Predictors of the depression and suicidal risk in patients with schizophrenia

Uvod : Shizofrenija kao mentalno oboljenje nosi povišen suicidalni rizik. Depresija u shizofreniji daje poseban aspekt u proučavanju suicidalnih faktora. Cilj: Istraživanje karakteristika emocionalnog profila i kliničke forme shizofrenije kao prediktora depresivnosti i mogućeg suicidalnog rizika u shizofreniji. Metod : Studija je dizajnirana kao slučaj-kontrola studija preseka koja uključuje pacijenate sa dijagnozom shizofrenije F20 po ICD-10 kriterijumima, u fazi inicijalne remisije ( CGI-I skor 2 ili 1), starosne dobi od 18 do 60 godina, na lečenju u Klinici za psihijatrijske bolesti “ Dr Laza Lazarević“. Grupu slučaj čine N = 53 pacijeta sa depresijom i suicidalnim rizikom u shizofreniji, a grupu kontrola N = 159 pacijenta sa shizofrenijom bez depresije i suicidalnog rizika.Instrumenti istraživanja su: CDSS za potvrdu depresije i suicidalnog rizika u shizofreniji, PANSS, PIE –JRS za utvđivanje emoconalnog profila i semistrukturisani intervju za prikupljanje dodatnih podataka. Rezultati :1. Intenzitet negativnih simptoma shizofrenije je značajno veći kod pacijenata koji ispoljavaju depresivnost i suicidalni rizik u fazi inicijalne remisije. 2.Emocionalni profil ličnosti pacijenata sa depresijom i suicidalnim rizikom u shizofreniji ima povišen skor na dimenzijama lišenost, agresivnost, odbacivanje, a niske skorove na dimenzijama zaštita, inkorporacija i reprodukcija. 3. Rad na boljoj psihofarmakoterapijskoj komplijansi i psihoedukaciji pacijenata obolelih od shizofrenije i njihove porodice umanjuje rizik od razvoja depresije u shizofreniji i smanjuje suicidalni rizik. Zaključak : Multiplim logističkim modelom kao prediktori depresivnosti i suicidalnog rizika izdvojeni su : dominacija negativnog sindroma i loša psihofarmakoterapijska kompijansa. Konstelacija dokazanog povišenog depresivnog potencijala i suicidalni rizika nameće potrebu primene preventivnih mera.Introduction : As a mental illness, schizophrenia carries an increased suicide risk. The depression in schizophrenia presents a special aspect of the study of suicidal factors. Aim : The study of the characteristics of the emotional profile and clinical form of schizophrenia as a predictor of the depression and possible suicidal risk in schizophrenia. Method : The study was designed as a case-control and cross-section study, involving patients with a diagnosis of schizophrenia F20, according to ICD-10 criteria, in the initial stage of remission (CGI-I score of 2 or 1), aged 18 to 60 and treated at the Clinic for psychiatric diseases, "Dr Laza Lazarević". The case group was consisted of N = 53 patients with the depression and suicidal risk in schizoprenia and the control group of N = 159 patients with schizophrenia without the depression and suicidal risk. Survey instruments were: CDSS to confirm the depression and suicidal risk in schizophrenia, PANSS, PIE-JRS to determine the emotional profile and semi-structured interviews to gather additional data. Results : 1) The intensity of the negative symptoms of schizophrenia is significantly higher in patients who exhibit the depression and suicide risk in the stage of initial remission. 2) Emotional profile of the patients’ personality with the depression and suicidal risk in schizophrenia has increased scores in the dimensions of deprivation, aggression, rejection, and low scores in the dimensions of protection, incorporation and reproduction. 3) Work on better psychopharmacotherapy compliance and psychoeducation of patients with schizophrenia and their families reduces the risk of depression in schizophrenia and the suicide risk. Conclusion : In multiple logistic model the following was singled out as predictors of depression and suicidal risk: predominance of the negative syndrome and poor compliance with psychopharmacotherapy. The constellation of the proven increased depressive potential and suicidal risk necessitates the application of preventive measures

INFLUENCE OF PSYCHO-SOCIAL FACTORS ON THE EMERGENCE OF DEPRESSION AND SUICIDAL RISK IN PATIENTS WITH SCHIZOPHRENIA

Background: The aim of this study was to investigate the influence of certain psychosocial factors – insight, psycho-education, family and social support, loneliness and social isolation – on the appearance of depression and suicidal risk in schizophrenia. Subjects and methods: This was a cross-sectional study that comprised hospitalized patients with schizophrenia in the initial remission phase. The assessment of depression and suicidal risk was made by applying a semi-structured psychiatric interview that included scrutinized factors (insight, psycho-education, family and social support, loneliness and social isolation), Positive and Negative Syndrome Scale (PANSS), and Calgary Depression Scale for Schizophrenia (CDSS). On the basis of the assessment results, the sample was divided into two groups: Group of patients with depression and suicidal risk in schizophrenia (N=53) and Control group (N = 159) of patients with schizophrenia without depression and suicidal risk. Results: In the Group of patients with depression and suicidal risk, compared with the Control group, there was significantly higher frequency of insight in the mental status

