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The British Journal of Psychiatry (2000) 177: 516-528
© 2000 The Royal College of Psychiatrists

Cognitive approach to depression and suicidal thinking in psychosis

I. Ontogeny of post-psychotic depression{dagger}

MAX BIRCHWOOD, FBPsS

Northern Birmingham Mental Health NHS Trust and University of Birmingham, Birmingham

ZAFFER IQBAL, PhD

Department of Psychology, Institute of Psychiatry, London

PAUL CHADWICK, PhD

Department of Clinical Psychology, University of Exeter

PETER TROWER, PhD

School of Psychology, University of Birmingham, UK

Correspondence: Max Birchwood, Department of Clinical Psychology, University of Birmingham, Harry Watton House, 97 Church Lane, Aston, Birmingham B6 5UG, UK

Declaration of interest This research was supported by the Mental Health Foundation and Department of Health.

{dagger} See pp. 522-528, this issue.

Background Depression in schizophrenia is a rather neglected field of study, perhaps because of its confused nosological status. Three course patterns of depression in schizophrenia, including post-psychotic depression (PPD), are proposed.

Aims We chart the ontogeny of depression and psychotic symptoms from the acute psychotic episode over a 12-month period and test the validity of the proposed course patterns.

Method One hundred and five patients with ICD-10 schizophrenia were followed up on five occasions over 12 months following the acute episode, taking measures of depression, positive symptoms, negative symptoms, neuroleptic exposure and side-effects.

Results Depression accompanied acute psychosis in 70% of cases and remitted in line with the psychosis; 36% developed PPD without a concomitant increase in psychotic symptoms.

Conclusions The results provided support for the validity of two of the three course patterns of depression in schizophrenia, including PPD. Post-psychotic depression occurs de novo without concomitant change in positive or negative symptoms.




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