616.895.

807085

:

. . 1,2, . . 2
1-

. . . , 2
. - .
Lundbeck.
591
.

, ,
.
,
(49%) , 51%
. ,
.
3 : 1) 1 5 (21%
), 2) 5 10
(35%) 3) 10 (44%).
, ,
, .
, , 55%, 49%.

,
,
,
,
[2].

, . ,
7% 70% [15, 24]. , ,
-10, . ,
, , ,
,
, ,
[6,
7, 911, 19, 20]. , [25]. -,

, ,


.
-

.

.
34% .
(31 %
). , (25%).
, , , . ,
,
, , -

-

. 21 ,
, , 5

 5 . , 5 ,
21,3% ,
27,7% .
5 10
26,0% 31,6% . , >10 26,9% 31,9% .
.

. 1.
,
.
,
,
(. 2).


(61% ), (52%), -

(45%).
39% , 34%.
27% .
(. 3). , ,
,
51,6% , ,
39,5% .
,
38,8% , , 29,9% .

(34,2% 20,2% ).


(. 4).

. 1.

. 2. ,

. 3.

.
, , 40,9% ,

, 92,0%
, 10,6% ,
. -

,
, .
61% , , 89% , 35% .
14% ,
.

. 4.

. 5.

 ,
10
(20,8%),

(9,4% 7,3 %
1 5 5 10 ).


.

. ,
28,2% , , (86,3%)
, , . .


. 5 58,3%
, . 5 10

71,2%.
10
55,4% .
, ,
, , 1 5 (42,9%)
10 , 27,7% . 1
5 .
, , ,

( 67%)
-10 (68%). 12%
- .
, , ,

(42,6%
34,2%).

-10
(71,5% 10 59,8%
1 5 ).

(47,7% 10 30,7%
1 5 ).

. 6.

. 7. ,

 99,7%
,
,
.

. 1
5 (97% 100%
).

. 73%
.

(77,0% 69,1% ).
.

(90%), (86%), (83%),
(70%),
(50%), (41%). 35% . 14%

.
.
, . 1 5

25,2% 7,1% , 5 10 34,2% 14,6%,
10 41,2% 15,8%.
, -

[8, 13, 14, 1618, 21, 26].
,
,
, . , (82% )
.
18% .
12%,
, ,
2 (24%).

(. 7),
.
, ,
,
,
, .


,
,
.
,

(47%) .
(41,0% 1 5 , 46,5%
5 10 , , , 48,3%
10 ).
,

(98%). .
.

. 8.

. 9.

. 10.

. 11.

).
.


(. 11).
2% , 34%
. (55%)
, 9% ,

.

. 56% , 47%
, a 24%
.
, (20%)
.
, , (60,5% 51,5% 10

. 12.

. 13.
: ; ; .

44,9% 1 5
57% 5 10
10 , 45,7%, 31,7%
30,8% .
,

. , Lundbeck,
, .

.
50,1% , , , 39,5%
.

(58,8%), ,
, (29,2%).


. , 11

 ,
-10

. , .
. , . ,
.

. , (51,6%)
, , ,

. , , .
. , ,
. , S.G.Sirris
D.D.Addington . ,

25% ( 52%
39% ). 40% ,
(chronic stable schizophrenia) ( 27% ) [5, 23].
. ,
, ,
.
. ,
, ,
,
. , ,
. . ,

102% ( 100,
3 ),
(74%) (38%). , ,
10% .
.
3 , .
- . ,
.
,
.
(5 , 1
, 0 ).
3

.

.
,
- ,
, ,
.
(
,
,
).


.

,
.
,
.
, , ,
. 12

 [12].
.

,
. ,
,
, [22, 27], .

,
,
.
, ,

, ,
, .

. ,

,
. , , ,

, ,
.

,

. .

, ,
,
. ,
,
[4]. ,
, [2].
,
, .
, , ,
[1, 12, 22, 27].

,
. ,
,
.
,

,
.
,
. , ,


, ,

-

1. .., .. : ,
// . 2001. . 3, 1.
2. .. //
. ., 2007. . 106.
3. .., .., ..
: // . 2007. . 9, 6.
4. .. . .: , 2003. 432 .
5. Addington D.D., Azorin J.M., Falloon I.R.H. et al. Clinical issues
related to depression in schizophrenia: an international survey of psychiatrists // Acta Psychiatr. Scand. 2002. Vol. 105. P. 189195.
6. Caldwell C.B., Gottesman I.I. Schizophrenics kill themselves too: a
review of risk factors for suicide /// Schizophr. Bull. 1990. Vol. 16. P.
571589.

