Post-schizophrenic depression (F20.4) is observed in at least 25% of patients (Knights A., Hirsch S., 1981). To diagnose it, it is necessary that the symptoms of depression as a consequence of a psychotic episode of schizophrenia last at least two years.
The factors contributing to the development of this variant of schizophrenia are loneliness, social isolation, depressive states in the family members of the patient.
Factors contributing to the development of postpsychotic depression
- Social factors: lack of work (employment), limited social contacts (loneliness), tense family environment (affective and personality disorders in family members), stigma of the diagnosis of “schizophrenia”
- Positive and negative symptoms
- Chronic alcohol intoxication and substance abuse
- Lack of compliance
- Side effects of antipsychotics: extrapyramidal symptoms (akathisia, akinesia, etc.), sedation, drowsiness, cognitive impairment, etc.
Despite the remark of E. Krepelin (1917) that in schizophrenia “emotions are silent”, E. Bleuler (1950) wrote that the gloomy state here is partly due to premorbid personality traits. Dysphoria increases markedly after awareness of the disease and understanding of its limiting impact on life.
According to the psychodynamic point of view of M. Kleine (1946), the breakdown of defense mechanisms leads to psychosis , and the reduction of these disorders in schizophrenia contributes to regression to the depressive phase.