Correlates and management of comorbid anxiety disorders in schizophrenia

BACKGROUND: Only a few studies have examined the treatability of anxiety disorders in schizophrenia, even though it is generally accepted that in the absence of schizophrenia, the anxiety disorders are safely and effectively treatable. AIM: The aim of this study was to study the relation of anxiety disorders with the positive and negative symptoms of schizophrenia and the effect of treatment of different anxiety disorders in schizophrenia patients. MATERIALS AND METHODS: The study was carried out on inpatients of a tertiary care psychiatric hospital using a purposive sampling technique. The schizophrenia patients were evaluated for psychopathology and the presence of anxiety disorder at baseline. After being prescribed with antipsychotic medication in a suitable dose for 8 weeks, they were followed up at monthly intervals for the course of both schizophrenia and anxiety disorders. Thereafter, an selective serotonin reuptake inhibitor (SSRI) was also prescribed to the schizophrenia patients with comorbid anxiety disorder, and the patients were again followed up for a period of 8 weeks to assess the progress of schizophrenia and anxiety disorder. RESULTS: The prevalence of anxiety disorder in 93 schizophrenia patients included in the present study was 45.16%. The most common comorbid anxiety disorders in schizophrenia patients were panic disorder (18.27%), social anxiety disorder (9.68%), obsessive-compulsive disorder (8.60%), and agoraphobia (6.45%). Schizophrenia patients with anxiety disorder had a significantly higher positive score of the Positive and Negative Symptom Scale for Schizophrenia (PANSS) and a significantly lower score on the negative scale and the general psychopathology scale of the PANSS, as compared to the scores of the schizophrenia group without anxiety disorders. Schizophrenia patients with anxiety disorders responded well to the combination of SSRIs and antipsychotics but not antipsychotics alone. CONCLUSIONS: Comorbid anxiety disorders are common in schizophrenia. Schizophrenia patients with anxiety disorders differ significantly from those without anxiety disorders in their basic psychopathology. These anxiety disorders are quite responsive to the SSRIs but not to antipsychotics alone. Further, there is a shorter duration of illness in schizophrenia patients with anxiety disorders as compared to schizophrenia patients without anxiety disorders assigning a prognostic significance to the presence of comorbid anxiety disorders in schizophrenia.