7. Fenton W.S. Depression, suicide, and suicide prevention in schizophrenia // Suicide Life Threat. Behav. 2000. Vol. 30. P. 3449.
8. Goldman R.S., Tandon R., Liberzon I., Greden J.F. Measurement of
depression and negative symptoms in schizophrenia // Psychopathology.
1992. Vol. 25. P. 4956.
9. Hafner H., Loffler W., Maurer K. et al. Depression, negative symptoms, social stagnation and social decline in the early course of schizophrenia // Acta Psychiatr. Scand. 1999. Vol. 100. P. 105118.
10. Harkavy-Friedman J.M., Restifo K., Malaspina D. et al. Suicidal
behavior in schizophrenia: characteristics of individuals who had and had
not attempted suicide // Am. J. Psychiatry. 1999. Vol. 156. P. 12761278.
11. Heila H., Isometsa E.T., Henriksson M.M. et al. Suicide and schizophrenia: a nationwide psychological autopsy study on age- and sex-specific clinical characteristic of 92 suicide victims with schizophrenia // Am.
J. Psychiatry. 1997. Vol. 154. P. 12351242.
12. Levinson D.F., Umapathy C., Musthaq M. Treatment of schizoaffective disorder and schizophrenia with mood symptoms // Am. J. Psychiatry. 1999. Vol. 156, N 8. P. 11381148.

13

13. Lindenmayer J., Grochowski S., Kay S.R. Schizophrenic patients

with depression: psychopathological profiles and the relationship with
negative symptoms // Compr. Psychiatry. 1991. Vol. 32. P. 528533.
14. Markou P. Depression in schizophrenia: a descriptive study // Aust.
N Z J. Psychiatry. 1996. Vol. 30. P. 354357.
15. McGlashan T.H., Carpenter W.T. Postpsychotic depression in schizophrenia // Arch. Gen. Psychiatry. 1976. Vol. 33. P. 231239.
16. Newcomer J.W., Faustman W.O., Yeh W., Csernansky J.G. Distinguishing depression and negative symptoms in unmedicated patients with
schizophrenia // Psychiatry Res. 1990. Vol. 31. P. 243250.
17. Norman R., Malla A.K. Correlations over time between dysphoric
mood and symptomatology in schizophrenia // Compr. Psychiatry. 1994.
Vol. 35. P. 3438.
18. Prosser E.S., Csernansky J.G., Kaplan J. et al. Depression, parkinsonian symptoms, and negative symptoms in schizophrenics treated with
neuroleptics // J. Nerv. Ment. Dis. 1987. Vol. 175. P. 100105.
19. Roy A., Thompson R., Kennedy S. Depression in chronic schizophrenia // Br. J. Psychiatry. 1983. Vol. 142. P. 465470.
20. Sands J.R., Harrow M. Depression during the longitudinal course
of schizophrenia // Schizophr. Bull. 1999. Vol. 25. P. 157171.

21. Siris S.G., Adan F., Cohen M. et al. Post psychotic depression and
negative symptoms: an investigation of syndromal overlap // Am. J.
Psychiatry. 1988. Vol. 145. P. 15321537.
22. Siris S.G. Depression in schizophrenia: Perspective in the era of
atypical antipsychotic agents // Am. J. Psychiatry. 2000. Vol. 157. P.
13791389.
23. Siris S.G. Depression in schizophrenia: recognition and management in the USA // Schizophr. Res. 2001. Vol. 47, N 23. P. 185197.
24. Siris S.G. Diagnosis of secondary depression in schizophrenia:
implications for DSM-IV // Schizophr. Bull. 1991. Vol. 17. P. 7598.
25. Stephens J.H., Astrup C., Mangrum J.C. Prognostic factors in recovered and deteriorated schizophrenics // Am. J. Psychiatry. 1966. Vol. 122,
N 10. P. 11161121.
26. Tapp A., Kilzieh N., Wood A.E. et al. Depression in patients with
schizophrenia during an acute psychotic episode // Compr. Psychiatry.
2001. Vol. 42, Suppl. 4. P. 314318.
27. Whitehead C., Moss S., Cardno A., Lewis G. Antidepressants for
the treatment of depression in people with schizophrenia: a systematic
review // Med. 2003. Vol. 33, N 4. P. 58999. Comment in: Evid. Based
Ment. Health. 2003. Vol. 6, N 4. P. 113.

. . , . .

, ,
, . 21 , .
,
-

. , ,
, .
,
.
: , , .

DEPRESSION IN SCHIZOPHRENIA: EXPERIENCES AND APPROACHES TO DIAGNOSIS AND

TREATMENT IN PSYCHIATRIC PRACTICE
G. E. Mazo, S. E. Gorbachyov
The authors have investigated the attitude of Russian psychiatrists,
both in in- and out-patient facilities, to the issue of diagnosis and treatment
of depression in schizophrenic patients by means of an inquiry. They analyzed the answers of doctors from different regions of the country to 21
questions on this subject. The results show certain differences in approaches towards diagnosis, prognosis and treatment of depression, which
depend on professional experience and the place of work of respondents.

It has been found that despite recommended in scientific papers restricted

use of antidepressants in schizophrenia, all practicing doctors choose for
adding antidepressants to antipsychotics. This choice cannot be evaluated
within evidence-based framework, but it is supported by daily clinical
practice.
Key words: schizophrenia, depression, diagnosis and treatment.

,
 . ..,  
; mail: galina_mazo@yandex.ru
 ;
mail: gorbach@bk.ru

14