Skip to main content
SpringerLink
Log in

Co-Occurring Depressive Symptoms in the Older Patient with Schizophrenia

  • Therapy In Practice
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Clinicians treating older patients with schizophrenia are often challenged by patients presenting with both depressive and psychotic features. The presence of co-morbid depression impacts negatively on quality of life, functioning, overall psychopathology and the severity of co-morbid medical conditions. Depressive symptoms in patients with schizophrenia include major depressive episodes (MDEs) that do not meet criteria for schizoaffective disorder, MDEs that occur in the context of schizoaffective disorder and subthreshold depressive symptoms that do not meet criteria for MDE. Pharmacological treatment of patients with schizophrenia and depression involves augmenting antipsychotic medications with antidepressants. Recent surveys suggest that clinicians prescribe antidepressants to 30% of inpatients and 43% of outpatients with schizophrenia and depression at all ages. Recent trials addressing the efficacy of this practice have evaluated selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, sertraline, fluvoxamine and citalopram. These trials have included only a small number of subjects and few older subjects participated; furthermore, the efficacy results have been mixed. Although no published controlled psychotherapeutic studies have specifically targeted major depression or depressive symptoms in older patients with schizophrenia, psychosocial interventions likely play a role in any comprehensive management plan in this population of patients.

Our recommendations for treating the older patient with schizophrenia and major depression involve a stepwise approach. First, a careful diagnostic assessment to rule out medical or medication causes is important as well as checking whether patients are adherent to treatments. Clinicians should also consider switching patients to an atypical antipsychotic if they are not taking one already. In addition, dose optimization needs to be targeted towards depressive as well as positive and negative psychotic symptoms. If major depression persists, adding an SSRI is a reasonable next step; one needs to start with a low dose and then cautiously titrate upward to reduce depressive symptoms. If remission is not achieved after an adequate treatment duration (8–12 weeks) or with an adequate dose (similar to that used for major depression without schizophrenia), switching to another agent or adding augmenting therapy is recommended.

We recommend treating an acute first episode of depression for at least 6–9 months and consideration of longer treatment for patients with residual symptoms, very severe or highly co-morbid major depression, ongoing episodes or recurrent episodes. Psychosocial interventions aimed at improving adherence, quality of life and function are also recommended. For patients with schizophrenia and subsyndromal depression, a similar approach is recommended.

Psychosis accompanying major depression in patients without schizophrenia is common in elderly patients and is considered a primary mood disorder; for these reasons, it is an important syndrome to consider in the differential diagnosis of older patients with mood and thought disturbance. Treatment for this condition has involved electroconvulsive therapy (ECT) as well as combinations of antidepressant and antipsychotic medications. Recent evidence suggests that combination treatment may not be any more effective than antidepressant treatment alone and ECT may be more efficacious overall.

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

Table I
Table II

Similar content being viewed by others

References

  1. Siris SG, Addington D, Azorin J, et al. Depression in schizophrenia: recognition and management in the USA. Schizophr Res 2001; 47: 185–97

    PubMed  CAS  Google Scholar 

  2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, DSM-III. 3rd ed. Washington, DC: American Psychiatric Association, 1980

    Google Scholar 

  3. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry 1994; 51: 8–19

    PubMed  CAS  Google Scholar 

  4. Siris SG. Depression in the course of schizophrenia. In: Hwang MY, Bermanzohn PC, editors. Schizophrenia and comorbid conditions. Washington, DC: American Psychiatric Press, Inc., 2001: 31–56

    Google Scholar 

  5. Cohen CI. Studies of the course and outcome of schizophrenia in later life. Psychiatr Serv 1995; 46: 877–879, 889

    PubMed  CAS  Google Scholar 

  6. Jin H, Zisook S, Palmer BW, et al. Association of depressive symptoms and functioning in schizophrenia: a study in older outpatients. J Clin Psychiatry 2001; 62: 797–803

    PubMed  CAS  Google Scholar 

  7. Zisook S, McAdams LA, Kuck J, et al. Depressive symptoms in schizophrenia. Am J Psychiatry 1999; 156: 1736–43

    PubMed  CAS  Google Scholar 

  8. Schwartz RC, Cohen BN. Psychosocial correlates of suicidal intent among patients with schizophrenia. Compr Psychiatry 2001; 42: 118–23

    PubMed  CAS  Google Scholar 

  9. Joukamaa M, Heliovaara M, Knekt P, et al. Mental disorders and cause-specific mortality. Br J Psychiatry 2001; 179: 498–502

