C Dondé1,2,3, P Vignaud1,2,3, E Poulet1,2,3,4, J Brunelin1,2,3, F Haesebaert1,2,3,5,6. 1. INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: From Resistance to Response Team, Lyon, France. 2. University Lyon 1, Villeurbanne, France. 3. Centre Hospitalier Le Vinatier, Bron, France. 4. Department of Psychiatry Emergencies, CHU Lyon, Hôpital Edouard Herriot, Lyon, France. 5. CERVO Brain Research Center, Québec, QC, Canada. 6. Département de Psychiatrie et Neurosciences, Faculté de Médecine, Université Laval, Québec, QC, Canada.
Abstract
OBJECTIVES: Depression is a frequent but potentially treatable clinical dimension in patients with schizophrenia spectrum disorders (PWS). However, there is a lack of consensual recommendations regarding the optimal strategy to manage depression in PWS. In this study, we aimed to compare the various proposed strategies to define a core set of valid care recommendations for depression management in PWS. METHODS: After a systematic search of the literature, the methodological quality of 10 international guidelines from four continents was compared using a validated guideline appraisal instrument (AGREE II). Key recommendations for the management of depression in PWS were subsequently reviewed and discussed. RESULTS: The methodological quality of the guidelines was heterogeneous. Although all guidelines proposed pharmacotherapy, psychosocial interventions were a minor concern. Waiting for antipsychotic effects mostly was recommended during the acute phase of schizophrenia. During the postpsychotic phase of the illness, a switch to a second-generation antipsychotic and/or the adjunction of an antidepressant were the primary recommendations. Cognitive behavioural therapy and other medications were considered with strong variations. CONCLUSIONS: Further studies are needed to strengthen the level of evidence for antidepressive approaches in PWS. The inclusion of PWS as stakeholders is also considered to be a major issue for future guideline development.
OBJECTIVES:Depression is a frequent but potentially treatable clinical dimension in patients with schizophrenia spectrum disorders (PWS). However, there is a lack of consensual recommendations regarding the optimal strategy to manage depression in PWS. In this study, we aimed to compare the various proposed strategies to define a core set of valid care recommendations for depression management in PWS. METHODS: After a systematic search of the literature, the methodological quality of 10 international guidelines from four continents was compared using a validated guideline appraisal instrument (AGREE II). Key recommendations for the management of depression in PWS were subsequently reviewed and discussed. RESULTS: The methodological quality of the guidelines was heterogeneous. Although all guidelines proposed pharmacotherapy, psychosocial interventions were a minor concern. Waiting for antipsychotic effects mostly was recommended during the acute phase of schizophrenia. During the postpsychotic phase of the illness, a switch to a second-generation antipsychotic and/or the adjunction of an antidepressant were the primary recommendations. Cognitive behavioural therapy and other medications were considered with strong variations. CONCLUSIONS: Further studies are needed to strengthen the level of evidence for antidepressive approaches in PWS. The inclusion of PWS as stakeholders is also considered to be a major issue for future guideline development.
Authors: Max Birchwood; Rachel Upthegrove; Siân Lowri Griffiths; Samuel P Leighton; Pavan Kumar Mallikarjun; Georgina Blake; Linda Everard; Peter B Jones; David Fowler; Joanne Hodgekins; Tim Amos; Nick Freemantle; Vimal Sharma; Max Marshall; Paul McCrone; Swaran P Singh Journal: Transl Psychiatry Date: 2021-11-06 Impact factor: 6.222