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October 1990

Use of Antidepressants in Schizophrenia: Diagnostic Problems

Author Affiliations

Massachusetts Mental Health Center 74 Fenwood Rd Boston, MA 02115

Arch Gen Psychiatry. 1990;47(10):979. doi:10.1001/archpsyc.1990.01810220095017

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To the Editor.—  Kramer et al1 reported on a controlled trial of antidepressants in actively psychotic inpatients with DSM-III schizophrenia. Notably, all patients met Research Diagnostic Criteria (RDC)2 for schizoaffective disorder, the "mainly schizophrenic" subtype. This study amplifies others' observations3 that the RDC mainly schizophrenic subtype of schizoaffective disorder has a poor outcome. However, for the clinician in practice who is using the current DSM-III-R criteria, there is a dilemma: to which patients does this study apply?To be considered mainly schizophrenic in the RDC, the patient must have either of the following: "A. Core schizophrenic symptoms... were present for at least 1 week in the absence of... depressive features. B. Prior to the onset of the affective features, patient exhibited the following features which are often associated with schizophrenia: social withdrawal, impairment in occupational functioning, eccentric behavior, or unusual thoughts or perceptual experiences."If the

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