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An Investigation Into the Depressive Symptomatology of Paranoid and Nonparanoid Schizophrenic Patients

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An Investigation Into the Depressive Symptomatology of Paranoid and Nonparanoid Schizophrenic Patients University of Calgary PRISM: University of Calgary's Digital Repository Graduate Studies Legacy Theses 1996 An investigation into the depressive symptomatology of paranoid and nonparanoid schizophrenic patients Candido, Carmie Lester Candido, C. L. (1996). An investigation into the depressive symptomatology of paranoid and nonparanoid schizophrenic patients (Unpublished doctoral thesis). University of Calgary, Calgary, AB. doi:10.11575/PRISM/24478 http://hdl.handle.net/1880/29325 doctoral thesis University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission. Downloaded from PRISM: https://prism.ucalgary.ca THE UNIVERSITY OF CALGARY An Investigation into the Depressive Symptomatology of Paranoid and Nonparanoid Schuophrenic Patients by Cannie Lester Candido A DISSERTATION SUBMïITED TO TEE FACULTY OF GRADUATE STUDIES IN PARTIAL FIKSXLMENT OF TRE REQWREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY PROGRAMME IN CLMICAL PSYCHOLOGY CALGARY, ALBERTA NOVEMBER, 1996 Carmie Lester Candido 1996 Acquisitions and Acquisitions et Bibliographie aivices services bibliographiques The author has granted a non- L'auîeur a accordé une licence non exclusive licence allowing the exclusive permettant à la National Liirary of Caoada to Bibliothèqpe naîionaie du Canada de reproduce, loan, distn'bute or seU reproduite, prêter, distri'buer ou copies of Merthesis by any means vendre des copies de sa thèse de and in any fom or format., making qyelqye manière et sous quelp this thesis adable to interested forme que ce soit pour mettre des persons. exemplaires de cette thèse à la disposition des personnes intéressées. The author retains ownership of the L'auteur CO-e la propriété du copyright in Merthesis. Neither droit d'auteur qui protège sa thèse. Ni the thesis nor substantial extracts la thèse ni des extraits substantiels de fiom it may be printed or otherwise celle-ci ne doivent être imprimés ou reproduced with the author's autrement reproduits sans son permission. autorisation. ABSTRACT Depression among schwphrenics is a reIatively cornmon occurrence throughout the various phases of the illness, but postpsychotic depression occurs in about 25% of cases. The current study was undertaken in order to examine the ciifferences in depressive symptomatology (cognitive, affkctive, somatic, motivational) between depressed paranoid and nonparanoid schizophrenïc patients compared to a group of patients with nonpsychotic majar depression. In addition, positive and negative symptoms including anhedonia were compared among the groups to examine the relationship of positive and negative symptoms to depressive symptoms. Hospital and commun.@ based setthgs were used to recruit three groups of 27 subjects inciuding a group of paranoid scbphrenics (24 male, 3 female), nonparanoid schizophrenics (18 male, 9 female), and major depressives (13 male, 14 female). All schizophrenic patients had to have a minimal level of depressive symptoms (Le., a score of 10 or more on the BDI to be included in the study). Several hypotheses were tested with respect to ciifferences in severity and profile of depressive symptoms, dong with self-esteem, positive, negative, and anhedonia symptoms. A psychiatrie history was obtained dong with a thorough medical chart review for each patient and all patients completed several self-report and clinician- rated scales. The results indicated that the paranoid schizophrenics exhibited more severe depression in all aspects (cognitive, affective, somatic, and motivational) and more positive symptoms than nonparanoid schizophrenics. In addition, the depressive iii symptom profies of the paranoid schuophrenia and major depression patients were more simüar than any other of the two group comparïsons. Conw to what was expected, however, the nonparanoid xhizophrenics did not show more anhedonia or negative symptoms than the paranoid schizophrenics. Rather, there was a nonsignificant trend for the paranoid schizophrenics to have more anhedonia than nonparanoid schitophrenics and a trend for the major depressives to have the most. These findhgs were discussed in relation to the etio10gica.i theones of depression in schizophrenïa, the fiterahire on positive, negative, and anhedonia symptoms, paranoidfnonparanoid dichotomy, Zigler's and Glick's unozthodox view of paranoid schizophrenia, and suicide. In addition, they were discussed in relation to medication usage and sociodemographic data. Finally, the limitations of the study, and its theoretical and clinical implications were also considered, and recommendations were made for future research. ACKNOWLEDGEMENTS 1 wish to express my sincere th& to Dr. David M. Romney, my dissertation supe~sor,for his support and aitical appraisal of this research. 