    PubMed  CAS  Google Scholar 

  10. First MB. Mutually exclusive versus co-occurring diagnostic categories: the challenge of diagnostic comorbidity. Psycho-pathology 2005; 38(4): 206–10

    Google Scholar 

  11. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, DSM-IV. 4th ed. Washington, DC: American Psychiatric Association, 1994

    Google Scholar 

  12. World Health Organization. International statistical classification of diseases and related health problems. 10th rev. Geneva: World Health Organization, 2007

    Google Scholar 

  13. Bressan RA, Chaves AC, Pilowsky LS, et al. Depressive episodes in stable schizophrenia: critical evaluation of the DSM-IV and ICD-10 diagnostic criteria. Psychiatry Res 2003; 117: 47–56

    PubMed  Google Scholar 

  14. Knights A, Hirsch SR. “Revealed” depression and drug treatment for schizophrenia. Arch Gen Psychiatry 1981; 38: 806–11

    PubMed  CAS  Google Scholar 

  15. Birchwood M, Iqbal Z, Chadwick P, et al. Cognitive approach to depression and suicidal thinking in psychosis. 1: ontogeny of post-psychotic depression. Br J Psychiatry 2000; 177: 516–21

    PubMed  CAS  Google Scholar 

  16. Bressan RA, Costa DC, Jones HM, et al. Typical antipsychotic drugs-D(2) receptor occupancy and depressive symptoms in schizophrenia. Schizophr Res 2002; 56: 31–6

    PubMed  Google Scholar 

  17. Van Putten T, May RP. “Akinetic depression” in schizophrenia. Arch Gen Psychiatry 1978; 35: 1101–7

    PubMed  Google Scholar 

  18. Leo RJ. Movement disorders associated with serotonin selective reuptake inhibitors. J Clin Psychiatry 1996; 57: 449–54

    PubMed  CAS  Google Scholar 

  19. American Psychiatric Association. Diagnostic and statistical manual of mental disorders — text revision, DSM-IV-TR. 4th ed. Washington, DC: American Psychiatric Association, 2000: 320

    Google Scholar 

  20. McGlashan TH, Carpenter WT. An investigation of the postpsychotic depressive syndrome. Am J Psychiatry 1976; 133: 14–9

    PubMed  CAS  Google Scholar 

  21. Birchwood M, Iqbal Z, Uptjegrove R. Psychologic pathways to depression in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2005; 225: 202–12

    Google Scholar 

  22. Chan Y, Parisier SE, Neufeld G. Atypical antipsychotics in older adults. Pharmacotherapy 1999; 19: 811–82

    PubMed  CAS  Google Scholar 

  23. Tariot PN. The older patient: the ongoing challenge of efficacy and tolerability. J Clin Psychiatry 1999; 60Suppl. 23: 29–33

    PubMed  Google Scholar 

  24. Kasckow JW, Mulchahey JJ, Aslam M, et al. When and how to use SSRIs to treat late-life depression. Curr Psychiatry 2003; 2: 43–7

    Google Scholar 

  25. Kasckow JW, Mohamed S, Granholm E, et al. use of novel antipsychotics in older patients with schizophrenia. In: Cohen C, editor. Schizophrenia into later life treatment, research and policy. Washington, DC: APA Press, 2003: 195–204

    Google Scholar 

  26. Calgiuri MP, Lacro JP, Jeste DV. Incidence and predictors of drug induced parkinsonism in older psychiatric patients treated with very low doses of neuroleptics. J Clin Psychopharmacol 1999; 19: 322–8

    Google Scholar 

  27. Jeste DV, Lacro JP, Palmer B, et al. Incidence of tardive dyskinesia in early stages of low-dose treatment with typical neuroleptics in older patients. Am J Psychiatry 1999; 156: 309–11

    PubMed  CAS  Google Scholar 

  28. Jeste DV, Lacro JP, Bailey A, et al. Lower incidence of tardive dyskinesia with risperidone compared with haloperidol in older patients. J Am Geriatric Soc 1999; 47: 716–9

    CAS  Google Scholar 

  29. Derry S, Moore RA. Atypical antipsychotics in bipolar disorder: systematic review of randomised trials. BMC Psychiatry 2007; 7: 40

    PubMed  Google Scholar 

  30. Dando TM, Keating GM. Quetiapine: a review of its use in acute mania and depression associated with bipolar disorder. Drugs 2005; 65: 2533–51

