Skip to main content

Advertisement

SpringerLink
Log in

Negative symptoms and their association with depressive symptoms in the long-term course of schizophrenia

  • Original Paper
  • Published:
European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

Depressive symptoms abound in schizophrenia and even in subclinical states of the disorder. We studied the frequency of these symptoms and their relationship to negative symptoms from the first psychotic episode on over a long-term course of 134 months on data for 107 patients in our ABC Schizophrenia Study. Prevalence rates of 90 % for presenting at least one negative symptom and of 60 % for presenting at least one depressive symptom in the first psychotic episode illustrate the frequency of these syndromes. After the remission of psychosis the rates fell to 50 % (negative symptoms) and 40 % (depressive symptoms) over a period of 5 years, remaining stable thereafter. After we broke the negative syndrome down into (SANS) subsyndromes, a positive association emerged between anhedonia and depressive symptoms and remained stable over the entire period studied. In contrast, the association between abulia and depression grew increasingly pronounced over the illness course. However, a more detailed look revealed this to be the case in female patients only, whereas male patients showed no such association of these symptom dimensions. We have no explanation at hand for this sex difference yet.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Notes

  1. Given the approach applied here, i.e. negative items modelled on the SANS and its subscales, the results reported in the present paper in part differ slightly from those reported from our previous analyses of the ABC cohort. Those analyses have been based on the entire spectrum of negative symptoms or the core syndromes with minimum overlap with other syndromes including depression.

References

  1. Häfner H, an der Heiden W, Maurer K (2008) Evidence for separate diseases? Stages of one disease or different combinations of symptom dimensions? Eur Arch Psychiatry Clin Neurosci 258:85–96

    Article  PubMed  Google Scholar 

  2. Häfner H, Maurer K (1997) Klinische Epidemiologie der schizophrenen Negativsymptomatik - viele Fragen, wenig Antworten. In: Rockstroh B, Elbert T, Watzl H (eds) Impulse für die klinische Psychologie. Hogrefe, Göttingen, pp 43–69

    Google Scholar 

  3. Häfner H (2005) Das Rätsel Schizophrenie - Eine Krankheit wird entschlüsselt. C.H. Beck Verlag, München, München

    Google Scholar 

  4. Malla AK, Norman RMG, Takhar J et al (2004) Can patients at risk for persistent negative symptoms be identified during their first episode of psychosis? J Nerv Ment Dis 192:455–463

    Article  PubMed  Google Scholar 

  5. Mäkinen J, Miettunen J, Isohanni M, Koponen H (2008) Negative symptoms in schizophrenia. A review. Nord J Psychiatry 62:334–341

    Article  PubMed  Google Scholar 

  6. Husted JA, Beiser M, Iacono WG (1992) Negative symptoms and the early course of schizophrenia. Psychiatry Res 43:215–222

    Article  CAS  PubMed  Google Scholar 

  7. Eaton WW, Thara R, Federman B, Melton B, Liang KY (1995) Structure and course of positive and negative symptoms in schizophrenia. Arch Gen Psychiatry 52:127–134

    Article  CAS  PubMed  Google Scholar 

  8. Herbener ES, Harrow M (2001) Longitudinal assessment of negative symptoms in schizophrenia/schizoaffective patients, other psychotic patients, and depressed patients. Schizophr Bull 27:527–537

    Article  CAS  PubMed  Google Scholar 

  9. Maurer K, Häfner H (1996) Negativsymptomatik im Frühverlauf der Schizophrenie und im Verlauf über drei Jahre nach Ersthospitalisation. In: Möller H-J, Engel RR, Hoff P (eds) Befunderhebung in der Psychiatrie: Lebensqualität, Negativsymptomatik und andere aktuelle Entwicklungen. Springer, New York, pp 225–240

    Chapter  Google Scholar 

  10. Bartels SJ, Drake RE (1988) Depressive symptoms in schizophrenia: comprehensive differential diagnosis. Compr Psychiatry 29:467–483

    Article  CAS  PubMed  Google Scholar 

  11. Siris SG, Bench C (2003) Depression and schizophrenia. In: Hirsch SR, Weinberger DR (eds) Schizophrenia, 2nd edn. Blackwell Publishing, Oxford, pp 142–167

