Depression in paranoid and nonparanoid schizophrenic patients compared with major depressive disorder

Background: Depression occurring in schizophrenia is a common problem; however, investigators have typically not studied it with the paranoid/nonparanoid dichotomy in mind. This study examines the quality as well as the severity of depression in three psychiatric groups: paranoid schizophrenia patients, nonparanoid schizophrenia patients, and nonpsychotic major depression patients. Method: Clinical and sociodemographic data were collected on 27 paranoid and 27 nonparanoid schizophrenia patients during their postpsychotic phase while they were at least mildly depressed, and a comparison group of 27 nonpsychotic patients diagnosed with major depressive disorder. The three groups were then assessed on various psychometric scales for severity of depression, profile of symptoms, suicidal risk, and anhedonia. Results: The paranoid schizophrenia patients were more depressed and more at risk for suicide than the nonparanoid schizophrenia patients, yet their depressive profiles and levels of anhedonia were similar. Conclusions: Depressed mood and anhedonia constitute serious problems for schizophrenia patients, but particularly for paranoid schizophrenia patients during the postpsychotic phase of their illnesses. Clinical implications: Schizophrenia patients, especially those with the paranoid features, should be routinely evaluated and monitored for depression. Apart from treatment with drugs, cognitive therapy may be considered a viable option, particularly for paranoid schizophrenia patients. Limitations: Gender was not matched for the two schizophrenia groups and extrapyramidal side effects were not measured.