Predictors of the depression and suicidal risk in patients with schizophrenia

Uvod : Shizofrenija kao mentalno oboljenje nosi povišen suicidalni rizik. Depresija u shizofreniji daje poseban aspekt u proučavanju suicidalnih faktora. Cilj: Istraživanje karakteristika emocionalnog profila i kliničke forme shizofrenije kao prediktora depresivnosti i mogućeg suicidalnog rizika u shizofreniji. Metod : Studija je dizajnirana kao slučaj-kontrola studija preseka koja uključuje pacijenate sa dijagnozom shizofrenije F20 po ICD-10 kriterijumima, u fazi inicijalne remisije ( CGI-I skor 2 ili 1), starosne dobi od 18 do 60 godina, na lečenju u Klinici za psihijatrijske bolesti “ Dr Laza Lazarević“. Grupu slučaj čine N = 53 pacijeta sa depresijom i suicidalnim rizikom u shizofreniji, a grupu kontrola N = 159 pacijenta sa shizofrenijom bez depresije i suicidalnog rizika.Instrumenti istraživanja su: CDSS za potvrdu depresije i suicidalnog rizika u shizofreniji, PANSS, PIE –JRS za utvđivanje emoconalnog profila i semistrukturisani intervju za prikupljanje dodatnih podataka. Rezultati :1. Intenzitet negativnih simptoma shizofrenije je značajno veći kod pacijenata koji ispoljavaju depresivnost i suicidalni rizik u fazi inicijalne remisije. 2.Emocionalni profil ličnosti pacijenata sa depresijom i suicidalnim rizikom u shizofreniji ima povišen skor na dimenzijama lišenost, agresivnost, odbacivanje, a niske skorove na dimenzijama zaštita, inkorporacija i reprodukcija. 3. Rad na boljoj psihofarmakoterapijskoj komplijansi i psihoedukaciji pacijenata obolelih od shizofrenije i njihove porodice umanjuje rizik od razvoja depresije u shizofreniji i smanjuje suicidalni rizik. Zaključak : Multiplim logističkim modelom kao prediktori depresivnosti i suicidalnog rizika izdvojeni su : dominacija negativnog sindroma i loša psihofarmakoterapijska kompijansa. Konstelacija dokazanog povišenog depresivnog potencijala i suicidalni rizika nameće potrebu primene preventivnih mera.Introduction : As a mental illness, schizophrenia carries an increased suicide risk. The depression in schizophrenia presents a special aspect of the study of suicidal factors. Aim : The study of the characteristics of the emotional profile and clinical form of schizophrenia as a predictor of the depression and possible suicidal risk in schizophrenia. Method : The study was designed as a case-control and cross-section study, involving patients with a diagnosis of schizophrenia F20, according to ICD-10 criteria, in the initial stage of remission (CGI-I score of 2 or 1), aged 18 to 60 and treated at the Clinic for psychiatric diseases, "Dr Laza Lazarević". The case group was consisted of N = 53 patients with the depression and suicidal risk in schizoprenia and the control group of N = 159 patients with schizophrenia without the depression and suicidal risk. Survey instruments were: CDSS to confirm the depression and suicidal risk in schizophrenia, PANSS, PIE-JRS to determine the emotional profile and semi-structured interviews to gather additional data. Results : 1) The intensity of the negative symptoms of schizophrenia is significantly higher in patients who exhibit the depression and suicide risk in the stage of initial remission. 2) Emotional profile of the patients’ personality with the depression and suicidal risk in schizophrenia has increased scores in the dimensions of deprivation, aggression, rejection, and low scores in the dimensions of protection, incorporation and reproduction. 3) Work on better psychopharmacotherapy compliance and psychoeducation of patients with schizophrenia and their families reduces the risk of depression in schizophrenia and the suicide risk. Conclusion : In multiple logistic model the following was singled out as predictors of depression and suicidal risk: predominance of the negative syndrome and poor compliance with psychopharmacotherapy. The constellation of the proven increased depressive potential and suicidal risk necessitates the application of preventive measures

Cardiovascular comorbidities in hospitalized psychiatric patients with diagnoses of schizophrenic and affective disorders

A cardiovascular comorbidity (CVC) in psychiatric patients represents a simultaneous occurrence of a cardiovascular and a mental illness in the same patient regardless of the order of occurrence or of the cause and effect relationship that conjoins them. The objective was to determine the frequency and sort of the CVC in previously hospitalized patients with diagnoses of schizophrenic and affective disorders along with the differences in distribution of said disorders between the two groups of patients. Design-wise this is a retrospective study of intersections. It is based on the analytics of medical data (the history of disease along with the internal medicine consultant reviews) of the hospitalized patients in the Clinic for psychiatric disorders 'Dr. Laza Lazarević' in Belgrade during the period between November 2014 and February 2015. Patients who were involved were older than 18 and they had diagnoses of schizophrenic disorders (F20-F29) and affective disorders (F30-F39), according to diagnostic criteria in the International classification of diseases 10 (ICD-10). CVC which were previously diagnosed or registered during the examination we separated into the following groups according to ICD-10: hypertension (HTA) I10, cardiac arrhythmia (CA) I47-I49, chronic cardiomyopathy (CMP) I42-I43 and ischemic heart disease (IHD) 120-125. The two groups of patients were analyzed according with socio-demographic characteristics (gender and age range) and CVC diagnosed according to MKB-10 classification. CVC were registered in 66% of the patients diagnosed with schizophrenia and 34% of the patients with affective disorders. Hypertension was most common in both groups of patients following with cardiac arrhythmia. Cardiac arrhythmias were statistically significantly more common in patients diagnosed with schizophrenic disorders (p<0.001) compared to patients with affective disorders. The frequency of hypertension, ischemic heart disease and chronic cardiomyopathy rises with age in both groups of patients. The results of this research confirm a high degree of CVC in hospitalized patients with diagnoses of schizophrenic and affective disorders (especially cardiac arrhythmia and hypertension). A multidisciplinary team is the key for diagnosing and monitoring patients with schizophrenic and affective diseases in both primary and secondary preventions