    Chapter  Google Scholar 

  12. Häfner H, Maurer K, Löffler W, an der Heiden W, Könnecke R, Hambrecht M (2002) The early course of schizophrenia. In: Häfner H (ed) Risk and protective factors in schizophrenia. Towards a conceptual model of the disease process. Steinkopff Verlag, Darmstadt, pp 207–228

    Chapter  Google Scholar 

  13. Yung AR, McGorry PD (1996) The initial prodrome in psychosis: descriptive and qualitative aspects. Aust N Z J Psychiatry 30:587–599

    Article  CAS  PubMed  Google Scholar 

  14. Krabbendam L, Myin-Germeys I, Hanssen M et al (2005) Development of depressed mood predicts onset of psychotic disorder in individuals who report hallucinatory experiences. Br J Clin Psychol 44:113–125

    Article  PubMed  Google Scholar 

  15. Smeets F, Lataster T, Dominguez M, Hommes J (2012) Evidence that onset of psychosis in the population reflects early hallucinatory experiences that through environmental risks and affective dysregulation become complicated by delusions. Schizophr Bull 38:531–542

    Article  PubMed  Google Scholar 

  16. Kelleher I, Cederlöf M, Lichtenstein P (2014) Psychotic experiences as a predictor of the natural course of suicidal ideation: a Swedish cohort study. World Psychiatry 13:184–188

    Article  PubMed  PubMed Central  Google Scholar 

  17. an der Heiden W, Könnecke R, Maurer K, Ropeter D, Häfner H (2005) Depression in the long-term course of schizophrenia. Eur Arch Psychiatry Clin Neurosci 255:174–184

    Article  Google Scholar 

  18. Addington D, Addington J, Patten S (1998) Depression in people with first-episode schizophrenia. Br J Psychiatry 172:90–92

    Article  CAS  Google Scholar 

  19. Koreen AR, Siris SG, Chakos M, Alvir J, Mayerhoff D, Lieberman J (1993) Depression in first-episode schizophrenia. Am J Psychiatry 150:1643–1648

    Article  CAS  PubMed  Google Scholar 

  20. Donlon PT, Rada RT, Arora KK (1976) Depression and the reintegration phase of acute schizophrenia. Am J Psychiatry 133:1265–1268

    Article  CAS  PubMed  Google Scholar 

  21. Knights A, Hirsch SR (1981) ‘Revealed’ depression and drug treatment for schizophrenia. Arch Gen Psychiatry 38:806–811

    Article  CAS  PubMed  Google Scholar 

  22. Gaebel W, Jänner M, Frommann N et al (2000) Prodromal states in schizophrenia. Compr Psychiatry 41:76–85

    Article  CAS  PubMed  Google Scholar 

  23. Herz MI, Melville C (1980) Relapse in schizophrenia. Am J Psychiatry 137:801–805

    Article  CAS  PubMed  Google Scholar 

  24. Hirsch SR, Jolley AG (1989) The dysphoric syndrome in schizophrenia and its implications for relapse. Br J Psychiatry 155:46–50

    Google Scholar 

  25. Subotnik KL, Nuechterlein KH (1988) Prodromal signs and symptoms of schizophrenic relapse. J Abnorm Psychol 97:405–412

    Article  CAS  PubMed  Google Scholar 

  26. Barnes TRE, Curson DA, Liddle PF, Patel M (1989) The nature and prevalence of depression in chronic schizophrenic inpatients. Br J Psychiatry 154:486–491

    Article  CAS  PubMed  Google Scholar 

  27. Birchwood M, Mason R, Macmillan F, Healy J (1993) Depression, demoralization and control over psychotic illness: a comparison of depressed and non-depressed patients with a chronic psychosis. Psychol Med 23:387–395

    Article  CAS  PubMed  Google Scholar 

  28. Liddle PF, Barnes TR, Curson DA, Patel M (1993) Depression and the experience of psychological deficits in schizophrenia. Acta Psychiatr Scand 88:243–247

    Article  CAS  PubMed  Google Scholar 

  29. Siris SG (1987) Akinesia and post-psychotic depression: a difficult differential diagnosis. J Clin Psychiatry 48:240–243

    CAS  PubMed  Google Scholar 

  30. van Putten T, Marder SR (1987) Behavioral toxicity of antipsychotic drugs. J Clin Psychiatry 48:13–19

    PubMed  Google Scholar 

  31. Bühler B, Hambrecht M, Loffler W, an der Heiden W, Häfner H (2002) Precipitation and determination of the onset and course of schizophrenia by substance abuse—a retrospective and prospective study of 232 population-based first illness episodes. Schizophr Res 54:243–251