    PubMed  CAS  Google Scholar 

  31. Alexopoulos GS, Streim J, Carpenter D, et al. Expert Consensus Panel for Using Antipsychotic Drugs in Older Patients: using antipsychotic agents in older patients. J Clin Psychiatry 2004; 65Suppl. 2: 5–99

    PubMed  Google Scholar 

  32. Ritchie CW, Chiu E, Harrigan S, et al. The impact upon extrapyramidal side effects, clinical symptoms and quality of life of a switch from conventional to atypical antipsychotics (risperidone or olanzapine) in elderly patients with schizophrenia. Int J Geriatr Psychiatry 2003; 18: 432–40

    PubMed  CAS  Google Scholar 

  33. Barak Y, Shamir E, Weizman R. Would a switch from typical antipsychotics to risperidone be beneficial for elderly schizophrenic patients? A naturalistic, long-term, retrospective, comparative study. J Clin Psychopharmacol 2002; 22: 115–20

    PubMed  CAS  Google Scholar 

  34. Hwang JP, Yang CH, Yu HC, et al. The efficacy and safety of risperidone for the treatment of geriatric psychosis. J Clin Psychopharmacol 2001; 21: 583–7

    PubMed  CAS  Google Scholar 

  35. Verma S, Orengo CA, Kunik ME, et al. Tolerability and effectiveness of atypical antipsychotics in male geriatric inpatients. Int J Geriatr Psychiatry 2001; 16: 223–7

    PubMed  CAS  Google Scholar 

  36. Davidson M, Harvey PD, Vervarcke J, et al. A long-term, multicenter, open-label study of risperidone in elderly patients with psychosis. On behalf of the Risperidone Working Group. Int J Geriatr Psychiatr 2000; 15: 506–14

    CAS  Google Scholar 

  37. Madhusoodanan S, Brecher M, Brenner R, et al. Risperidone in the treatment of elderly patients with psychotic disorders [published erratum appears in Am J Geriatr Psychiatry 1999; 7: 268]. Am J Geriatr Psychiatry 1999; 7: 132–8

    PubMed  CAS  Google Scholar 

  38. Madhusoodanan S, Brenner R, Alcantra A. Clinical experience with quetiapine in elderly patients with psychotic disorders. J Geriatr Psychiatry Neurol 2000; 13: 28–32

    PubMed  CAS  Google Scholar 

  39. Tariot PN, Salzman C, Yeung PP, et al. Long-term use of quetiapine in elderly patients with psychotic disorders. Clin Ther 2000; 22: 1068–84

    PubMed  CAS  Google Scholar 

  40. McManus DQ, Arvanitis LA, Kowalcyk BB. Quetiapine, a novel antipsychotic: experience in elderly patients with psychotic disorders: Seroquel Trial 48 Study Group. J Clin Psychiatry 1999; 60: 292–8

    PubMed  CAS  Google Scholar 

  41. Hwang JP, Yang CH, Lee TW, et al. The efficacy and safety of olanzapine for the treatment of geriatric psychosis. J Clin Psychopharmacol 2003; 23: 113–8

    PubMed  CAS  Google Scholar 

  42. Barak Y, Shamir E, Zemishlani H, et al. Olanzapine vs. haloperidol in the treatment of elderly chronic schizophrenia patients. Prog Neuropsychopharmacol Biol Psychiatry 2002; 26: 1199–202

    PubMed  CAS  Google Scholar 

  43. Madhusoodanan S, Brenner R, Suresh P, et al. Efficacy and tolerability of olanzapine in elderly patients with psychotic disorders: a prospective study. Ann Clin Psychiatry 2000; 12: 11–8

    PubMed  CAS  Google Scholar 

  44. American Diabetes Association; American Psychiatric Association; American Association of Clinical Endocrinologists; North American Association for the Study of Obesity. Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes. Diabetes 2004; 27: 596–601

    Google Scholar 

  45. Glassman AH, Bigger JT. Antipsychotic drugs: prolonged QTc interval, torsade de pointe, and sudden death. Am J Psychiatry 2001; 158: 1774–82

    PubMed  CAS  Google Scholar 

  46. Vartiainen H, Tihonen J, Putkonen A, et al. Citalopram, a selective serotonin reuptake inhibitor, in the treatment of aggression in schizophrenia. Acta Psychiatr Scand 1995; 91: 348–51

