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Depressive symptoms are associated with (sub)clinical psychotic symptoms in patients with non-affective psychotic disorder, siblings and healthy controls

Published online by Cambridge University Press:  18 July 2012

R. M. C. Klaassen*
Rivierduinen Mental Health, Leiden, The Netherlands AMC Academic Medical Centre, Amsterdam, The Netherlands
M. Heins
Maastricht University Medical Centre, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht, The Netherlands
L. B. Luteijn
Rivierduinen Mental Health, Leiden, The Netherlands
M. van der Gaag
Parnassia Psychiatric Institute, The Hague, The Netherlands VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
N. J. M. van Beveren
Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, The Netherlands Delta Centre for Mental Health Care, Department ‘Nieuwe Kennis’, Rotterdam, The Netherlands Department of Neuroscience, Erasmus University Medical Centre, Rotterdam, The Netherlands
*Address for correspondence: R. M. C. Klaassen, M.D., Department of Child and Adolescent Psychiatry, Rivierduinen, Albinusdreef 6, 2301 CE, Leiden, The Netherlands. (Email:



Depression is a clinically relevant dimension, associated with both positive and negative symptoms, in patients with schizophrenia. However, in siblings it is unknown whether depression is associated with subclinical positive and negative symptoms.


Depressive symptoms and their association with positive and negative symptoms were examined in 813 healthy siblings of patients with a non-affective psychotic disorder, 822 patients and 527 healthy controls. Depressive episodes meeting DSM-IV-TR criteria (lifetime) and depressed mood (lifetime) were assessed with the Comprehensive Assessment of Symptoms and History (CASH) in all three groups. In the patient group, the severity of positive and negative psychosis symptoms was assessed with the CASH. In the siblings and healthy controls, the severity of subclinical psychosis symptoms was assessed with the Community Assessment of Psychic Experiences (CAPE).


Patients reported more lifetime depressed mood and more depressive episodes than both siblings and controls. Siblings had a higher chance of meeting lifetime depressive episodes than the controls; no significant differences in depressed mood were found between siblings and controls. In all three groups the number and duration of depressive symptoms were associated with (sub)clinical negative symptoms. In the patients and siblings the number of depressive symptoms was furthermore associated with (sub)clinical positive symptoms. Finally, lifetime depressed mood showed familial clustering but this clustering was absent for lifetime depressive episodes.


These findings suggest that a co-occurring genetic vulnerability for both depressive and psychotic symptomatology exists on a clinical and a subclinical level.

Original Articles
Copyright © Cambridge University Press 2012

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Depressive symptoms are associated with (sub)clinical psychotic symptoms in patients with non-affective psychotic disorder, siblings and healthy controls
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