Skip to main content Accessibility help

Comorbidity with Axis I Anxiety Disorders in Remitted Psychotic Patients 1 Year After Hospitalization

  • Antonio Ciapparelli, Rosemma Paggini, Donatella Marazziti, Claudia Carmassi, Maria Bianchi, Claudia Taponecco, Giorgio Consoli, Valentina Lombardi, Gabriele Massimetti and Liliana Dell'Osso...



Comorbid anxiety disorders are frequently encountered in psychoses and mainly assessed during the hospitalization.


Comorbidity was investigated in 98 patients with schizophrenia, schizoaffective, or bipolar disorder, previously hospitalized for psychotic symptoms. Assessments, including Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Brief Psychiatric Rating Scale, and Clinical Global Impressions Scale, were performed during hospitalization (t0) and subsequently in a phase of remission (t1). Comorbidity was assessed at t1 only.


One or more comorbid anxiety diagnoses were made in 46 (46.9%) patients. Of these, 15 (32.6%) received multiple anxiety diagnoses, while 31 (67.4%) single anxiety diagnoses. Schizophrenic patients had a rate of social anxiety disorder (SAD) higher (P<.05) than the others. Patients assessed with panic disorder or with obsessive-compulsive disorder at t1 showed significantly greater severity of illness at t0; patients with SAD demonstrated greater severity at t1. No significant differences in the rates of individual anxiety disorders were found in patients treated with typical or atypical antipsychotics or with both.


Anxiety disorders, particularly obsessive-compulsive disorder, panic disorder and SAD, seem to be frequently comorbid in remitted psychotic patients; SAD would be more prevalent in schizophrenia and might negatively impact the course of the illness.


Corresponding author

Please direct all correspondence to: Rosemma Paggini, MD, University of Pisa, Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, via Roma 67, 1-56100 Pisa, Italy; Tel: 39 050 835423, Fax: 39 050 21581; E-mail:


Hide All
1.Muller, JE, Koen, L, Soraya, S, Emsley, RA, Stein, DJ. Anxiety disorders and schizophrenia. Curr Psychiatry Rep. 2004;6:255261.
2.Blanchard, JJ, Mueser, KT, Bellack, AS. Anhedonia, positive and negative affect, and social functioning in schizophrenia. Schizophr Bull. 1998;24:413424.
3.Cassano, GB, Pini, S, Saettani, M, Dell'Osso, L. Multiple anxiety disorder comorbidity in patients with mood spectrum disorders with psychotic features. Am J Psychiatry. 1999;156:474476.
4.Huppert, JD, Weiss, KA, Lim, R, Pratt, S, Smith, TE. Quality of life in schizophrenia: contributions of anxiety and depression. Schizophr Res. 2001;51:171180.
5.Wetherell, JL, Palmer, BW, Thorp, SR, Patterson, TL, Golshan, S, Jeste, DV. Anxiety symptoms and quality of life in middle-aged and older outpatients with schizophrenia and schizoaffective disorder. J Clin Psychiatry. 2003;64:14761482.
6.Braga, RJ, Mendlowicz, MV, Marrocos, RP, Figueira, IL. Anxiety disorder in outpatients with schizophrenia: prevalence and impact on the subjective quality of life. J Psychiatr Res. 2005;39:409414.
7.Taiminen, T, Huttunen, J, Heila, H, et al.The Schizophrenia Suicide Risk Scale (SSRS): development and Initial validation. Schizophr Res. 2001;47:199213.
8.Craig, T, Hwang, MY, Bromet, EJ. Obsessive-compulsive and panic symptoms in patients with first-admission psychosis. Am J Psychiatry. 2002;159:592598.
9.Braga, RJ, Petrides, G, Figueira, I. Anxiety disorders in schizophrenia. Compr Psychiatry. 2004;45:460468.
10.Byerly, M, Goodman, W, Acholonu, W, Bugno, R, Rush, AJ. Obsessive compulsive symptoms in schizophrenia: frequency and clinical features. Schizophr Res. 2005;76:309316.
11.Labbate, LA, Young, PC, Arana, GW. Panic disorder in schizophrenia. Can J Psychiatry. 1999;44:488490.
12.Tibbo, P, Swainson, J, Chue, RLeMelledo, JM. Prevalence and relationship to delusions and hallucinations of anxiety disorders in schizophrenia. Depress Anxiety. 2003;17:6572.
13.Kendler, KS, Gallagher, TJ, Abelson, JM, Kessler, RC. Lifetime prevalence, demographic risk factors, and diagnostic validity of nonaffective psychosis as assessed in a US community sample. The National Comorbidity Survey. Arch Gen Psychiatry. 1996;53:10221031.
14.Goodwin, R, Amador, XF, Malaspina, D, Yale, SA, Goetz, RR, Gorman, JM. Anxiety and substance use comorbidity among inpatients with schizophrenia. Schizophr Res. 2003;61:8995.
15.Pallanti, S, Quercioli, L, Hollander, E. Social anxiety in outpatients with schizophrenia: a relevant cause of disability. Am J Psychiatry. 2004;161:5358.
16.Resnick, SG, Bond, GR, Mueser, KT. Trauma and post-traumatic stress disorder in people with schizophrenia. J Abnorm Psychol. 2003;112:415423.
17.Cutler, JL, Siris, SG. “Panic-like” symptomatology in schizophrenic and schizoaffective patients with postpsychotic depression: observations and implications. Compr Psychiatry. 1991;32:465473.
18.First, MB, Spitzer, RL, Gibbon, M, Williams, JB. Structured Clinical Interview for DSM-IV Axis I Disorders, Patient Edition. SCID-I/P, Version 2.0. New York, NY: New York State Psychiatric Institute, Biometrics Research: 1994.
19.Overall, JE, Gorham, DR. The Brief Psychiatric Rating Scale. Psychol Rep. 1962;10:799812.
20.Guy, W. Clinical Global Impressions (CGI). ECDEU Assessment Manual for Psychopharmacology. revised (DHEW Publ No ADM 76-338). Rockville, Md: United States Department of Health Education and Welfare; 1976:218222.
21.Conti, L. Repertorio delle scale di valutazione in psichiatria. Firenze, Italia: S.E.E. Società Editrice Europea di Nicodemo Maggiulli & C; 1999.
22.Sassaroli, S, Ruggiero, MG. La psicopatologia cognitiva del rimuginio. It J Behav Cogn Psychother. 2003;9:1.
23.Cassano, GB, Pini, S, Saettani, M, Rucci, P, Dell'Osso, L. Occurrence and clinical correlates of psychiatric comorbidity in patients with psychotic disorders. J Clin Psychiatry. 1998;59:6068.
24.Cosoff, SJ, Hafner, RJ. The prevalence of comorbid anxiety in schizophrenia, schizoaffective disorder, and bipolar disorder. Aust N Z J Psychiatry. 1998;32:6772.
25.Pilkonis, PA, Feldman, H, Himmelhoch, J, Cornes, C. Social anxiety and psychiatric diagnosis. J Nerv Ment Dis. 1980;168:1318.
26.Addington, J, Addington, D. Premorbid functioning, cognitive functioning, symptoms and outcome in schizophrenia. J Psychiatry Neurosci. 1993;18:1823.
27.Penn, DL, Hope, DA, Spaulbing, W, Kucera, J. Social anxiety in schizophrenia. Schizophr Res. 1994;11:277284.
28.Malmberg, A, Lewis, G, David, A, