Depressive symptoms are common and tend to be neglected in patients with first episode schizophrenia spectrum disorders, according to a medical file audit involving records for more than 400 patients.

Of 405 patients with an available baseline Clinical Global Impressions-Severity of Illness Scale-Bipolar Illness (CGI-BP) depression score, 106 (26.2%) had moderate to severe depression at service entry, Sue M. Cotton, Ph.D., of the University of Melbourne, and her colleagues report in the January issue of Schizophrenia Research.

Among the characteristics of patients with moderate to severe depression at service entry, compared with those without depressive symptoms, were a significantly greater likelihood of a past history of major depressive disorder (MDD; odds ratio, 2.58) and suicide attempts (OR, 1.55), a family history of psychiatric disorder (OR, 1.40), and significantly reduced likelihood of a past history of substance use disorder (OR, 0.67), the investigators found (Schizophr. Research 2012;134:20-6).

The patients with depressive symptoms also were more likely to have current MDD (OR, 5.52), and to have partial/full insight into their psychotic disorder (OR, 0.68), and they were less likely to have a current substance use disorder (OR, 0.65).

During treatment they were less likely to be admitted to the hospital (OR, 0.79), with a lower number of admission (OR, 0.84), and were less likely to be using substances (OR, 0.40).At discharge they were more likely to be depressed and to have partial/full insight to their illness (OR, 2.04 and 0.70, respectively), the investigators said.

Data on antidepressant medication use were available for 254 patients, and of those with moderate to severe depressive symptoms, 45 (55.6%) were prescribed antidepressants; these patients had significantly higher CGI-BP depression scores than did those with depressive symptoms who were not prescribed antidepressants.

The audit also provided descriptive characteristics of the 15 patients with persistent depressive symptoms and the 91 without persistent depressive symptoms (of the 105 patients with moderate to severe depressive symptoms at service entry). For example, those with persistent symptoms were significantly more likely to have a past diagnosis of personality disorder, as well as a diagnosis of a personality disorder at service entry (OR, 10.88 and 3.81, respectively).

Personality disorder diagnoses at service entry included borderline personality disorder, schizotypal, antisocial personality disorder, and personality disorder not otherwise specified.

Patients with persistent depression were also significantly more likely to have a past history of suicide attempts as compared with the two other groups (OR, 2.54).

Those patients with persistent depression had a shorter duration of treatment, all were noncompliant with treatment, and they were more likely to have ongoing substance use. At discharge, they had a significantly higher CGI symptom severity score, a lower global assessment of functioning mean score, and were less likely to be working, the investigators noted.

Of 81 patients with depression for whom antidepressant treatment information was available, 4 had persistent depressive symptoms and 77 did not. All four of those with persistent symptoms received treatment, and 41 of those without persistent symptoms received treatment.

The findings regarding the prevalence of depressive symptoms support the notion that the condition is common in early schizophrenia, and the fact that only about 29% of those with depressive symptoms had a comorbid clinical diagnosis of major depressive disorder at service entry might reflect underdiagnosis or underreporting of MDD. That finding also might be a sign that depressive symptoms are neglected in first episode of schizophrenia (FES) treatment, with more emphasis being placed on management of positive and negative symptoms, the investigators suggested.