    Article  PubMed  Google Scholar 

  32. Schuckit A (1983) Alcoholism and other psychiatric disorders. Hosp Community Psychiatry 34:1022–1027

    CAS  PubMed  Google Scholar 

  33. Weissman MM, Myers JK (1980) Clinical depression in alcoholism. Am J Psychiatry 137:372–373

    Article  CAS  PubMed  Google Scholar 

  34. Andreasen NC (1990) Positive and negative symptoms: historical and conceptual aspects. In: Anreasen NC (ed) Schizophrenia: positive and negative symptoms and syndromes. Karger, Basel, pp 1–42

    Google Scholar 

  35. Crow TJ (1985) The two-syndrome concept: origins and current status. Schizophr Bull 11:471–486

    Article  CAS  PubMed  Google Scholar 

  36. Chemerinski E, Bowie C, Anderson H, Harvey PD (2008) Depression in schizophrenia: methodological artifact or distinct feature of the illness? J Neuropsychiatry Clin Neurosci 20:431–440

    Article  PubMed  PubMed Central  Google Scholar 

  37. Lindenmayer JP, Brown E, Baker RW et al (2004) An excitement subscale of the Positive and Negative Syndrome Scale. Schizophr Res 68:331–337

    Article  PubMed  Google Scholar 

  38. Rabany L, Weiser M, Werbeloff N, Levkovitz Y (2011) Assessment of negative symptoms and depression in schizophrenia: revision of the SANS and how it relates to the PANSS and CDSS. Schizophr Res 126:226–230

    Article  PubMed  Google Scholar 

  39. Majadas S, Olivares J, Galan J, Diez T (2012) Prevalence of depression and its relationship with other clinical characteristics in a sample of patients with stable schizophrenia. Compr Psychiatry 53:145–151

    Article  PubMed  Google Scholar 

  40. Addington D, Addington J, Maticka-Tyndale E (1993) Assessing depression in schizophrenia: the Calgary Depression Scale. Br J Psychiatry 163(Suppl 22):39–44

    Google Scholar 

  41. Andreasen NC (1989) Scale for the assessment of negative symptoms (SANS). Br J Psychiatry 155:53–58

    Google Scholar 

  42. Emsley RA, Oosthuizen PP, Joubert AF, Roberts MC, Stein DJ (1999) Depressive and anxiety symptoms in patients with schizophrenia and schizophreniform disorder. J Clin Psychiatry 60:747–751

    Article  CAS  PubMed  Google Scholar 

  43. Kay SR, Fiszbein A, Opler LA (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 13:261–276

    Article  CAS  PubMed  Google Scholar 

  44. Collins AA, Remington G, Coulter K, Birkett K (1996) Depression in schizophrenia: a comparison of three measures. Schizophr Res 20:205–209

    Article  CAS  PubMed  Google Scholar 

  45. Fitzgerald PB, Rolfe TJ, Brewer K et al (2002) Depressive, positive, negative and parkinsonian symptoms in schizophrenia. Aust N Z J Psychiatry 36:340–346

    Article  PubMed  Google Scholar 

  46. Jäger M, Riedel M, Schmauss M et al (2008) Depression during an acute episode of schizophrenia or schizophreniform disorder and its impact on treatment response. Psychiatry Res 158:297–305

    Article  PubMed  Google Scholar 

  47. Lancon C, Auquier P, Reine G, Bernard D, Addington D (2001) Relationships between depression and psychotic symptoms of schizophrenia during an acute episode and stable period. Schizophr Res 47:135–140

    Article  CAS  PubMed  Google Scholar 

  48. Lindenmayer JP, Grochowski S, Kay SR (1991) Schizophrenic patients with depression: psychopathological profiles and relationship with negative symptoms. Compr Psychiatry 32:528–533

    Article  CAS  PubMed  Google Scholar 

  49. Zisook S, McAdams LA, Kuck J et al (1999) Depressive symptoms in schizophrenia. Am J Psychiatry 156:1736–1743

    CAS  PubMed  Google Scholar 

  50. Rabany L, Weiser M, Levkovitz Y (2013) Guilt and depression: two different factors in individuals with negative symptoms of schizophrenia. Eur Psychiatry 28:327–331