    PubMed  CAS  Google Scholar 

  47. Silver H, Nassar A. Fluvoxamine improves negative symptoms in treated chronic schizophrenia: an add-on double-blind, placebo-controlled study. Biol Psychiatry 1992; 31: 698–704

    PubMed  CAS  Google Scholar 

  48. Addington D, Addington J, Patten S. Double-blind, placebo-controlled comparison of the efficacy of sertraline as treatment for a major depressive episode in patients with remitted schizophrenia. J Clin Psychopharmacol 2002; 22: 20–5

    PubMed  CAS  Google Scholar 

  49. Buchanan RW, Kirkpatrick B, Bryant N, et al. Fluoxetine augmentation of clozapine treatment in patients with schizophrenia. Am J Psychiatry 1996; 153: 1625–7

    PubMed  CAS  Google Scholar 

  50. Goff DC, Midha KK, Sarid-Segal O, et al. A placebo-controlled trial of fluoxetine added to neuroleptic in patients with schizophrenia. Psychopharmacology 1995; 117: 417–23

    PubMed  CAS  Google Scholar 

  51. Spina E, DeDomenico P, Ruello C, et al. Adjunctive fluoxetine in the treatment of negative symptoms in chronic schizophrenia patients. Int Clin Psychopharmacol 1994; 9: 281–28

    PubMed  CAS  Google Scholar 

  52. Salokangas RK, Saarijarvi S, Taiminen T, et al. Citalopram as an adjuvant in chronic schizophrenia: a double-blind placebo-controlled study. Acta Psychiatr Scand 1996; 94: 175–80

    PubMed  CAS  Google Scholar 

  53. Kasckow JW, Mohamed S, Thallasinos AS, et al. Antidepressant augmentation of antipsychotic treatment in older schizophrenia patients. Int J Geriatr Psychiatry 2001; 16: 1163–7

    PubMed  CAS  Google Scholar 

  54. Pugh R. Rehabilitation and long-term management. In: Copeland JRM, Abou-Saleh MT, Blazer DG, editors. Principles and practice of geriatric psychiatry. 2nd ed. Chichester: John Wiley and Sons, Ltd, 2002: 517–22

    Google Scholar 

  55. Karim S, Overshott R, Burns A. Older people with schizophrenia. Aging Ment Health 2005; 9: 315–24

    PubMed  CAS  Google Scholar 

  56. Liberman RP, Eckman TA. Dissemination of skills training modules to psychiatric facilities: overcoming obstacles to the utilization of a rehabilitation innovation. Br J Psychiatry Suppl; 1989 Jul; (5): 17–22

    Google Scholar 

  57. Liberman RP, Wallace CJ, Blackwell G, et al. Innovations in skills training for the seriously mentally ill: the UCLA Social and Independent Living Skills Modules. Innovations Res 1993; 2: 43–60

    Google Scholar 

  58. Heinssen RK, Liberman RP, Kopelowicz A. Psychosocial skills training for schizophrenia: lessons from the laboratory. Schizophr Bull 2000; 26: 21–46

    PubMed  CAS  Google Scholar 

  59. Granholm E, McQuaid JR, McClure FS, et al. A randomized, controlled trial of cognitive behavioral social skills training for middle-aged and older outpatients with chronic schizophrenia. Am J Psychiatry 2005; 162: 520–9

    PubMed  Google Scholar 

  60. Audini B, Marks IM, Lawrence RE, et al. Home based versus out-patient/inpatient care for people with serious mental illness: phase II of a controlled study. Br J Psychiatry 1994; 165: 204–10

    PubMed  CAS  Google Scholar 

  61. Borland A, McRae J, Lycan C. Outcomes of five years of continuous intensive care management. Hosp Community Psychiatry 1989; 40: 369–76

    PubMed  CAS  Google Scholar 

  62. Lafave HG, de Souza HR, Gerber GJ. Assertive community treatment of severe mental illness: a Canadian experience. Psychiatr Serv 1996; 47: 757–9

    PubMed  CAS  Google Scholar 

  63. Muijen M, Cooney M, Strathdee G, et al. Community psychiatric nurse teams: intensive support versus geriatric care. Br J Psychiatry 1994; 165: 211–7

    PubMed  CAS  Google Scholar 

  64. Stein LI, Test MA. Alternative to mental hospital treatment. I: conceptual model, treatment program, and clinical evaluation. Arch Gen Psychiatry 1980; 37: 392–7

