Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-23T00:30:12.112Z Has data issue: false hasContentIssue false
  • English
  • Français

Depressive psychopathology in first-episode schizophrenia spectrum disorders: a systematic review, meta-analysis and meta-regression

Published online by Cambridge University Press:  16 September 2019

Sarah E. Herniman Open the ORCID record for Sarah E. Herniman [Opens in a new window] ,
Kelly Allott ,
Lisa J. Phillips ,
Stephen J. Wood ,
Jacqueline Uren ,
Sumudu R. Mallawaarachchi  and
Sue M. Cotton
Sarah E. Herniman*
Affiliation:
Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
Kelly Allott
Affiliation:
Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
Lisa J. Phillips
Affiliation:
Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
Stephen J. Wood
Affiliation:
Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia School of Psychology, University of Birmingham, Birmingham, UK
Jacqueline Uren
Affiliation:
Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
Sumudu R. Mallawaarachchi
Affiliation:
Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
Sue M. Cotton
Affiliation:
Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
*
Author for correspondence: Sarah E. Herniman, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Despite knowing for many decades that depressive psychopathology is common in first-episode schizophrenia spectrum disorders (FES), there is limited knowledge regarding the extent and nature of such psychopathology (degree of comorbidity, caseness, severity) and its demographic, clinical, functional and treatment correlates. This study aimed to determine the pooled prevalence of depressive disorder and caseness, and the pooled mean severity of depressive symptoms, as well as the demographic, illness, functional and treatment correlates of depressive psychopathology in FES.

Methods

This systematic review, meta-analysis and meta-regression was prospectively registered (CRD42018084856) and conducted in accordance with PRISMA and MOOSE guidelines.

Results

Forty studies comprising 4041 participants were included. The pooled prevalence of depressive disorder and caseness was 26.0% (seven samples, N = 855, 95% CI 22.1–30.3) and 43.9% (11 samples, N = 1312, 95% CI 30.3–58.4), respectively. The pooled mean percentage of maximum depressive symptom severity was 25.1 (38 samples, N = 3180, 95% CI 21.49–28.68). Correlates of depressive psychopathology were also found.

Conclusions

At least one-quarter of individuals with FES will experience, and therefore require treatment for, a full-threshold depressive disorder. Nearly half will experience levels of depressive symptoms that are severe enough to warrant diagnostic investigation and therefore clinical intervention – regardless of whether they actually fulfil diagnostic criteria for a depressive disorder. Depressive psychopathology is prominent in FES, manifesting not only as superimposed comorbidity, but also as an inextricable symptom domain.

