Review ArticleAnxiety comorbidity in schizophrenia
Introduction
The phenomenological characterization of distinct anxiety subtypes in schizophrenia has been a challenge. Historically, diagnostic systems have been rooted in hierarchical reductionism, where the ostensibly more “severe” disorders take precedence over lower ranking ones (Hausmann and Fleischhacker, 2002). Similarly, the management of anxiety has presumptively been considered to be less important than the management of psychotic symptoms, with clinicians and researchers often viewing anxiety symptoms as being merely a byproduct of the psychosis and not being in any way a separate, co-existing, or important independent entity. Moreover, it has commonly been assumed that whatever influence anxiety disorders might exert on patients with schizophrenia would pale in comparison to the impact of the psychosis itself (Hausmann and Fleischhacker, 2002).
Nevertheless, symptoms of anxiety have long been described in patients with schizophrenia, and they are recognized as being a significant source of morbidity in this patient group (Bleuler, 1950, Braga et al., 2005, Buckley et al., 2009). Anxiety symptoms in schizophrenia can present in various ways, such as secondary phenomena to positive psychotic symptoms, a reactive manifestation to external circumstances, or as a discrete comorbid condition. Furthermore, this comorbidity can have profound effect on prognosis, functioning, and quality of life that is not directly correlated with positive or negative symptoms (Buckley et al., 2009, Hausmann and Fleischhacker, 2002, Siris and Bench, 2003).
The objective of the current paper is to review the available knowledge about anxiety comorbidity in schizophrenia, recognizing the term “anxiety” can be used to describe several different mental phenomena – an affect, a symptom, or one of several syndromes or diseases. Although the level of meaning intended for the term “anxiety” is often not clearly indicated in the literature, we will nevertheless do our best to describe findings in accordance with which concept of anxiety is involved.
Section snippets
Method
A computerized search of the literature published from 1966 to April 2012 was conducted on Pubmed/Medline using the words schizophrenia AND anxiety AND each anxiety disorder diagnosis listed in the DSM-IV, namely social phobia, post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), generalized anxiety disorder (GAD), panic disorder, specific phobia, and acute stress disorder. This overview was limited to papers written in English. Each reference was inspected to ensure that
Epidemiology
A number of studies have found increased rates of anxiety symptoms and syndromes in patients with schizophrenia. The literature shows higher prevalence rates than those typically reported in the general population for every anxiety disorder in patients within the schizophrenia spectrum. Initial reviews pointed out that most available studies consisted of clinical samples, with small number of subjects included, and due to that prevalence results are highly variable. For instance, studies
Discussion
Anxiety, either in the form of a symptom or in the form of one or more of the recognized anxiety syndromes, has been noted to occur commonly in the course of patients who are otherwise appropriately diagnosed as suffering from schizophrenia. The seven recognized anxiety syndromes potentially occurring in schizophrenia include OCD, panic, PTSD, social phobia, specific phobias, GAD and acute stress disorder. Additionally, anxiety can present as an isolated symptom, or be induced by untoward
References (93)
- et al.
Obsessive and compulsive symptoms in chronic schizophrenia
Comprehensive Psychiatry
(1995) - et al.
Anxiety disorders in outpatients with schizophrenia: prevalence and impact on the subjective quality of life
Journal of Psychiatry Research
(2005) - et al.
Anxiety disorders in schizophrenia
Comprehensive Psychiatry
(2004) - et al.
Posttraumatic stress disorder, cognitive function and quality of life in patients with schizophrenia
Psychiatry Research
(2008) - et al.
Panic attacks in schizophrenia
Schizophrenia Research
(2002) - et al.
Symptom structure of antipsychotic-induced obsessive compulsive symptoms in schizophrenia patients
Progress in Neuro-Psychopharmacology and Biological Psychiatry
(2012) - et al.
Cognitive behavioural group treatment for social anxiety in schizophrenia
Schizophrenia Research
(2003) - et al.
Association of delusions and lack of cognitive flexibility with social anxiety in schizophrenia spectrum disorders
Schizophrenia Research
(2006) - et al.
Deficits in theory of mind and social anxiety as independent paths to paranoid features in schizophrenia
Schizophrenia Research
(2010) - et al.