    PubMed  CAS  Google Scholar 

  65. Wood K, Anderson J. The effect on hospital admissions of psychiatric case management involving general practitioners: preliminary results. Aust N Z J Psychiatry 1995; 29: 223–9

    PubMed  CAS  Google Scholar 

  66. Mohamed S, Kasckow JW, Granholm E, et al. Community-based treatment of schizophrenia and other severe mental illness. In: Cohen C, editor. Schizophrenia into later life: treatment, research and policy. Washington, DC: APA Press, 2003: 205–22

    Google Scholar 

  67. Ford R, Beadsmore A, Ryan P, et al. Providing the safety net: case management for people with serious mental illness. J Ment Health 1995; 1: 91–7

    Google Scholar 

  68. Macias C, Kinney R, Farley OW, et al. The role of case management within a community support system: partnership with psychosocial rehabilitation. Community Ment Health J 1994; 30: 323–39

    PubMed  CAS  Google Scholar 

  69. Hornstra RK, Bruce-Wolfe V, Sagduyu K, et al. The effect of intensive case management on hospitalization of patients with schizophrenia. Hosp Community Psychiatry 1993; 44: 844–7

    PubMed  CAS  Google Scholar 

  70. Rossler W, Loffler W, Fatkenheuer B, et al. Does case management reduce the rehospitalization rate? Acta Psychiatrica Scand 1992; 86: 445–9

    CAS  Google Scholar 

  71. Rossler W, Loffler W, Fatkenheuer B, et al. Case management for schizophrenic patients at risk for rehospitalization: a case control study. Eur Arch Psychiatry Clin Neurosci 1995; 246: 29–36

    PubMed  CAS  Google Scholar 

  72. Quinlaven R, Hough R, Crowell A, et al. Service utilization and costs of care for severely mentally ill clients in an intensive case management program. Psychiatr Serv 1995; 46: 365–71

    Google Scholar 

  73. Franklin JL, Solovitz B, Mason M, et al. An evaluation of case management. Am J Public Health 1987; 77: 674–8

    PubMed  CAS  Google Scholar 

  74. Nierenberg AA, Katz J, Fava M. A critical overview of the pharmacologic management of treatment-resistant depression. Psychiatr Clin North Am 2007; 30: 13–29

    PubMed  Google Scholar 

  75. Kendler KS, McGuire M, Gruenberg AM, et al. Examining the validity of DSM-III-R schizoaffective disorder and its putative subtypes in the Roscommon family study. Am J Psychiatry 1995; 152: 755–64

    PubMed  CAS  Google Scholar 

  76. Danileviciute V. Schizoaffective disorder: clinical symptoms and present-day approach to treatment [in Lithuanian]. Medicina (Kaunas) 2002; 38: 1057–65

    Google Scholar 

  77. Azorin JM, Kaladjian A, Fakra E. Current issues on schizoaffective disorder. Encephale 2005; 31: 359–65

    PubMed  Google Scholar 

  78. Levinson DF, Umapathy C, Musthaq M. Treatment of schizoaffective disorder and schizophrenia with mood symptoms. Am J Psychiatry 1999; 156: 1138–48

    PubMed  CAS  Google Scholar 

  79. Bartels SJ, Drake RE. Depressive symptoms in schizophrenia: comprehensive differential diagnosis. Compr Psychiatry 1988; 29: 467–83

    PubMed  CAS  Google Scholar 

  80. Leff J. Depressive symptoms in the course of schizophrenia. In: DeLisi LE, editor. Depression in schizophrenia. Washington, DC: American Psychiatric Press, 1990: 3–23

    Google Scholar 

  81. Stern MJ, Pillsbury JA, Sonnenberg SM. Postpsychotic depression in schizophrenia. Compr Psychiatry 1972; 13: 591–8

    PubMed  CAS  Google Scholar 

  82. Tollefson G, Sanger TM, Lu Y, et al. Depressive signs and symptoms in schizophrenia. Arch Gen Psychiatry 1998; 55: 250–8

    PubMed  CAS  Google Scholar 

  83. Kay SR, Sevy S. Pyramidal model of schizophrenia. Schizophr Bull 1990; 16: 537–45

    PubMed  CAS  Google Scholar 

  84. Jin H, Zisook S, Patterson TL, et al. Depressive symptoms, functioning, and well-being in older outpatients with schizophrenia. J Clin Psychiatry 2001; 62: 797–803

