Zhu Jiannan, Sun Taipeng, Li Jian, Geng Deqin, Du Gang*
Xuzhou Medical College, Jiangsu province 221003, Xuzhou, People Republic of China.
Abstract: Present studies explore the clinical characteristics of depressive disorder of male patients with schizophrenia, and provide evidence for the treatment and prevention of the disease. Retrospective study of statistical analysis was done in January 2013–December 2014 in severe psychiatric wards with 1871 cases of male hospitalized psychiatric patients. A total of 136 cases of male post-schizophrenic depression patients were recruited and the occurrence of the disease was studied according to the level of education, occupation, marital status and other related factors. The antidepressant treatment was effective. Male schizophrenia patients with high level of education, unmarried, stable career have higher probability of post-schizophrenic depression. The occurrence of post-schizophrenic depression is associated with psychological reaction, the depressive symptoms is different from the depression, low-dose antidepressant treatment effect is good.
Keywords: Post-schizophrenic depression, male psychiatric patients; antidepressants
Citation: Jiannan Z, Taipeng S, Jian L, Deqin G, Gang D. Clinical research of male patients with Post-schizophrenic depression. J Gen Neurol 2016; 1(1): x-x.
*Correspondence to: Du Gang, Xuzhou Medical College, Jiangsu 221003, Xuzhou, Jiangsu 221003, China.
Received: Accepted: Published Online:
In recent years, with the increase of social pressure, the prevalence of mental illness is increasing in our country, has become an increasingly serious social problems
[1]. The incidence of schizophrenia showed an increasing trend and schizophrenia is highest caused among the psychiatric hospitalization and post-schizophrenic depression is the prominent problems of schizophrenia remission, its incidence is not exact, it is estimated about 25%, 7%–70% were reported in the literature
[2]. Male schizophrenic occurrence rate and harm of post-schizophrenic depression is different from the female patients due to its own characteristics. The study on related factors in male patients with post-schizophrenic depression and intervention has important significant guidance on the early intervention and correct treatment of the disease.
Materials and methods
A total of 1871 male psychiatric patient were screened from a period of January 2013 to December 2014. 136 male patients showed positive for post-schizophrenic depression and used for the following studies. Hospitalized patients were diagnosed by an associate chief physician and attending physician based on ICD - 10 criteria. General information of the patients was collected upon admission. 24-item hamilton depression rating scale (HAMD24) was used to measure the severity of the depression symptoms in patients. The depressive symptoms and antipsychotic use situation at that time were statisticed. Curative effect of antidepressant medications were assessed by depressive symptoms using HAMD24 at two, four, six weeks.
Statistical analysis
All the data were inputted into the SPSS 13.0 software package of computer for statistical analysis, the data were analyzed by descriptive statistical method.
Results
The patient's general demographic information
Age: 3 patients were <20 (2.2%), 47 patients were in between 20–29 (34.6%), 59 patients were in the range of 29–39 (43.4%), 23 patients were from 39–49 (16.9%), 4 patients were >49 (2.9%).
Marital status: 71 cases were unmarried (52.2%); 52 cases were married (38.3%); 10 cases were divorce (7.8%); 3 cases of death spouse (2.2%).
Education level may vary among all the patients with 11(8.1%), 17(12.6%), 45(32.8%), 63(46.5%) cases of primary school or below, middle school, high school, college degree or above, respectively.
Native place: Town, 85 cases (62.5%); countryside, 51 cases (37.5%). Personality traits: introversion, 112 cases (82.3%); neutral, 8 cases (5.9%); extroversion, 16 cases (11.8%).
Family history: Positive, 25 cases (18.4%); negative, 111 cases (81.6%).
The occupational distribution of mental illness patients: Students, 23 cases (16.9%); farmers, 18 cases (13.2%); workers, 35 cases (25.8%); cadres, 44 cases (32.4%); retirement , 4 cases (2.9%); jobless, 12 cases (8.8%).
Major depressive symptoms
Loss of interest and unhappy feeling in 28 cases; energy loss or fatigue in 36 cases; 57 cases of low self-assessment; 18 cases of insomnia, early wake up and sleep disorders; appetite and other instinct obstacles in 26 cases; Overly concerned about the attitude change of family on disease in 62 cases, pessimism, helplessness, discrimination in 58 cases; negative words and behavior in 32 cases; among them, suicide idea in 29 cases and suicidal behavior in 3 cases.
Antipsychotic drug usage
52 cases of risperidone, 43 cases of olanzapine, 12 cases of sulpiride, 23 cases of quetiapine, 18 cases of clozapine, 7 cases of perphenazine, 5 cases of chlorpromazine, 16 cases of aripiprazole.
Antidepressants usage and HAMD scores
28 cases of Fluoxetine (20 to 40 mg/d), 20 cases of citalopram (20 to 40 mg/d), 37 cases of paroxetine (20 to 40 mg/d), 6 cases of sertraline (50-100 mg/d), 41 cases of venlafaxine(75-150 mg/d), 4 cases of mirtazapine (15-30 mg/d).