Keywords

Casenesscomorbiditydepressiondisorderpsychosissymptoms
Type
Review Article
Information
Psychological Medicine , Volume 49 , Issue 15 , November 2019 , pp. 2463 - 2474
Copyright
Copyright © Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Addington, D, Addington, J and Schissel, B (1990) A depression rating scale for schizophrenics. Schizophrenia Research 3, 247–251.Google Scholar
Addington, D, Addington, J and Patten, S (1998) Depression in people with first-episode schizophrenia. The British Journal of Psychiatry 172, 90–92.Google Scholar
Addington, J, van Mastrigt, S, Hutchinson, J and Addington, D (2002) Pathways to care: help seeking behaviour in first episode psychosis. Acta Psychiatrica Scandinavica 106, 358–364.Google Scholar
Allott, KA, Yuen, HP, Garner, B, Bendall, S, Killackey, EJ, Alvarez-Jimenez, M, Phassouliotis, C, Markulev, C, Yun, Y, McGorry, PD and Phillips, LJ (2013) Relationship between vocational status and perceived stress and daily hassles in first-episode psychosis: an exploratory study. Social Psychiatry and Psychiatric Epidemiology 48, 1045–1052.Google Scholar
Arranz, B, San, L, Ramirez, N, Duenas, R, Perez, V, Salavert, J, Corripio, I and Alvarez, E (2009) Clinical and serotonergic predictors of non-affective acute remitting psychosis in patients with a first-episode psychosis. Acta Psychiatrica Scandinavica 119, 71–77.Google Scholar
Arrasate, M, Gonzalez-Ortega, I, Alberich, S, Gutierrez, M, Martinez-Cengotitabengoa, M, Mosquera, F, Cruz, N, Gonzalez-Torres, M, Henry, C and Gonzalez-Pinto, A (2014) Affective dimensions as a diagnostic tool for bipolar disorder in first psychotic episodes. European Psychiatry 29, 424–430.Google Scholar
Barrett, EA, Sundet, K, Faerden, A, Agartz, I, Bratlien, U, Romm, KL, Mork, E, Rossberg, JI, Steen, NE, Andreassen, OA and Melle, I (2010) Suicidality in first episode psychosis is associated with insight and negative beliefs about psychosis. Schizophrenia Research 123, 257–262.Google Scholar
Bath, PA, Deeg, D and Popellaars, J (2010) The harmonisation of longitudinal data: a case study using data from cohort studies in The Netherlands and the United Kingdom. Ageing and Society 30, 1419–1437.Google Scholar
Bendall, S, Allott, K, Johnson, T, Jackson, HJ, Killackey, E, Harrigan, S and McGorry, PD (2008) Pattern of lifetime axis I morbidity among a treated sample of first-episode psychosis patients. Psychopathology 41, 90–95.Google Scholar
Bertelsen, M, Jeppesen, P, Petersen, L, Thorup, A, Ohlenschlaeger, J, le Quach, P, Christensen, TO, Krarup, G, Jorgensen, P and Nordentoft, M (2007) Suicidal behaviour and mortality in first-episode psychosis: the OPUS trial. British Journal of Psychiatry – Supplementum 51, s140–s146.Google Scholar
Binder, J, Albus, M, Hubmann, W, Scherer, J, Sobizack, N, Franz, U, Mohr, F and Hecht, S (1998) Neuropsychological impairment and psychopathology in first-episode schizophrenic patients related to the early course of illness [Erratum appears in Eur Arch Psychiatry Clin Neurosci 1998;248(4):212]. European Archives of Psychiatry & Clinical Neuroscience 248, 70–77.Google Scholar
Birchwood, M, Iqbal, Z and Upthegrove, R (2005) Psychological pathways to depression in schizophrenia: studies in acute psychosis, post psychotic depression and auditory hallucinations. European Archives of Psychiatry and Clinical Neuroscience 255, 202–212.Google Scholar
Chang, WC, Pang, SL, Chung, DW and Chan, SS (2009) Five-year stability of ICD-10 diagnoses among Chinese patients presented with first-episode psychosis in Hong Kong. Schizophrenia Research 115, 351–357.Google Scholar
Chang, WC, Hui, CLM, Tang, JYM, Wong, GH, Lam, MM, Chan, SK and Chen, EYH (2011) Persistent negative symptoms in first-episode schizophrenia: a prospective three-year follow-up study. Schizophrenia Research 133, 22–28.Google Scholar
