Depressive symptoms and their influence and predictive validity on treatment outcome in patients with first-episode schizophrenia

Background: To evaluate depressive symptoms regarding their predictive validity on treatment outcome in patients with first-episode schizophrenia. Methods: 275 patients were analysed within a double-blind randomized controlled trial and treated with risperidone or haloperidol. The patients were grouped according to their baseline HAMD-21 total score in either „depressive“ (HAMD-21 >16) or „not depressive“ (HAMD-21 ≤16) patient subgroups. Weekly PANSS, HAMD-21 and AIMS ratings were performed. Early response was defined as a 20% reduction of the PANSS total score from admission to week 2, response as a 40% reduction of the PANSS total score to discharge and remission according to the criteria of the Remission in Schizophrenia Working Group. Results: 124 patients (45%) were classified as depressive at baseline with 22 of these patients (18%) still being depressive at discharge. No significant differences were found regarding the antipsychotic treatment applied. The depressive patients scored significantly higher on the PANSS total score and all PANSS subscales at baseline and discharge (p<0.001). Depressive symptoms were revealed to be a significant predictor for remission, but not for response. Conclusion: Almost 10% of the assessed patients were still depressive at discharge underlining the importance of adequately treating depressive symptoms. Less depressive symptoms were significantly associated with achieving remission.