Depression in schizophrenia: a comparison of three measures

doi:10.1016/0920-9964(95)00107-7

Schizophrenia Research

Volume 20, Issues 1–2, May 1996, Pages 205-209

https://doi.org/10.1016/0920-9964(95)00107-7 Get rights and content

Abstract

Depression, as a feature of schizophrenia, is well established. However, clarifying the exact nature of this relationship has been problematic. The clinical measures routinely utilized to evaluate depression have not been specifically designed for use in schizophrenia, and it is well recognized that a variety of depressive symptoms overlap with other features common to this illness, e.g. negative symptoms, neuroleptic induced side effects. The present study compared three commonly used measures of depression (Hamilton Depression Rating Scale (Ham-D), Calgary Depression Scale (CDS) and the depression subscale of the Positive and Negative Syndrome scale (PANSS-D) in a group of outpatients with schizophrenia, evaluating the degree of association between the scales. Additionally, the relationship between each of the depression measures, negative symptoms and extrapyramidal symptoms (EPS) was calculated. Results revealed that all three measures of depression were significantly correlated, although the CDS was unique in its ability to distinguish between depression, negative symptoms and EPS. It is concluded that the CDS, when compared with the HAM-D and the PANSS-D, is the most suitable measure of depression in schizophrenia.

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A double-blind RCT was performed with patients randomized to 2 mA active-tDCS or sham-tDCS (15 daily sessions) with a bilateral bipolar-nonbalanced prefrontal placement (anode: left Dorsolateral prefrontal cortex; cathode: right orbitofrontal region). Clinical outcomes included variations of Calgary Depression Scale for Schizophrenia total score (CDSS) and of Depression-hopelessness and Guilty idea of reference-pathological guilt factors. Analysis of covariance was performed evaluating between-group changes over time. The presence/absence of probable clinically significant depression was determined when CDSS > 6.
As 50 outpatients were included (both groups, n = 25), significant improvements following active-tDCS were observed for CDSS total score (p = 0.001), Depression-hopelessness (p = 0.001) and Guilty idea of reference-pathological guilt (p = 0.03). Considering patients with CDSS>6 (n = 23), compared to sham, active-tDCS significantly improved CDSS total score (p < 0.001), Depression-hopelessness (p = 0.001) but Guilty idea of reference-pathological guilt only marginally improved (p = 0.051). Considering response rates of clinically significant depression, important reductions of CDSS score were observed (78 % of the sample scored ≤6; active-tDCS, n = 23; sham-tDCS, n = 16; p = 0.017). Early wakening item did not significantly change in any group.
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Bilateral bipolar-nonbalanced prefrontal tDCS is a successful protocol for the treatment of depressive symptoms in patients with schizophrenia.
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Patients with delusional disorder (DD) are at an increased risk for the development of depressive symptoms. We aimed to examine the literature dealing with assessment tools to assess depressive symptoms in DD. A systematic review was performed by searching PubMed, Scopus and clinicaltrials.gov databases from inception until June 2021 (PRISMA guidelines). From 1863 initial retrieved records, 11 studies were included (N = 715 DD patients). Depressive comorbidity ranged from 20.9% to 53.5%. Seven studies used semistructured/structured interviews: OPCRIT 4.0 (n = 1), Manual for Assessment and Documentation of Psychopathology in Psychiatry (AMDP System) (n = 2), the MINI interview (n = 1), DSM-IV (n = 1), ICD-10 (n = 1); and the Diagnostic Interview Schedule (DIS-R) (n = 1). Seven studies used at least one observer-rated scale: Positive and Negative Syndrome Scale (PANSS)-depressive component (n = 2), Hamilton Rating Scale for Depression (HRSD, n = 3), Montgomery-Asberg Depression Rating Scale (MADRS, n = 1), Clinical Global Impression Scale (CGI, n = 1) and the Bipolar Affective Disorder Dimension Scale (BADDS, n = 1). Assessment scales administered in depressive disorders and schizophrenia are applied to DD. This is the first systematic review exploring the use of assessment tools for depressive symptoms in DD. The use of the MADRS to assess depressive symptoms can be recommended in combination with other clinical scales, for instance, the CGI.
Depression: An actionable outcome for those at clinical high-risk
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Comorbid diagnoses are common in youth who are at clinical high-risk (CHR) for developing psychosis, with depression being the most common. The aim of this paper is to examine depression over two years in a large sample of CHR youth who do not make the transition to psychosis, considering both categorical and dimensional ratings of depression severity. The sample consisted of 267 CHR youth who were followed for two years. Based on DSM-IV diagnoses over this time period, 100 CHR individuals never received a diagnosis of depression, 64 individuals continuously met criteria for depression, 92 individuals received a diagnosis of depression at one or more timepoints, and 11 participants had a diagnosis of depression only at 24-months. These groupings were supported by six-monthly ratings on the Calgary Depression Scale. The majority of this sample experienced a major depressive episode on more than one occasion, suggesting that depression and depressive symptoms identify a domain of substantial unmet clinical need. Recommendations are that depression in CHR youth and young adults should be monitored more frequently and that there is a need for clinical trials to address depression systematically in this vulnerable population.
Toward a transdiagnostic tool to evaluate depressive symptoms across mental disorders: Validation of the Calgary depression rating scale in patients with major depressive disorder
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The severity of depressive symptoms across two discrete mental disorders should be evaluated with the same psychometrically validated tools. In patients with schizophrenia the Calgary Depression Rating Scale (CDSS) is recommended for evaluating depressive symptoms. The aim of this study was to validate the CDSS in patients with major depressive disorder. The CDSS exhibit satisfactory psychometric properties for evaluating depressive symptoms in major depressive disorder. Clinicians and researchers now have a validated scale at their disposal to evaluate depressive symptoms in various mental disorders using a transdiagnostic approach.
Clinical utility of the Calgary Depression Scale for Schizophrenia in individuals at ultra-high risk of psychosis
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There is a pressing need for reliable and valid rating scales to assess and measure depression in individuals at ultra-high risk (UHR) of psychosis. The aim of this study was to examine the clinical utility of the Calgary Depression Scale for Schizophrenia (CDSS) in individuals at UHR of psychosis. 167 individuals at UHR of psychosis were included as participants in this study. The Structured Clinical Interview for DSM-IV Axis I Disorders, CDSS, Beck Anxiety Inventory and Global Assessment of Functioning were administered. A receiver operating characteristic (ROC) curve analysis and factor analyses were performed. Cronbach's alpha was computed. Correlations between CDSS factor scores and other clinical variables were examined. The median CDSS total score was 5.0 (IQR 1.0–9.0). The area under ROC curve was 0.886 and Cronbach's alpha was 0.855. A score of 7 on the CDSS yielded the highest sensitivity and specificity in detecting depression in UHR individuals. Exploratory factor analysis of the CDSS yielded two factors: depression-hopelessness and self depreciation-guilt, which was confirmed by confirmatory factor analysis. Further analysis showed that the depression-hopelessness factor predicted functioning; whereas the self depreciation-guilt factor was related to the severity of the attenuated psychotic symptoms. In conclusion, the CDSS demonstrates good psychometric properties when used to evaluate depression in individuals at UHR of psychosis. Our study results also support a two-factor structure of the CDSS in UHR individuals.
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Citation Excerpt :
Researchers have used Calgary Depression Scale for Schizophrenia (CDSS) (Addington et al., 1992), Beck Depressive Inventory (Beck et al., 1961), Hamilton Rating Scale for Depression (HAM-D/HDRS)(Hamilton, 1960), Montgomery-Asberg Depression Rating Scale (MADRS)(Montgomery and Asberg, 1979) and Depressive subscale of Positive and Negative Syndrome Scale (PANSS-D) (Kay et al., 1987) to evaluate the prevalence of depression in patients with schizophrenia. Some of studies across the world have compared the usefulness of HDRS with CDSS in assessment of depressive symptoms in patients with schizophrenia (Addington et al., 1996; Collins et al., 1996; Liu et al., 2009; Müller et al., 2006) and have found CDSS to be a more specific measure of depression in patients with schizophrenia (Addington et al., 1996; Schennach et al., 2012). Studies also suggest that CDSS is able to distinguish depression from negative symptoms and extrapyramidal symptoms (Collins et al., 1996).
This study aimed to evaluate the factor structure of Calgary depression rating scale (CDSS) and Hamilton Depression Rating Scale (HDRS) among patients with schizophrenia in acute and remission phase of illness by using exploratory factor analysis. For this, 267 patients with schizophrenia were assessed on CDSS and HDRS. Exploratory factor analysis of CDSS yielded 2 factor models for the whole sample, patients in clinical remission and patients not in clinical remission phase of schizophrenia. Factor analysis of HDRS yielded 3 factor models; however, there was significant difference in the factor structure between those in clinical remission and those not in clinical remission phase of schizophrenia. CDSS total score did not correlate with PANSS positive and negative subscale scores. In contrast, HDRS total score correlated positively with PANSS positive subscale score, PANSS negative subscale score and PANSS general psychopathology subscale score. To conclude, present study suggests while CDSS items separate out into 2 factors, which are stable across different stages of illness, whereas HDRS factor structure appears to be less stable across different stages of illness. Correlation analysis suggests that rating on HDRS may be affected by positive and negative symptoms of schizophrenia, whereas CDSS do not correlate with positive and negative symptoms of schizophrenia.