Chang, WC, Chen, ESM, Hui, CLM, Chan, SKW, Lee, EHM and Chen, EYH (2014) The relationships of suicidal ideation with symptoms, neurocognitive function, and psychological factors in patients with first-episode psychosis. Schizophrenia Research 157, 12–18.Google Scholar
Chang, WC, Cheung, R, Hui, CLM, Lin, JX, Chan, SKW, Lee, EHM and Chen, EYH (2015) Rate and risk factors of depressive symptoms in Chinese patients presenting with first-episode non-affective psychosis in Hong Kong. Schizophrenia Research 168, 99–105.Google Scholar
Chang, WC, Kwong, VWY, Chan, GHK, Jim, OTT, Lau, ESK, Hui, CLM, Chan, SKW, Lee, EHM and Chen, EYH (2017) Prediction of motivational impairment: 12-month follow-up of the randomized-controlled trial on extended early intervention for first-episode psychosis. European Psychiatry 41, 37–41.Google Scholar
Chen, DC, Wang, J, Wang, B, Yang, SC, Zhang, CX, Zheng, YL, Li, YL, Wang, N, Yang, KB, Xiu, MH, Kosten, TR and Zhang, XY (2009) Decreased levels of serum brain-derived neurotrophic factor in drug-naive first-episode schizophrenia: relationship to clinical phenotypes. Psychopharmacology 207, 375–380.Google Scholar
Chiappelli, J, Nugent, KL, Thangavelu, K, Searcy, K and Hong, LE (2014) Assessment of trait and state aspects of depression in schizophrenia. Schizophrenia Bulletin 40, 132–142.Google Scholar
Coentre, R, Talina, MC, Gois, C and Figueira, ML (2017) Depressive symptoms and suicidal behavior after first-episode psychosis: a comprehensive systematic review. Psychiatry Research 253, 240–248.Google Scholar
Conley, RR, Ascher-Svanum, H, Zhu, B, Faries, DE and Kinon, BJ (2007) The burden of depressive symptoms in the long-term treatment of patients with schizophrenia. Schizophrenia Research 90, 186–197.Google Scholar
Cotton, S, Gleeson, J, Alvarez-Jimenez, M and McGorry, P (2010) Quality of life in patients who have remitted from their first episode of psychosis. Schizophrenia Research 121, 259–265.Google Scholar
Cotton, S, Lambert, M, Schimmelmann, B, Mackinnon, A, Gleeson, J, Berk, M, Hides, L, Chanen, A, McGorry, P and Conus, P (2012) Depressive symptoms in first episode schizophrenia spectrum disorder. Schizophrenia Research 134, 20–26.Google Scholar
Cotton, SM, Lambert, M, Schimmelmann, BG, Mackinnon, A, Gleeson, JFM, Berk, M, Hides, L, Chanen, AM, Scott, J, Schottle, D, McGorry, PD and Conus, P (2013) Differences between first episode schizophrenia and schizoaffective disorder. Schizophrenia Research 147, 169–174.Google Scholar
Dai, J, Du, X, Yin, G, Zhang, Y, Xia, H, Li, X, Cassidy, R, Tong, Q, Chen, D, Teixeira, AL, Zheng, Y, Ning, Y, Soares, JC, He, M and Zhang, XY (2017) Prevalence, demographic and clinical features of comorbid depressive symptoms in drug naive patients with schizophrenia presenting with first episode psychosis. Schizophrenia Research 193, 182–187.Google Scholar
Ebdrup, BH, Raghava, JM, Nielsen, MO, Rostrup, E and Glenthoj, B (2016) Frontal fasciculi and psychotic symptoms in antipsychotic-naive patients with schizophrenia before and after 6 weeks of selective dopamine D2/3 receptor blockade. Journal of Psychiatry and Neuroscience 41, 133–141.Google Scholar
Emsley, R, Asmal, L, du Plessis, S, Chiliza, B, Kidd, M, Carr, J and Vink, M (2015) Dorsal striatal volumes in never-treated patients with first-episode schizophrenia before and during acute treatment. Schizophrenia Research 169, 89–94.Google Scholar
Garcia, M, Montalvo, I, Creus, M, Cabezas, A, Sole, M, Algora, MJ, Moreno, I, Gutierrez-Zotes, A and Labad, J (2016) Sex differences in the effect of childhood trauma on the clinical expression of early psychosis. Comprehensive Psychiatry 68, 86–96.Google Scholar
Gonzalez-Ortega, I, Alberich, S, Echeburua, E, Aizpuru, F, Millan, E, Vieta, E, Matute, C and Gonzalez-Pinto, A (2015) Subclinical depressive symptoms and continued cannabis use: predictors of negative outcomes in first episode psychosis. PLoS ONE 10, 1–12.Google Scholar
Gregory, A, Mallikarjun, P and Upthegrove, R (2017) Treatment of depression in schizophrenia: systematic review and meta-analysis. British Journal of Psychiatry 211, 198–204.Google Scholar
