Occurrence and clinical correlates of psychiatric comorbidity in patients with psychotic disorders
Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnology, University of Pisa, Italy. The Journal of Clinical Psychiatry
(Impact Factor: 5.5).
The aim of this study was to explore patterns and clinical correlates of psychiatric comorbidity in patients with schizophrenia spectrum disorders and mood spectrum disorders with psychotic features.
Ninety-six consecutively hospitalized patients with current psychotic symptoms were recruited and included in this study. Index episode psychotic diagnosis and psychiatric comorbidity were assessed using the Structured Clinical Interview for DSM-III-R-Patient Version (SCID-P). Psychopathology was assessed by the SCID-P, Brief Psychiatric Rating Scale, Scale for the Assessment of Negative Symptoms, and Hopkins Symptom Checklist. Awareness of illness was assessed with the Scale to Assess Unawareness of Mental Disorders.
The total lifetime prevalence of psychiatric comorbidity in the entire cohort was 57.3% (58.1% in schizophrenia spectrum disorders and 56.9% in mood spectrum psychoses). Overall, panic disorder (24%), obsessive-compulsive disorder (24%), social phobia (17.7%), substance abuse (11.5%), alcohol abuse (10.4%), and simple phobia (7.3%) were the most frequent comorbidities. Within the group of mood spectrum disorders, negative symptoms were found to be more frequent among patients with psychiatric comorbidity than among those without comorbidity, while such a difference was not detected within the group of schizophrenia spectrum disorders. Social phobia, substance abuse disorder, and panic disorder comorbidity showed the greatest association with psychotic features. An association between earlier age at first hospitalization and comorbidity was found only in patients with unipolar psychotic depression. Patient self-reported psychopathology was more severe in schizophrenia spectrum patients with comorbidity than in those without, while such a difference was less pronounced in mood spectrum psychoses.
These findings suggest that psychiatric comorbidity is a relevant phenomenon in psychoses and is likely to negatively affect the phenomenology of psychotic illness. Further studies in larger psychotic populations are needed to gain more insight into the clinical and therapeutic implications of psychiatric comorbidity in psychoses.
Available from: Philip L Jackson
- "People with schizophrenia (SZ) display important rates of comorbid anxiety disorders (Kendler et al., 1996; Cassano et al., 1998; Cosoff and Hafner, 1998; Pallanti et al., 2004; Voges and Addington, 2005) and yet we know little about the relationship of these comorbid disorders with other aspects of schizophrenia such as positive or negative symptoms, cognitive deficits, and functioning. Among anxiety disorders, social anxiety disorder (SAD) seems particularly important as it was identified as the most prevalent comorbid anxiety disorder in people with SZ in a recent meta-analysis (Achim et al., 2011a), with a pooled prevalence of 14.9%, a rate much higher than in the general population (3.6%) (Somers et al., 2006). "
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ABSTRACT: Schizophrenia patients display important rates of comorbid social anxiety disorder (SAD) but few studies have directly examined how SAD affects the presentation of schizophrenia, notably social cognition deficits and functioning.
To compare social cognition performance of schizophrenia patients who meet the diagnostic criteria for a comorbid SAD (SZ+) relative to patients without such comorbidity (SZ-) and to determine if the impact of social cognition performance on functioning is moderated by that comorbidity.
Social cognition performance (emotion recognition, social knowledge, and mentalizing), a control non-social reasoning task, as well as clinical symptoms and functioning were assessed in 26 patients with comorbid SAD (SZ+), 29 SZ- and 84 healthy controls.
Patient groups significantly differed from each other on social knowledge performance, but not in levels of symptoms or overall functioning. Relative to healthy controls, SZ+ were impaired uniquely on mentalizing, whereas SZ- showed a more encompassing social cognition deficit that included mentalizing, social knowledge and non-social reasoning impairments. Mentalizing was the best predictor of functioning across both patient groups. Importantly, non-social reasoning negatively influenced mentalizing and in turn functioning only in the SZ- group.
The overall pattern of results indicates common mentalizing deficits in SZ+ and SZ-; however, these deficits appear linked to different underlying deficits and different pathways to functional impact in the two patient subgroups. This study highlights some distinctive characteristics of schizophrenia patients with comorbid SAD and signals a need for further investigations into the sources of the mentalizing and functioning impairments in SZ+ patients.
Available from: Jeffrey P Kahn
- "Panic disorder is a distinct form of anxiety, and has been identified in some 20–30% of cases of schizophrenia (Cassano et al., 1998; Labbate et al., 1999; Turnbull and Bebbington, 2001). In schizophrenia, panic incidence is associated with increased service utilization (Goodwin et al., 2002; Ciapparelli et al., 2007), suicidality (Siris, 2001; Goodwin et al., 2002, 2004), hostility (Chen et al., 2001), and substance use (Goodwin et al., 2003). "
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ABSTRACT: Panic is commonly co-morbid with schizophrenia. Panic may emerge prodromally, contribute to specific psychotic symptoms, and predict medication response. Panic is often missed due to agitation, impaired cognition, psychotic symptom overlap and limited clinician awareness. Carbon dioxide exposure has been used reliably to induce panic in non-psychotic panic subjects, but has not been systematically studied in schizophrenia. Eight inpatients with schizophrenia, recent auditory hallucinations, none preselected for panic, all on antipsychotic medication, received a structured Panic and Schizophrenia Interview (PaSI), assessing DSM-IV panic symptoms concurrent with paroxysmal auditory hallucinations. On that interview, all eight subjects reported panic concurrent with auditory hallucinations. At one sitting, subjects were exposed, in random order, to 35% carbon dioxide and to placebo room air, blinded to condition. All subjects experienced panic to carbon dioxide, one with limited symptoms. Only one subject panicked to placebo. One subject (one of only two without antipanic medication) had paroxysmal voices concurrent with induced panic. With added adjunctive clonazepam, that patient had marked clinical improvement and no response to carbon dioxide re-challenge. This first systematic examination offers preliminary evidence that carbon dioxide safely induces panic symptoms in schizophrenia. Panic may be prevalent and pathophysiologically significant in schizophrenia with auditory hallucinations.
Available from: Aslihan Okan Ibiloglu
- "Vieta et al. (2001) reported no relationship between psychotic symptoms and comorbidity. In parallel with these reports, we found that patients with comorbid AnxD had more hospitalizations than those without such comorbid conditions (Amador et al., 1993; Cassano, Pini, Saettoni, Rucci, & Dell'Osso, 1998). "
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ABSTRACT: High rates of anxiety disorders have been reported in bipolar disorders. The study aimed to investigate prevalence of anxiety disorders in remitted bipolar subjects and their influence on the illness severity. Bipolar subjects with anxiety disorders were younger, had earlier age at onset of illness, and were overrepresented by female subjects and those with earlier onset illness compared to those without anxiety disorder. The study demonstrated that (1) anxiety disorders are highly prevalent in bipolar subjects, (2) individual anxiety disorders, particularly SP and PD seem to have an effect on illness severity, (3) bipolar subjects with comorbid anxiety tend to have a poorer course and are less responsive to treatment, and (4) anxiety tends to be associated with an earlier age at onset of bipolar disorder (BPD) and results in a more complicated and severe disease course.
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