Anxiety in schizophrenia
- Samuel G Siris, MD
Samuel G Siris, MD
- Professor Emeritus of Psychiatry
- Hofstra University/Northwell Health
- Raphael J Braga, MD
Raphael J Braga, MD
- Assistant Professor of Psychiatry
- Hofstra University/Northwell Health
- Center for Treatment and Research of Bipolar Disorder
- The Zucker Hillside Hospital
Anxiety is frequently observed among patients with schizophrenia. Anxiety may present as a component of schizophrenia (particularly during an acute psychotic episode), a result of an underlying organic condition, a medication side effect, or a symptom of a co-occurring anxiety disorder. A thorough psychiatric examination, including a medical history and physical exam, and possibly intervention trials, may be needed to arrive at an accurate diagnosis. Treatment is based on this determination.
Posttraumatic stress disorder, which was redefined as a trauma-related disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), was previously studied in patients with co-occurring schizophrenia along with the anxiety disorders and is included in this topic.
The epidemiology, clinical manifestations, diagnosis, and treatment of anxiety in patients with schizophrenia are discussed here. Anxiety disorders and schizophrenia as individual, non-comorbid conditions are discussed separately. (See "Posttraumatic stress disorder in adults: Epidemiology, pathophysiology, clinical manifestations, course, assessment, and diagnosis" and "Obsessive-compulsive disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis" and "Generalized anxiety disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Social anxiety disorder in adults: Epidemiology, clinical manifestations, and diagnosis" and "Schizophrenia: Clinical manifestations, course, assessment, and diagnosis".)
A meta-analysis of 52 studies with a total of 4032 patients with a schizophrenia spectrum disorder found that 38.3 percent suffered from a comorbid anxiety disorder . Schizophrenia spectrum disorders include schizophrenia, schizoaffective, schizophreniform and delusional disorders, and psychosis not otherwise specified. Mean prevalence rates were as follows:
●Social anxiety disorder (social phobia) – 14.9 percent
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- CLINICAL MANIFESTATIONS
- ASSESSMENT AND INITIAL MANAGEMENT
- Differential diagnosis
- - Organic factors
- - Side effects of antipsychotics
- Obsessions and compulsions
- - Symptoms of schizophrenia
- - Anxiety disorders
- TREATMENT FOR CO-OCCURRING ANXIETY DISORDERS
- - Obsessive-compulsive disorder
- - Panic attacks
- - Social anxiety disorder
- - Other anxiety disorders
- Cognitive behavioral therapy
- SUMMARY AND RECOMMENDATIONS