Helfer, B, Samara, MT, Huhn, M, Klupp, E, Leucht, C, Zhu, Y, Engel, RR and Leucht, S (2016) Efficacy and safety of antidepressants added to antipsychotics for schizophrenia: a systematic review and meta-analysis. American Journal of Psychiatry 173, 876–886.Google Scholar
Herniman, S, Allott, K, Killackey, E, Hester, R and Cotton, S (2017) The psychometric validity of the Center for Epidemiological Studies-Depression Scale (CES-D) in first episode schizophrenia spectrum. Psychiatry Research 252, 16–22.Google Scholar
Jager, M, Haack, S, Becker, T and Frasch, K (2011) Schizoaffective disorder – an ongoing challenge for psychiatric nosology. European Psychiatry 26, 159–165.Google Scholar
Kampman, O, Kiviniemi, P, Koivisto, E, Vaananen, J, Kilkku, N, Leinonen, E and Lehtinen, K (2004) Patient characteristics and diagnostic discrepancy in first-episode psychosis. Comprehensive Psychiatry 45, 213–218.Google Scholar
Koreen, AR, Siris, SG, Chakos, M, Alvir, J, Mayerhoff, D and Lieberman, J (1993) Depression in first-episode schizophrenia. American Journal of Psychiatry 150, 1643–1648.Google Scholar
Kraemer, HC, Noda, A and O'Hara, R (2004) Categorical versus dimensional approaches to diagnosis: methodological challenges. Journal of Psychiatric Research 38, 17–25.Google Scholar
Lee, SJ, Kim, KR, Lee, SY and An, SK (2017) Impaired social and role function in ultra-high risk for psychosis and first-episode schizophrenia: its relations with negative symptoms. Psychiatry Investigation 14, 539–545.Google Scholar
Majadas, S, Olivares, J, Galan, J and Diez, T (2012) Prevalence of depression and its relationship with other clinical characteristics in a sample of patients with stable schizophrenia. Comprehensive Psychiatry 53, 145–151.Google Scholar
McGorry, PD and Yung, AR (2003) Early intervention in psychosis: an overdue reform. Australian and New Zealand Journal of Psychiatry 37, 393–398.Google Scholar
Minor, KS, Friedman-Yakoobian, M, Leung, Y, Meyer, EC, Zimmet, SV, Caplan, B, Monteleone, T, Bryant, C, Guyer, M, Keshavan, MS and Seidman, LJ (2015) The impact of premorbid adjustment, neurocognition, and depression on social and role functioning in patients in an early psychosis treatment program. Australian and New Zealand Journal of Psychiatry 49, 444–452.Google Scholar
Moher, D, Shamseer, L, Clarke, M, Ghersi, D, Liberati, A, Petticrew, M, Shekelle, P and Stewart, LA and PRISMA-P Group (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews 4, 1–9.Google Scholar
Mutsatsa, SH, Joyce, EM, Hutton, SB and Barnes, TR (2006) Relationship between insight, cognitive function, social function and symptomatology in schizophrenia: the west London first episode study. European Archives of Psychiatry and Clinical Neuroscience 256, 356–363.Google Scholar
Noto, C, Ota, VK, Santoro, ML, Ortiz, BB, Rizzo, LB, Higuchi, CH, Cordeiro, Q, Belangero, SI, Bressan, RA, Gadelha, A, Maes, M and Brietzke, E (2015) Effects of depression on the cytokine profile in drug naive first-episode psychosis. Schizophrenia Research 164, 53–58.Google Scholar
O'Callaghan, E, Turner, N, Renwick, L, Jackson, D, Sutton, M, Foley, SD, McWilliams, S, Behan, C, Fetherstone, A and Kinsella, A (2010) First episode psychosis and the trail to secondary care: help-seeking and health-system delays. Social Psychiatry and Psychiatric Epidemiology 45, 381–391.Google Scholar
Ohmuro, N, Matsumoto, K, Katsura, M, Obara, C, Kikuchi, T, Hamaie, Y, Sakuma, A, Iizuka, K, Ito, F and Matsuoka, H (2015) The association between cognitive deficits and depressive symptoms in at-risk mental state: a comparison with first-episode psychosis. Schizophrenia Research 162, 67–73.Google Scholar
Oosthuizen, P, Emsley, RA, Roberts, MC, Turner, J, Keyter, L, Keyter, N and Torreman, M (2002) Depressive symptoms at baseline predict fewer negative symptoms at follow-up in patients with first-episode schizophrenia. Schizophrenia Research 58, 247–252.Google Scholar
