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20-12-2010 | Mental health | Article

Social anxiety an ‘independent domain’ in psychotic disorders


Free abstract

MedWire News: Social anxiety is strongly correlated with self-esteem and active withdrawal in patients with psychotic disorders and is not simply a by-product of positive and negative symptoms, study results show.

The findings support the notion of "social anxiety as an independent domain in psychotic disorder," say K Romm (Oslo University Hospital, Norway) and colleagues in the journal European Psychiatry.

Social anxiety disorder is an extremely common comorbid condition in patients with psychotic disorder and contributes significantly to a reduced quality of life.

However, social anxiety often goes untreated in patients with psychotic disorders, mostly due to it not being accepted as a separate construct in this group.

"Clinicians tend to apply the clinical misconception that withdrawal from social interaction is either due to negative symptoms (eg, avolition or anhedonia) or a behavioral consequence of positive psychotic symptoms (eg, hallucinations and delusions, in particular suspiciousness/paranoid delusions), which makes focusing on social anxiety per se superfluous," Romm et al comment.

The researchers assessed 144 first episode psychosis patients at the time of first treatment from the ongoing Thematically Organized Psychosis (TOP) study.

Patients were assessed with a battery of tests including the Liebowitz Social Anxiety Scale, Self-Rating version (LSAS-SR), the Positive and Negative Syndrome Scale (PANSS), and the Rosenberg self-esteem questionnaire.

Initial analysis of the LSAS-SR showed a strong relationship between the fear and avoidance subscales, which was more pronounced than reported previously for individuals with social anxiety disorder alone.

"Patients with isolated social anxiety might be more willing and able to make an effort overcoming their fears than patients disabled by additionally psychiatric problems leading to compromised social functioning," the researchers speculate.

Factor analysis of the LSAS-SR data identified three subscales: public performance, social interaction, and observation, which is in agreement with data from individuals with social anxiety disorder alone.

The researchers found that social anxiety on the LSAS-SR was strongly correlated with active social avoidance on the PANSS and self-esteem on the Rosenberg scale.

Indeed, self-esteem explained a significant amount of the variance in social anxiety, even after adjusting for the effects of delusions, suspiciousness, and depression.

Romm et al comment: "Social anxiety in psychotic disorders is associated with shame and feeling subordinate, and the notion that low self-esteem might underpin social anxiety in schizophrenia."

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Andrew Czyzewski

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