Screen Schizophrenia Patients for Social Anxiety. (Treat as Separate Diagnosis)

Article excerpt

PHILADELPHIA -- Social anxiety is frequently comorbid with schizophrenia and should be treated as a separate diagnosis or symptom dimension with serious clinical consequences, according to speakers at the annual meeting of the American Psychiatric Association.

Various factors interfere with the assessment and appreciation of anxiety disorders, particularly social anxiety, in schizophrenic patients, said Dr. Stefano Pallanti of the University of Florence, Italy.

In the "hierarchy of psychopathologic diagnoses," the assessment process often ends with the identification of more serious illnesses, and there is a tendency to consider social anxiety symptoms as manifestations of psychosis, he said.

Research suggests, however, that social anxiety in patients with schizophrenia looks quite similar to its manifestations in other patients and bears no relation to psychotic symptoms. In his clinical and research experience, its prevalence in this population is between 20% and 30%, he said.

There was no significant difference between groups in scores on items that had to do with avoidance, performance anxiety, or social fear, even in areas like eye contact that would seem to be affected by schizophrenia. "We were surprised. We didn't think you could use the same scale for these patients," he said.

Dr. Pallanti reported a study in which 80 consecutive outpatients with a diagnosis of paranoid schizophrenia were evaluated with the Liebowitz Social Anxiety Scale (LSAS), a standard instrument. The 29 patients who were diagnosed with social anxiety disorder were compared with 27 consecutive outpatients with social anxiety disorder alone.

Compared with the other schizophrenia patients, the socially anxious group did not have more positive or negative symptoms, and there were no differences in age, gender, or age of onset. …