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Research paperDepression in schizophrenia: a comparison of three measures

Abstract

Schizophr. Res.

Schizophr. Res.

Schizophr. Res.

Comp. Psychiatry

Schizophr. Res.

Schizophr. Res.

Psychiatr. Clin. North Am.

The assessment of depression in schizophrenia

Assessing depression in schizophrenia: the Calgary Depression Scale

Br. J. Psychiatry

Factor analysis of depression scales in schizophrenia

Schizophr. Res.

Negative symptoms in schizophrenia: definition and reliability

Arch. Gen. Psychiatry

Positive vs negative schizophrenia: a critical evaluation

Schizophr. Bull.

Negative v positive schizophrenia: definition and validation

Arch. Gen. Psychiatry

The nature and prevalence of depression in chronic schizophrenic inpatients

Br. J. Psychiatry

Depressive symptoms in the early course of schizophrenia

Schizophr. Res.

Schizophrenics kill themselves too: a review of risk factors for suicide

Schizophr. Bull.

The long-term maintenance treatment of schizophrenic outpatients with depot fluphenthixol

Curr. Med. Res. Opin.

The extrapyramidal symptom rating scale

Can. J. Neurol. Sci.

An extrapyramidal rating scale for idiopathic and neuroleptic induced parkinsonism and dyskinesia

Diagnostic change in a longitudinal study of psychiatric patients

Br. J. Psychiatry

Depression and social adjustment among chronic schizophrenic outpatients

J. Nervous Mental Dis.

Research paper
Depression in schizophrenia: a comparison of three measures