Lower levels of whole blood serotonin in obsessive-compulsive disorder and in schizophrenia with obsessive-compulsive symptoms
Psychiatry Research
(2007)
Obsessive-compulsive disorder and obsessive-compulsive symptoms in Japanese inpatients with chronic schizophrenia—a possible schizophrenic subtype
Psychiatry Research
Treating obsessive-compulsive disorder and schizophrenia: the case of sam
Cognitive and Behavioral Practice
Schizophrenia comorbid with panic disorder: evidence for distinct cognitive profiles
Psychiatry Research
Suicidality in schizophrenic patients with and without obsessive-compulsive disorder
Schizophrenia Research
Imipramine-responsive panic-like symptomatology in schizophrenia/schizoaffective disorder
Biological Psychiatry
Obsessive-compulsive disorder in schizophrenia
Journal of Psychiatric Research
Obsessive compulsive disorder and symptoms may have different effects on schizophrenia
Progress in Neuro-Psychopharmacology and Biological Psychiatry
Impact of panic attacks on quality of life among patients with schizophrenia
Progress in Neuro-Psychopharmacology and Biological Psychiatry
The many faces of akathisia
Comprehensive Psychiatry
Correlates, change and ‘state or trait’ properties of insight in schizophrenia
Schizophrenia Research
How prevalent are anxiety disorders in schizophrenia? A meta-analysis and critical review on a significant association
Schizophrenia Bulletin
Treatment of clozapine-induced obsessive-compulsive symptoms with sertraline
American Journal of Psychiatry
Panic attacks in chronic schizophrenia
British Journal of Psychiatry
Cognitive-behavioral treatment of panic attacks in chronic schizophrenia
Journal of Psychotherapy Practice and Research
Dementia Praecox or the Group of Schizophrenias (J. Zinkin, Trans.)
Psychiatric comorbidities and schizophrenia
Schizophrenia Bulletin
The impact of posttraumatic stress disorder on quality of life and health service utilization among veterans who have schizophrenia
Journal of Traumatic Stress
Efficacy of progressive muscle relaxation training in reducing anxiety in patients with acute schizophrenia
Journal of Clinical Nursing
Obsessive-compulsive and panic symptoms in patients with first-admission psychosis
American Journal of Psychiatry
Relationships between obsessive-compulsive symptomatology and severity of psychosis in schizophrenia: a systematic review and meta-analysis
Journal of Clinical Psychiatry
Anxiety interacts with expressed emotion criticism in the prediction of psychotic symptom exacerbation
Schizophrenia Bulletin
Neurocognitive function in schizophrenia with comorbid posttraumatic stress disorder
Journal of Clinical and Experimental Neuropsychology
Response to fluvoxamine augmentation for obsessive and compulsive symptoms in schizophrenia
Journal of Child and Adolescent Psychopharmacology
Clozapine-induced obsessive-compulsive syndromes improve in combination with aripiprazole
Clinical Neuropharmacology
Social phobia and panic disorder in psychotic patients: psychopharmacology series 6
Jornal Brasiliero de Psiquiatria
Exposure-based cognitive-behavioral treatment of PTSD in adults with schizophrenia or schizoaffective disorder: a pilot study
Journal of Anxiety Disorders
Aripiprazole in schizophrenia patients with comorbid obsessive-compulsive symptoms: an open-label study of 15 patients
Journal of Clinical Psychiatry
Patient psychopathology and expressed emotion in schizophrenia
British Journal of Psychiatry
Neurocognitive deterioration in elderly chronic schizophrenia patients with and without PTSD
Journal of Nervous and Mental Disease
Panic attacks in psychosis
Acta Psychiatrica Scandinavica
A cognitive-behavioural, group-based intervention for social anxiety in schizophrenia
Australian and New Zealand Journal of Psychiatry
Differential diagnosis of depressed mood in patients with schizophrenia: a diagnostic algorithm based on a review
Acta Psychiatrica Scandinavica
Relation of schizophrenia and panic disorder: evidence from a controlled family study
American Journal of Medical Genetics
Cognitive-behavioral treatment of panic in patients with schizophrenia: preliminary findings
Journal of Cognitive Psychotherapy
Anxiety and schizophrenia: the interaction of subtypes of anxiety and psychotic symptoms
CNS Spectrums
Treatment of schizophrenia with obsessive-compulsive features with serotonin reuptake inhibitors
American Journal of Psychiatry
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