Pawelczyk, T, Grancow-Grabka, M, Kotlicka-Antczak, M, Trafalska, E and Pawelczyk, A (2016) A randomized controlled study of the efficacy of six-month supplementation with concentrated fish oil rich in omega-3 polyunsaturated fatty acids in first episode schizophrenia. Journal of Psychiatric Research 73, 34–44.Google Scholar
Pena, J, Ojeda, N, Segarra, R, Eguiluz, JI, Garcia, J and Gutierrez, M (2011) Executive functioning correctly classified diagnoses in patients with first-episode psychosis: evidence from a 2-year longitudinal study. Schizophrenia Research 126, 77–80.Google Scholar
Potvin, S, Sepehry, AA and Stip, E (2007) Meta-analysis of depressive symptoms in dual-diagnosis schizophrenia. Australian and New Zealand Journal of Psychiatry 41, 792–799.Google Scholar
Riedel, M, Mayr, A, Seemller, F, Maier, W, Klingberg, S, Heuser, I, Klosterkotter, J, Gastpar, M, Schmitt, A, Sauer, H, Schneider, F, Gaebel, W, Jger, M, Moller, HJ and Schennach-Wolff, R (2012) Depressive symptoms and their association with acute treatment outcome in first-episode schizophrenia patients: comparing treatment with risperidone and haloperidol. World Journal of Biological Psychiatry 13, 30–38.Google Scholar
Roche, E, Clarke, M, Browne, S, Turner, N, McTuige, O, Kamali, M, Kinsellla, A, Larkin, C, Waddington, JL and O'Callaghan, E (2010) Prevalence and clinical correlates of depression in the acute phase of first episode schizophrenia. Irish Journal of Psychological Medicine 27, 15–18.Google Scholar
Romm, KL, Rossberg, JI, Berg, AO, Barrett, EA, Faerden, A, Agartz, I, Andreassen, OA and Melle, I (2010) Depression and depressive symptoms in first episode psychosis. Journal of Nervous and Mental Disease 198, 67–71.Google Scholar
Ruggeri, M, Bonetto, C, Lasalvia, A, Fioritti, A, de Girolamo, G, Santonastaso, P, Pileggi, F, Neri, G, Ghigi, D, Giubilini, F, Miceli, M, Scarone, S, Cocchi, A, Torresani, S, Faravelli, C, Cremonese, C, Scocco, P, Leuci, E, Mazzi, F, Pratelli, M, Bellini, F, Tosato, S, De Santi, K, Bissoli, S, Poli, S, Ira, E, Zoppei, S, Rucci, P, Bislenghi, L, Patelli, G, Cristofalo, D and Meneghelli, A (2015) Feasibility and effectiveness of a multi-element psychosocial intervention for first-episode psychosis: results from the cluster-randomized controlled GET UP PIANO trial in a catchment area of 10 million inhabitants. Schizophrenia Bulletin 41, 1192–1203.Google Scholar
Rush, JA, First, MB and Blacker, D (2008) Handbook of Psychiatric Measures. Washington, DC: American Psychiatric Association.Google Scholar
Sanchez-Gistau, V, Baeza, I, Arango, C, Gonzalez-Pinto, A, de la Serna, E, Parellada, M, Graell, M, Paya, B, Llorente, C and Castro-Fornieles, J (2015) The affective dimension of early-onset psychosis and its relationship with suicide. Journal of Child Psychology and Psychiatry 56, 747–755.Google Scholar
Sandhu, A, Ives, J, Birchwood, M and Upthegrove, R (2013) The subjective experience and phenomenology of depression following first episode psychosis: a qualitative study using photo-elicitation. Journal of Affective Disorders 149, 166–174.Google Scholar
Schultze-Lutter, F, Ruhrmann, S, Picker, H, von Reventlow, HG, Brockhaus-Dumke, A and Klosterkotter, J (2007) Basic symptoms in early psychotic and depressive disorders. British Journal of Psychiatry – Supplementum 51, s31–s37.Google Scholar
Shoval, G, Feld-Olspanger, J, Nahshoni, E, Gothelf, D, Misgav, S, Manor, I, Apter, A and Zalsman, G (2011) Suicidal behavior and related traits among inpatient adolescents with first-episode schizophrenia. Comprehensive Psychiatry 52, 596–599.Google Scholar
Siris, SG (2000) Depression in schizophrenia: perspective in the era of ‘atypical’ antipsychotic agents. American Journal of Psychiatry 157, 1379–1389.Google Scholar
Siris, SG and Bench, C (2003) Depression and schizophrenia. In Hirsch, SR and Weinberger, D (eds), Schizophrenia. Oxford, UK: Blackwell Publishing, pp. 142–167.Google Scholar