    Article  CAS  PubMed  Google Scholar 

  51. Maggini C, Raballo A (2006) Exploring depression in schizophrenia. Eur Psychiatry 21:227–232

    Article  PubMed  Google Scholar 

  52. Müller MJ (2007) Gender-specific associations of depression with positive and negative symptoms in acute schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 31:1095–1100

    Article  PubMed  Google Scholar 

  53. Häfner H, Maurer K, Trendler G, an der Heiden W, Schmidt M, Könnecke R (2005) Schizophrenia and depression: challenging the paradigm of two separate diseases—a controlled study of schizophrenia, depression and healthy controls. Schizophr Res 77:11–24

    Article  PubMed  Google Scholar 

  54. Peralta V, Cuesta MJ (1999) Dimensional structure of psychotic symptoms: an item-level analysis of SAPS and SANS symptoms in psychotic disorders. Schizophr Res 38:13–26

    Article  CAS  PubMed  Google Scholar 

  55. Horan WP, Kring AM, Gur RE, Reise SP, Blanchard JJ (2011) Development and psychometric validation of the clinical assessment interview for negative symptoms (CAINS). Schizophr Res 132:140–145

    Article  PubMed  PubMed Central  Google Scholar 

  56. Kring AM, Gur RE, Blanchard JJ, Horan WP, Reise SP (2013) The clinical assessment interview for negative symptoms (CAINS): final development and validation. Am J Psychiatry 170:165–172

    Article  PubMed  PubMed Central  Google Scholar 

  57. Addington D, Addington J, Maticka-Tyndale E (1994) Specificity of the Calgary depression scale for schizophrenics. Schizophr Res 11:239–244

    Article  CAS  PubMed  Google Scholar 

  58. Kim S-W, Kim S-J, Yoon B-H et al (2006) Diagnostic validity of assessment scales for depression in patients with schizophrenia. Schizophr Res 144:57–63

    Google Scholar 

  59. Liu H, Zhang H, Xiao W et al (2009) Scales for evaluating depressive symptoms in Chinese patients with schizophrenia. J Nerv Ment Dis 197:140–142

    Article  PubMed  Google Scholar 

  60. Häfner H, Riecher A, Maurer K et al (1990) Ein Instrument zur retrospektiven Einschätzung des Erkrankungsbeginns bei Schizophrenie (Instrument for the retrospective assessment of the onset of schizophrenia - “IRAOS”) - Entwicklung und erste Ergebnisse-. Z Klin Psychol 19:230–255

    Google Scholar 

  61. Andreasen NC (1983) The Scale for the Assessment of Negative Symptoms (SANS). University of Iowa, Iowa City

    Google Scholar 

  62. Häfner H, Löffler W, Maurer K, Riecher-Rössler A, Stein A (1999) IRAOS - Interview für die retrospektive Erfassung des Krankheitsbeginns und -verlaufs bei Schizophrenie und anderen Psychosen. Huber, Bern

    Google Scholar 

  63. Häfner H, Löffler W, Maurer K, Riecher-Rössler A, Stein A (2003) IRAOS Interview for the retrospective assessment of the onset and course of schizophrenia and other psychoses. Hogrefe & Huber Publishers, Göttingen

    Google Scholar 

  64. Häfner H, an der Heiden W (2003) Course and outcome of schizophrenia. In: Hirsch SR, Weinberger DR (eds) Schizophrenia, 2nd edn. Blackwell Publishing, Oxford, pp 101–141

    Chapter  Google Scholar 

Download references

Acknowledgments

The ABC Schizophrenia Study was funded by the German Research Foundation (DFG) as part of the Special Research Branch (Sonderforschungsbereich) 258 at the Central Institute of Mental Health from 1 January 1987 to 30 December 1998 and from 1 January 1999 to 31 May 2012 as an independent project.

Author information

Authors and Affiliations

  1. Schizophrenia Research Group, Central Institute of Mental Health, Heidelberg University/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany

    Wolfram an der Heiden, Anne Leber & Heinz Häfner

Authors
  1. Wolfram an der Heiden
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anne Leber
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Heinz Häfner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Heinz Häfner.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interests in relation to the subject of this study.

Ethical standards

All human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

an der Heiden, W., Leber, A. & Häfner, H. Negative symptoms and their association with depressive symptoms in the long-term course of schizophrenia. Eur Arch Psychiatry Clin Neurosci 266, 387–396 (2016). https://doi.org/10.1007/s00406-016-0697-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00406-016-0697-2

Keywords

Search

Navigation