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Treating depressive episodes or symptoms in patients with schizophrenia

机译：治疗精神分裂症患者的抑郁情节或症状

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摘要

Depressive episodes or symptoms occur frequently in patients with schizophrenia and may have far-reaching consequences. Despite the high prevalence rate and clinical relevance of this comorbidity, knowledge about treatment options is still limited. The aim of this review is to provide an overview of the literature concerning treatment options for depressive episodes or symptoms in schizophrenia. Based on the current evidence, we present a stepwise treatment approach. The first step is to evaluate the current antipsychotic treatment of psychotic symptoms and consider lowering the dosage, since increased blockade of the dopamine D2 receptors may be associated with a worse subjective sense of well-being and dysphoria. A second step is to consider switching antipsychotics, since there are indications that some antipsychotics (including sulpiride, clozapine, olanzapine, aripiprazole, quetiapine, lurasidone, or amisulpride) are slightly more effective in reducing depressive symptoms compared to other antipsychotics or placebo. In the case of a persistent depressive episode, additional therapeutic interventions are indicated. However, the evidence is indecisive regarding the treatment of choice: either starting cognitive-behavioral therapy or adding an antidepressant. A limited number of studies examined the use of antidepressants in depressed patients with schizophrenia showing modest effectiveness. Overall, additional research is needed to determine the most effective treatment approach for patients with schizophrenia and depressive episodes.
机译：抑郁发作或症状经常发生精神分裂症患者，并且可能具有深远的后果。尽管这种合并症的普及率和临床相关性，但关于治疗选择的知识仍然有限。本综述的目的是提供有关精神分裂症中抑郁发作或症状的治疗选择的文献概述。根据目前的证据，我们提出了一种逐步处理方法。第一步是评估当前的精神病症状的抗精神病药治疗，并且考虑降低剂量，因为多巴胺D2受体的增加可能与较差的主观幸福感和疑似感染。第二步是考虑切换抗精神病药，因为存在一些抗精神病药（包括硫吡啶，氯氮平，奥氮藻，喹喔啉，喹喔啉，喹喔啉或氨基丙酮）与其他抗精神科或安慰剂相比减少抑郁症状略有有效。在持续抑郁发作的情况下，表明了额外的治疗干预。然而，证据对选择的治疗方法是犹豫不决：开始认知行为治疗或添加抗抑郁药。有限数量的研究检测了在抑郁症患者中使用精神分裂症患者显示适度的有效性。总体而言，需要额外的研究来确定精神分裂症和抑郁发作患者最有效的治疗方法。

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