Slade, T, Johnston, A, Oakley Browne, MA, Andrews, G and Whiteford, H (2009) 2007 national survey of mental health and wellbeing: methods and key findings. Australian and New Zealand Journal of Psychiatry 43, 594–605.Google Scholar
Stouten, LH, Veling, W, Laan, W, van der Helm, M and van der Gaag, M (2014) Psychotic symptoms, cognition and affect as predictors of psychosocial problems and functional change in first-episode psychosis. Schizophrenia Research 158, 113–119.Google Scholar
Stowkowy, J, Addington, D, Liu, L, Hollowell, B and Addington, J (2012) Predictors of disengagement from treatment in an early psychosis program. Schizophrenia Research 136, 7–12.Google Scholar
Stroup, DF, Berlin, JA, Morton, SC, Olkin, I, Williamson, GD, Rennie, D, Moher, D, Becker, BJ, Sipe, TA and Thacker, SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283, 2008–2012.Google Scholar
Strous, RD, Maayan, R, Kaminsky, M, Blumensohn, R, Weizman, A and Spivak, B (2009) DHEA and DHEA-S levels in hospitalized adolescents with first-episode schizophrenia and conduct disorder: a comparison study. European Neuropsychopharmacology 19, 499–503.Google Scholar
Strous, RD, Bar, F, Keret, N, Lapidus, R, Kosov, N, Chelben, J and Kotler, M (2006) Analysis of Clinical Characteristics and Antipsychotic Medication Prescribing Practices of First-Episode Schizophrenia in Israel: A Naturalistic Prospective Study. Israel Journal of Psychiatry and Related Sciences 43, 2–9.Google Scholar
Tosato, S, Lasalvia, A, Bonetto, C, Mazzoncini, R, Cristofalo, D, De Santi, K, Bertani, M, Bissoli, S, Lazzarotto, L, Marrella, G, Lamonaca, D, Riolo, R, Gardellin, F, Urbani, A, Tansella, M and Ruggeri, M (2013) The impact of cannabis use on age of onset and clinical characteristics in first-episode psychotic patients. Data from the psychosis incident cohort outcome study (PICOS). Journal of Psychiatric Research 47, 438–444.Google Scholar
Upthegrove, R, Birchwood, M, Ross, K, Brunett, K, McCollum, R and Jones, L (2010) The evolution of depression and suicidality in first episode psychosis. Acta Psychiatrica Scandinavica 122, 211–218.Google Scholar
Upthegrove, R, Ross, K, Brunet, K, McCollum, R and Jones, L (2014) Depression in first episode psychosis: the role of subordination and shame. Psychiatry Research 217, 177–184.Google Scholar
Upthegrove, R, Marwaha, S and Birchwood, M (2017) Depression and schizophrenia: cause, consequence, or trans-diagnostic issue? Schizophrenia Bulletin 43, 240–244.Google Scholar
Wassink, TH, Flaum, M, Nopoulos, P and Andreasen, NC (1999) Prevalence of depressive symptoms early in the course of schizophrenia. The American Journal of Psychiatry 156, 315–316.Google Scholar
Weissman, MM, Scholomskas, D, Pottenger, M, Prusoff, BA and Locke, BZ (1977) Assessing depressive symptoms in five psychiatric populations: a validation study. American Journal of Epidemiology 106, 203–214.Google Scholar
Zabala, A, Bustillo, M, Querejeta, I, Alonso, M, Mentxaka, O, Gonzalez-Pinto, A, Ugarte, A, Meana, J, Gutierrez, M and Segarra, R (2017) A pilot study of the usefulness of a single olanzapine plasma concentration as an indicator of early drug effect in a small sample of first-episode psychosis patients. Journal of Clinical Psychopharmacology 37, 569–577.Google Scholar
Zalsman, G, Carmon, E, Martin, A, Bensason, D, Weizman, A and Tyano, S (2003) Effectiveness, safety, and tolerability of risperidone in adolescents with schizophrenia: an open-label study. Journal of Child & Adolescent Psychopharmacology 13, 319–327.Google Scholar
Zhao, T, Park, T, Yang, J, Huang, G, Kim, M, Lee, K and Chung, Y (2012) Efficacy and safety of ziprasidone in the treatment of first-episode psychosis: an 8-week, open-label, multicenter trial. International Clinical Psychopharmacology 27, 184–190.Google Scholar
Supplementary material: File

Herniman et al. supplementary material

Tables S1-S5 and Figures S1-S10

Download Herniman et al. supplementary material(File)
File 129.8 KB