1 will always remember his brilliance, encouragement, and support. I would also iike to thank Dr. R.W.J. Neufeld, extenial examiner, Dr. J.R* McDondd, Faculty of Social Work, aad to all members of the supervisory cornmittee: Drs. D.E. Addington and W. G. McElheran, for their interest in this research. 1 am very grateN to Drs. R. Williams, R. Fairbah, H. Colohan, R. Dickson, P. Lam, N. Singh, S. Boucher. D. Dawson, M. Dumka, G. McDougall, A. Chuang, and other clinical and nushg staff of the Bow Valley Centre, Alberta Mental Health SeMces, and Claresholm Care Centre for theu help with patient recruitment. 1 am also grateful to Dr. T. Fung for his help with the statistical analyses. Special thanks go to the Programme in Clùiical Psychology and the Department of Educational Psychology for providing me with financial support during my studies and Donna Russell and Dolores Clarkson for their unfailing dependability and time in the typing of this dissertation. Perhaps most importantly, I wish to thank ail of the people who volunteerai to participate as subjects in this research. For their trust and patience 1 am m>ly grateful. Finally, I would like to thank my wife, Marlene, and children, Evan and Andrea, for their constant love, support, encouragement, and tolerance. Maine Scale ........................ 111 Positive and Negative Syndrome Scale ............................ 113 Revised Physicai and Social Anhedonia Scaies ........................... 114 Measurement of SuicideIRisk Potentiai .......................... 116 Ptocedure ........................................ 116 Data Analyses ...................................... 119 CHAPTER FOUR RESULTS ............................................ 122 Sociodemographic Variables ............................ 122 Diagnostic Classification ............................... 126 Tests ofHypotheses .................................. 133 Use of Medications .................................. 168 General Psychopathology .............................. 177 Gender Effects ..................................... 182 Correlational Analyses ................................ 184 Measures of Depression,Self.Esteern, and Suicide Risk ............................... 184 Measures of Depression, SelfXsteem, Suicide Risk, and Positive Symptoms (PANSS and Maine Scale) ......................... 187 Measures of Depression, Self-Esteem Suicide Risk, and Negative Symptoms (PANSS and Anhedonia Scales) ..................... 191 Measures of Depression, Self-Esteem, Suicide Risk, and Generai Psychopathology (PANSS) .................................... 195 Measures of Positive and Negative Symptorns ............. 199 Measures of Positive, Negative and General Psychopathology Symptoms ........................ 206 Factor Analysis .................................... 212 Measures of Generai Psychopathology (PANSS) ........... 212 Correlations Among Medications and the Symptom Measures .................................. 215 CHAPTER FIE DISCUSSION .......................................... 224 Sociodemographic Variables ............................ 224 Diagnostic Classification ............................... 229 Ayoireses ....................................... 231 Usv ;i Medication ................................... 260 General Psychopathology .......................... 264 Gender Effects ..................................... 268 Correlational Analyses ................................ 272 Measures of Depression, SeIf.Esteem. and Suicide Risk ...... 272 Measures of Depression, SeIGEsteem. Suicide Risk, lad Positive Symptoms ........................... 274 Measures of Depression. SeIf.Esteem .Suicide Risk. and Negative Symptoms .......................... 277 Measures of Depression. SelfXsteem. Suicide Eüsk. and General Psychopathology ....................... 280 Measures of Positive and Negative Spptom ............. 282 Measures of Positive. Negative and General Psychopathology Symptoms ........................ 287 Measures of Generai Psychopathology ................. 289 Factor Analysis .................................... 289 Corrdationd Analyses of MedicaciCo~and Symptom Measures ...... 292 nieoretical and Clinid Impiications ....................... 293 Limitations of the Study ............................... 299 Recommendations for Future Research ...................... 300 Summary and ConcIusions .............................. 301 APPENDICES ............................................... 352 LIST OF TABLES Means and Standard Deviatons for Age aad Duration of IlInes ..........
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