    PubMed  CAS  Google Scholar 

  85. Birchwood M, Mason R, MacMillan F, et al. Depression, demoralization and control over psychotic illness: a comparison of depressed and non-depressed patients with a chronic psychosis. Psychol Med 1993; 23: 387–95

    PubMed  CAS  Google Scholar 

  86. Tollefson GD, Andersen SW, Tran PV. The course of depressive symptoms in predicting relapse in schizophrenia: a double-blind, randomized comparison of olanzapine and risperidone. Biol Psychiatry 1999; 46: 365–73

    PubMed  CAS  Google Scholar 

  87. Zisook S, Nyer M, Kasckow JW, et al. Depressive symptom patterns in patients with chronic schizophrenia and subsyndromal depression. Schizophr Res 2006; 86: 226–33

    PubMed  Google Scholar 

  88. Zisook S, Montross L, Kasckow J, et al. Subsyndromal depressive symptoms in middle-aged and older persons with schizophrenia. Am J Geriatr Psychiatry 2007; 15(12): 1005–14

    PubMed  Google Scholar 

  89. Cohen CI, Talavera N, Hartung R. Predictors of subjective well being among older, community-dwelling persons with schizophrenia. Am J Geriatr Psychiatry 1999; 5: 145–55

    Google Scholar 

  90. Diwan S, Cohen CI, Bankole AO, et al. Depression in older adults with schizophrenia spectrum disorders: prevalence and associated factors. Am J Geriatr Psychiatry 2007; 15(12): 991–8

    PubMed  Google Scholar 

  91. Graham C, Arthus A, Howard R. The social functioning of older adults with schizophrenia. Aging Ment Health 2002; 6: 149–53

    PubMed  CAS  Google Scholar 

  92. Gupta S, Steinmeyer CH, Lockwood K, et al. Comparison of older patients with bipolar disorder and schizophrenia/schizoaffective disorder. Am J Geriatr Psychiatry 2007; 15: 627–33

    PubMed  Google Scholar 

  93. Kasckow J, Montross L, Golshan S, et al. Suicidality in middle aged and older patients with schizophrenia and depressive symptoms: relationship to functioning and quality of life. Int J Geriatr Psychiatry 2007; 22: 1223–8

    PubMed  CAS  Google Scholar 

  94. Taiminen T, Syvalahti E, Saarijarvi S, et al. Citalopram as an adjuvant in schizophrenia: further evidence for a serotonergic dimension in schizophrenia. Int Clin Psychopharmacol 1997; 12: 31–5

    PubMed  CAS  Google Scholar 

  95. Flores BH, Schatzberg AF. Psychotic depression In: Stein DJ, Kupfer D, Schatzberg AF, editors. Textbook of mood disorders. Washington, DC: American Psychiatric Publishing Inc., 2006: 561–71

    Google Scholar 

  96. Ohayon MM, Schatzberg AF. Prevalence of depressive episodes with psychotic features in the general population. Am J Psychiatry 2002; 159: 1855–61

    PubMed  Google Scholar 

  97. Coryell W, Pfohl B, Zimmerman M. The clinical and neuroendocrine features of psychotic depression. J Nerv Ment Dis 1984; 172: 521–8

    PubMed  CAS  Google Scholar 

  98. Meyers BS, Greenberg R. Late-life delusional depression. J Affect Disord 1986; 11: 133–7

    PubMed  CAS  Google Scholar 

  99. Kivela SL, Pahkala K, Laippala P. Prevalence of depression in an elderly population in Finland. Acta Psychiatr Scand 1988; 78: 401–13

    PubMed  CAS  Google Scholar 

  100. Ostling S, Skoog I. Psychotic symptoms and paranoid ideation in a nondemented population-based sample of the very old. Arch Gen Psychiatry 2002; 59: 53–9

    PubMed  Google Scholar 

  101. Schwartz JE, Fennig S, Tanenberg-Karant M, et al. Congruence of diagnoses 2 years after a first-admission diagnosis of psychosis. Arch Gen Psychiatry 2000; 57: 593–600

    PubMed  CAS  Google Scholar 

  102. Nelson JC, Charney DS. The symptoms of major depressive illness. Am J Psychiatry 1981; 138: 1–13

    PubMed  CAS  Google Scholar 

  103. Burch Jr EA, Anton RF, Carson WH. Mood congruent and incongruent psychotic depressions: are they the same? J Affect Disord 1994; 31: 275–80

