Objective: Previous research suggests high levels of comorbidity between social phobia and paranoid symptoms, although the nature of this association remains unclear. Method: Data were derived from the Early Developmental Stages of Psychopathology study, a 10-year longitudinal study in a representative German community sample of 3021 participants aged 14-24 years at baseline. The Munich-Composite International Diagnostic Interview was used to assess social phobia and paranoid symptoms, along with data on social phobia features. Cross-sectional and longitudinal analyses were conducted. Differential associations with environmental risk factors and temperamental traits were investigated. Results: Lifetime social phobia and paranoid symptoms were associated with each other cross-sectionally (OR = 1.80, 95% CI = 1.31-2.47). Lifetime paranoid symptoms were associated specifically with social anxiety cognitions. Lifetime cognitions of negative evaluation predicted later onset of paranoid symptoms, whereas onset of social phobia was predicted by cognitions of loss of control and fear/avoidance of social situations. Lifetime social phobia and paranoid symptoms shared temperamental traits of behavioural inhibition, but differed in environmental risks. Conclusions: The present study showed that paranoid symptoms and social phobia share similarities in cognitive profile and inhibited temperament. Avoidance appears to be important in the development of social phobia, whereas cannabis use and traumatic experiences may drive paranoid thinking in vulnerable individuals. Language: en

The association between social phobia, social anxiety cognitions and paranoid symptoms

The presence of comorbidity in major psychoses (e.g., schizophrenia and psychotic subtypes of bipolar disorder and major depressive disorder) seems to be the rule rather than the exception in both DSM-IV and ICD-10. Examining comorbidity in major psychoses, however, requires an investigation into the different levels of comorbidity (either full-blown and subsyndromal) which should be analyzed in both psychopathological and medical fields. On one hand, the high prevalence of psychiatric comorbidity in major psychoses may be the result of the current nosographic systems. On the other hand, it may stem from a common neurobiological substrate. In fact, comorbid psychopathological conditions may share a biological vulnerability, given that dysfunction in specific brain areas may be responsible for different symptoms and syndromes. The high rates of comorbidity in major psychoses require targeted pharmacological treatments in order to effectively act on both the primary diagnosis and comorbid conditions. Nevertheless, few controlled trials in comorbid major psychoses had been carried out and treatment recommendations in this field have mostly an empirical basis. The aim of the present article is to provide a comprehensive and updated overview in relation to epidemiological and clinical issues of comorbidity in major psychoses.

An epidemiologic and clinical overview of medical and psychopathological comorbidities in major psychoses.

Severe social anxiety in early psychosis is associated with poor premorbid functioning, depression, and reduced quality of life☆☆☆

Assessment of social anxiety in first episode psychosis using the Liebowitz Social Anxiety scale as a self-report measure.

Background:We previously noted increased shyness in stable community outpatients with schizophrenia compared to healthy controls and that shyness may be a risk factor for social functioning impairment in this population (Goldberg & Schmidt, 2001).Aims:We attempted to replicate and extend these findings by comparing the use of a brief trait measure of shyness and sociability (SS; Cheek, 1983; Cheek & Buss, 1981) with the longer Temperament and Character Inventory (TCI; Cloninger, Przybeck, Svrakic, & Wetzel, 1994) used traditionally in work to measure personality dimensions in this population.Methods:A group of stable outpatients with schizophrenia (n = 41) and healthy controls (n = 41) matched on age and gender were compared on the SS and TCI measures. Patients were assessed on clinical symptoms using the Positive and Negative Symptom Scale (PANSS) and on social functioning measures using a Quality of Life Scale (QLS).Results:Patients reported significantly higher shyness, retrospective inhibition and har...

Temperament and its relation to social functioning in schizophrenia.

Background: The co-morbid occurrence of anxiety disorders and schizophrenia has recently begun to be investigated. Social anxiety may be especially important to diagnose and manage among patients with schizophrenia. Aim: To investigate the prevalence and correlates of social phobia in patients with schizophrenia. Method: Diagnosis of schizophrenia and schizoaffective disorders as well as co-morbid anxiety disorders was established according to DSM-IV and the Structured Clinical Interview for Diagnosis (SCID-P Hebrew version). Severity of psychotic symptoms and social anxiety symptoms was assessed with the Positive and Negative Symptom Scale (PANSS) and the Liebowitz Social Anxiety Scale (LSAS). Results: The cohort studied included 117 patients with schizophrenia. Thirteen patients were diagnosed as suffering from co-morbid social phobia (11%). There was a tendency for patients with co-morbid social phobia to have higher severity PANSS total score. There was a signifi cant correlation between the score of the LSAS ‘fear’ and PANSS positive subscales. Avoidance scores were higher among patients with negative signs. Conclusion: Co-morbidity of schizophrenia and social anxiety disorder is not rare among patients with schizophrenia. Treatment implications need be further investigated.

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Yael Delayahu

Papers

Co-morbid social phobia in schizophrenia.