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Reappraisal of the interplay between psychosis and depression symptoms in the pathogenesis of psychotic syndromes: results from a twenty-year prospective community study

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Abstract

The interplay of psychotic and affective symptoms is a crucial challenge in understanding the pathogenesis of psychosis. In this study, we analyzed the interplay between two subclinical psychosis symptoms dimensions, and one depression symptoms dimension, using longitudinal data from Zurich. The Zurich study started in 1979 with a representative sample of 591 participants who were aged 20/21. Follow-up interviews were conducted at age 23, 28, 30, 35, and 41. The psychiatric symptoms were assessed with a semi-structured interview and the SCL 90-R. In this study, we analyzed three SCL-90-R subscales: the depression symptoms dimension and two distinct symptoms dimensions of subclinical psychosis, one representing a schizophrenia nuclear symptom dimension, the other representing a schizotypal symptoms dimension. Modeling was done with hybrid latent growth models, thereby including simultaneous and cross-lagged effects. The interplay between the two subclinical psychosis symptoms dimensions and the depression symptoms dimension includes several intertwined pathways. The schizotypal symptoms dimension has strong direct effects on the schizophrenia nuclear symptoms dimension, but also on the depression symptoms dimension. The latter has for its part an effect on the schizophrenia nuclear symptoms dimension. The main driving force within the dynamic interplay between depression and psychosis symptoms is a schizotypal symptoms dimension, which represents social and interpersonal deficiencies, ideas of reference, suspiciousness, paranoid ideation, and odd behavior. It does not only directly influence subclinical nuclear schizophrenia symptoms but also the symptoms of depression.

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Acknowledgments

The study was supported by the Swiss National Science Foundation (grant # 32-50881.97).

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Authors and Affiliations

  1. Department of General and Social Psychiatry, Psychiatric University Hospital, University of Zurich, Militärstrasse 8, 8021, Zurich, Switzerland

    Wulf Rössler, Jules Angst, Alex Gamma, Helene Haker, Niklaus Stulz & Vladeta Ajdacic-Gross

  2. Collegium Helveticum, University of Zurich and Swiss Federal Institute of Technology, Zurich, Switzerland

    Wulf Rössler

  3. Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA

    Kathleen R. Merikangas

Authors
  1. Wulf Rössler
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  2. Jules Angst
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  3. Alex Gamma
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  4. Helene Haker
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  5. Niklaus Stulz
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  6. Kathleen R. Merikangas
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  7. Vladeta Ajdacic-Gross
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Correspondence to Wulf Rössler.

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Rössler, W., Angst, J., Gamma, A. et al. Reappraisal of the interplay between psychosis and depression symptoms in the pathogenesis of psychotic syndromes: results from a twenty-year prospective community study. Eur Arch Psychiatry Clin Neurosci 261, 11–19 (2011). https://doi.org/10.1007/s00406-010-0123-0

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  • DOI: https://doi.org/10.1007/s00406-010-0123-0

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