    PubMed  Google Scholar 

  104. Leyton M, Corin E, Martial J, et al. Psychotic symptoms and vulnerability to recurrent major depression. J Affect Disord 1995; 33: 107–15

    PubMed  CAS  Google Scholar 

  105. Alexopoulos GS. Affective disorders. In: Sadavoy J, Lazarus LW, Jarvik LF, et al., editors. Comprehensive textbook of geriatric psychiatry. 2nd ed. Washington, DC: APA Press, 1996: 563–92

    Google Scholar 

  106. Pini S, Cassano GB, Dell’Osso L, et al. Insight into illness in schizophrenia, schizoaffective disorder, and mood disorders with psychotic features. Am J Psychiatry 2001; 158: 122–5

    PubMed  CAS  Google Scholar 

  107. Jeste DV, Heaton SC, Paulsen JS, et al. Clinical and neuropsychological comparison of psychotic depression with nonpsychotic depression and schizophrenia. Am J Psychiatry 1996; 153: 490–6

    PubMed  CAS  Google Scholar 

  108. Hill SK, Keshavan MS, Thase ME, et al. Neuropsychological dysfunction in antipsychotic-naive first-episode unipolar psychotic depression. Am J Psychiatry 2004; 161: 996–1003

    PubMed  Google Scholar 

  109. Mulsant BH, Haskett RF, Prudic J, et al. Low use of neuroleptic drugs in the treatment of psychotic major depression. Am J Psychiatry 1997; 154: 559–61

    PubMed  CAS  Google Scholar 

  110. Wijkstra J, Lijmer J, Balk F, et al. Pharmacological treatment for psychotic depression. Cochrane Database Syst Rev 2005 Oct 19; (4): CD004044

    Google Scholar 

  111. Meyers BS, Klimstra SA, Gabriele M, et al. Continuation treatment of delusional depression in older adults. Am J Geriatr Psychiatry 2001; 9: 415–22

    PubMed  CAS  Google Scholar 

  112. Flint AJ, Rifat SL. The treatment of psychotic depression in later life: a comparison of pharmacotherapy and ECT. Int J Geriatr Psychiatry 1998; 13: 23–8

    PubMed  CAS  Google Scholar 

  113. Birkenhager TK, Pluijms EM, Lucius SA. ECT response in delusional versus non-delusional depressed inpatients. J Affect Disord 2003; 74: 191–5

    PubMed  Google Scholar 

  114. Spiker DG, Stein J, Rich CL. Delusional depression and electroconvulsive therapy: one year later. Convuls Ther 1985; 1: 167–72

    PubMed  Google Scholar 

  115. O’Connor MK, Knapp R, Husain M, et al. The influence of age on the response of major depression to electroconvulsive therapy: a C.O.R.E. report. Am J Geriatr Psychiatry 2001; 9: 382–90

    PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by MH063931 (SZ), MH6398 (JK), the Veterans Integrated Services Network (VISN) 4 (JK) and VISN 22 (SZ) Mental Illness Research, Education and Clinical Centers, and the University of California, San Diego Center for Community-based Research in Older People with Psychoses (SZ). John Kasckow has acted as a consultant for, received honoraria from, and been a recipient of grant support from Forest, Pfizer, AstraZeneca, Lilly, Bristol-Myers Squibb, and Johnson and Johnson. Sidney Zisook is a consultant for GlaxoSmithKline, has received honoraria from GlaxoSmithKline, Forest, Pfizer, Wyeth and Eli Lilly, and has received grant support from Aspect Medical Systems, PamLab and the National Institute of Mental Health.

Author information

Authors and Affiliations

  1. VA Pittsburgh Health Care System; Behavioral Health, 7180 Highland Drive, Pittsburgh, Pennsylvania, 15206, USA

    John W. Kasckow

  2. Western Psychiatric Institute and Clinics, University of Pittsburgh Department of Psychiatry, Pittsburgh, Pennsylvania, USA

    John W. Kasckow

  3. VA San Diego Healthcare System, San Diego, California, USA

    Sidney Zisook

Authors
  1. John W. Kasckow
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sidney Zisook
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John W. Kasckow.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kasckow, J.W., Zisook, S. Co-Occurring Depressive Symptoms in the Older Patient with Schizophrenia. Drugs Aging 25, 631–647 (2008). https://doi.org/10.2165/00002512-200825080-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002512-200825080-00002

Keywords

Search

Navigation