Comorbid Anxiety Disorders and Persons with Schizophrenia

It might not come as a surprise to most that anxiety is often observed among patients diagnosed with schizophrenia. Frequently, anxiety may present as a component of schizophrenia (particularly during an acute psychotic episode), a result of an underlying organic condition, a medicinal side effect, or a symptom of a co-occurring anxiety disorder. Proper evaluation as well as accurate diagnosis can help with identifying the presence of anxiety in people with schizophrenia. However, before an accurate diagnosis can be made a comprehensive psychiatric examination, thorough medical history and physical examination must be conducted. As continuing research is done on schizophrenia, it is becoming more evident that many people with schizophrenia have a comorbid anxiety disorder. Interestingly, previous research conducted on schizophrenia suggests anxiety disorders amongst persons with schizophrenia patients is higher than in the general population.

Isolating and identifying anxiety in persons with schizophrenia can be difficult as symptoms related to anxiety typically appear without warning along with psychotic symptoms. Symptoms of anxiety may also appear in response to a psychotic episode, in response to a change in medication (increase or decrease), or as a side effect of antipsychotic medication.  

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 people diagnosed with schizophrenia and should not be ignored by treatment providers. By failing to properly identify anxiety disorders present in people with schizophrenia symptoms can become more pronounced and destabilizing to individual sufferers. Findings conducted on anxiety disorders present in persons with schizophrenia suggest accurate assessment is possible once symptoms are properly isolated from symptoms of psychosis, making a reduction in symptoms possible.

Mental health professionals have both identified as well as acknowledged the benefits of treating the “whole” person, rather than focusing on controlling the positive and negative symptoms associated with schizophrenia. Mental health providers are encouraged to focus on achieving appropriate overall functioning and an improved quality of life. Identifying comorbid anxiety disorders as potential treatment targets may contribute to more positive outcomes.

Unfortunately, for many years the presence of anxiety disorders present in people with schizophrenia has been highly underdiagnosed and undertreated. Under diagnosis and lack of appropriate treatment can lead to increased symptoms, confusion, and undue to distress for persons with schizophrenia, therefore, accurate diagnosis and effective treatment is important to reducing or eliminating symptoms.  

Signs of Schizophrenia Include:

·         Hallucinations

·         Inappropriate affect

·         Disorganized thinking

·         Delusions

·         Social withdrawal or self-isolating

·         Lack of emotional responsiveness

·         Lack of motivation

·         Apathy

·         Paranoia, suspiciousness, hostility

·         Difficulty concentrating

·         Unusual bodily movements

Signs of Anxiety Include:

·         Excessive worrying or apprehension

·         Irrational fears

·         Sweating

·         Trembling / shaking

·         Weakness or fatigue

·         Difficulty getting, or staying, asleep

·         Feelings of intense fear

·         A sense of danger, panic

Individuals with schizophrenia that include comorbid anxiety are more likely to benefit from cognitive behavioral therapy (CBT), individual psychotherapy, and antipsychotics that target anxiety or a combination of all three approaches to treatment.