Cognitive approach to depression and suicidal thinking in psychosis I. Ontogeny of post-psychotic depression

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 postpsychotic 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. Postpsychotic depression occurs de novo without concomitant change in positive or negative symptoms.