156, 48–58.CrossRefGoogle ScholarPubMed
Sachs, G. S., Nierenberg, A. A., Calabrese, J. R., et al. (2007). Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med, 356, 1711–1722.Google Scholar
Gitlin, M. J. (2018). Antidepressants in bipolar depression: an enduring controversy. Int J Bipolar Disord, 6, 25.CrossRefGoogle ScholarPubMed
Cheniaux, E., Nardi, A. E. (2019). Evaluating the efficacy and safety of antidepressants in patients with bipolar disorder. Expert Opin Drug Saf, 18, 893–913.Google Scholar
Marx, W., Moseley, G., Berk, M., et al. (2017). Nutritional psychiatry: the present state of the evidence. Proc Nutr Soc, 76, 427–436.Google Scholar
Dougall, N., Maayan, N., Soares-Weiser, K., et al. (2015). Transcranial magnetic stimulation for schizophrenia. Schizophr Bull, 41, 1220–1222.CrossRefGoogle ScholarPubMed
Moffa, A. H., Brunoni, A. R., Nikolin, S., et al. (2018). Transcranial direct current stimulation in psychiatric disorders: a comprehensive review. Psychiatr Clin North Am, 41, 447–463.CrossRefGoogle ScholarPubMed
Pompili, M., Lester, D., Dominici, G., et al. (2013). Indications for electroconvulsive treatment in schizophrenia: a systematic review. Schizophr Res, 146, 1–9.Google Scholar
Tiihonen, J., Suokas, J. T., Suvisaari, J. M., et al. (2012). Polypharmacy with antipsychotics, antidepressants, or benzodiazepines and mortality in schizophrenia. Arch Gen Psychiatry, 69, 476–483.Google Scholar
Tiihonen, J., Mittendorfer-Rutz, E., Torniainen, M., et al. (2016). Mortality and cumulative exposure to antipsychotics, antidepressants, and benzodiazepines in patients with schizophrenia: an observational follow-up study. Am J Psychiatry, 173, 600–606.CrossRefGoogle ScholarPubMed
Rubio, J. M., Correll, C. U. (2017). Reduced all-cause mortality with antipsychotics and antidepressants compared to increased all-cause mortality with benzodiazepines in patients with schizophrenia observed in naturalistic treatment settings. Evid Based Ment Health, 20, e6.Google Scholar
Loebel, A., Xu, J., Hsu, J., et al. (2015). The development of lurasidone for bipolar depression. Ann N Y Acad Sci, 1358, 95–104.Google Scholar
Post, R. M. (2016). Treatment of bipolar depression: evolving recommendations. Psychiatr Clin North Am, 39, 11–33.CrossRefGoogle ScholarPubMed
Szmulewicz, A. G., Angriman, F., Samame, C., et al. (2017). Dopaminergic agents in the treatment of bipolar depression: a systematic review and meta-analysis. Acta Psychiatr Scand, 135, 527–538.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×