Initial HAMD scores <35 points were 109 cases (80.1%) and ≥35 points were 27 cases (19.9%), HAMD scores of 23.33±3.66. HAMD scores were 13.26±3.74 after 2 weeks of treatment, 9.50±6.35 after 4 weeks of treatment, 8.80±6.38 after 6 weeks of treatment.
3. Discussion
Post-schizophrenic depression refers to depressive symptoms appeared when the schizophrenia improved but not cured for patients diagnosed as schizophrenia in recent 1 year, the depressive symptoms last for 2 weeks or more
[3]. In recent years, the incidence, relevant factors, treatment and other aspects are regularly reported
[4, 5]. The pathogenesis of the disease is relatively complex, at present there are three types of reports, including the composition of depression disease itself, depression caused by nerve blockers and psychological reaction after control of symptoms. If depression may be part of the symptoms of schizophrenia, the accompany symptoms should be relieved as effective antipsychotic drug treatment. But the clinical symptoms of depression often appeared when the effective antipsychotic drugs treatment were used and the psychotic symptoms basically disappeared. Liang shaocai et al.
[6] also considered that the occurrence of depressive symptoms is less when schizophrenia symptom still exist, while it would increase with the relief of psychotic symptoms. Therefore, such causes is unlikely; some study Reported that it was related to antipsychotic drugs or commonly used auxiliary drug side effects, especially for butyryl benzene, phenol thiazide , but the relationship has not been clarified. This research shows that among the 136 cases of patients, atypical antipsychotic drug had higher percent of antipsychotics, butyryl benzene, phenol thiazide accounted for only 17.7%, so it does not support the inference. The most known view is, it is related to the psychological response of patients after schizophrenia symptoms control. This study found that age to the patient was concentrated in 20-40 years old, most patients were unmarried, high level of education or above was the main education level, professional was mainly focused on workers and students. Among the depressive symptoms, the percentage of pessimistic, helpless, discriminatory sense, overly concerned about family about their attitude and disease change and self-assessment low was higher. After psychotic symptoms disappeared, these patients began to worry about their identity, occupation, prospect and family burden, they would have apparent shame, so obvious depressive symptoms appeared. The worry and stress is consistent with the ordinary responsibility and pressure of the men. Individual with older or younger age, non-professional and low education will be lacking of above care or burden, hence, the risk of depression were low. Chun-shan li et al[7] reported hospitalized schizophrenia patients were positively correlated to depression, thus the above criteria able to prove that depression after schizophrenia is associated with psychological reaction.
This survey also shows that this type of depressive symptoms patients has mild symptom, HAMD score <35 (80.1%), the usage of lower doses of antidepressants, and the treatment is markedly effective in 2 weeks of treatment, depressive symptoms will disappear after six weeks. According to our current 4-grade evaluation criteria rating: reductive ratio ≥75% refers to clinical recovery, 50%–74% refers to significantly effective, 25%–49% refers to better, <25% refers to invalid, the clinical cure rate is 52.13%, markedly effective rate was 26.34%, The results showed different from mere depression with sufficient doses of full course treatment, also shows that post-schizophrenic depression may be secondary symptoms, the effect is better after support therapy.
In conclusion, the male schizophrenia patients with high level of education
[8], unmarried, a stable career have a greater chance of post-schizophrenic depression. The occurrence of post-schizophrenic depression is associated with psychological reaction. For these patients, we should ensure early identification, diagnosis, treatment; the depressive symptoms of post-schizophrenic depression were different from depression, timely low-dose antidepressant treatment effect is good.
References
1. Zhen Z, Hit and cause trouble women mental patient 82 cases investigation analysis. J Qiqihar Med Coll 2008; 29(12): 1456-1457.
2. Liu XJ, Guo TS. Depressive symptoms of schizophrenia. J Int Psychiatry 2006; (3): 129-131.
3. Psychiatric branch of Chinese medical association. China's mental disorder classification and diagnostic criteria. 3rd edition. Jinan: shandong science and technology press 2001: 77.
4. Qi XQ. Schizophrenia depression. J Int Psychiatry 2002; 29(1): 15-17.
5. Li YJ. Post-Schizophrenia depression. Chin Ment Health 2000; 14(6): 395-396.
6. Liang SC, Yu Gh, Zhang CP, Ding GA, Guan BB, et al. A survey of prevalence of post-schizophrenic depression in schizophrenic inpatients. Med J Chin Civil Admin 2003; (7): 389-417.
7. Chen H, Huang FZY, Li CS, Tang P. Shame hospitalized patients with schizophrenia disease with depression. Chin J Health Psychol 2014; 22(8): 1156-1157.
8. Liu LQ, Zhou P.
Study of depressive symptoms of patients with chronic schizophrenia. J Clinical Psychol Med 2009; 12(1): 34-36.
