Anxiety and Schizophrenia

As continuing research is done on schizophrenia, it is becoming more evident that many schizophrenics have a comorbid anxiety disorder. In fact, research is showing that the prevalence of anxiety disorders amongst schizophrenic patients is higher than in the general population ^{1 2}. A study which reviewed the literature from 1966 until 2004 showed that anywhere from 30% to 85% of individuals with schizophrenic spectrum disorders (schizophrenia and similar disorders) had an anxiety disorder at some point in their lifetime. Their research also showed that in at least half of the patients, the anxiety disorder was present prior to the first psychotic episode ².

Diagnosing anxiety in schizophrenia can be tricky. For example, the anxiety may appear spontaneously with the psychotic symptoms. Also, it may be a direct response to the psychosis or come and go during a psychotic episode. Additionally, symptoms of anxiety can be a side effect of antipsychotic drugs prescribed for schizophrenia ¹.

Anxiety disorders including generalized anxiety disorder (GAD), social anxiety disorder (SAD), post traumatic stress disorder (PTSD), panic disorder, and obsessive-compulsive disorder (OCD) are often present in schizophrenic patients and should not be ignored by treatment providers.

Social Anxiety Disorder

SAD can be especially disabling in schizophrenic individuals. It is quite prevalent amongst schizophrenics - some research has shown that between 10% and 20% of schizophrenic patients also have SAD ³. One theory about this high rate of comorbidity is that dopaminergic dysfunction may be involved in the development of both disorders. Unfortunately, when SAD is also present, the schizophrenic patient is even more likely to withdraw socially and have even greater difficulty functioning in social situations.

Schizophrenic individuals who have SAD are more likely to have a history of alcohol and substance abuse. They are more likely to attempt suicide, and do so using more lethal means than schizophrenics who do not have SAD ⁴.

OCD

Studies on OCD in schizophrenic individuals suggest that anywhere from 10% to 25% have OCD symptoms, with around 15% actually meeting the criteria for an OCD diagnosis ⁵. Schizophrenics who have symptoms of OCD tend to be more impaired in terms of thinking, motor skills, and social functioning ².

It has been suggested by some researchers that a separate category be made for these individuals ⁶. The term “schizo-obsessive disorder” has been suggested for this category ⁷.

Panic Disorder

Research has shown that schizophrenic individuals who also have panic symptoms are more inclined towards suicide. Also, they tend to use treatment services more often than schizophrenic patients who don’t have panic symptoms ².

written by Dr. Cheryl Lane, PsyD

References

1. Psychiatric Comorbidities and Schizophrenia: Schizophrenia and Anxiety
2. Prevalence of Comorbid Anxiety Disorders in Schizophrenia Spectrum Disorders: A Literature Review
3. Schizophrenia and Social Anxiety Disorder (2003)
4. Social Anxiety in Outpatients With Schizophrenia: A Relevant Cause of Disability
5. OCD and Schizophrenia
6. Comorbidity: Schizophrenia With Obsessive-Compulsive Disorder (2009)
7. Comorbidity and pathophysiology of obsessive–compulsive disorder in schizophrenia: Is there evidence for a schizo-obsessive subtype of schizophrenia?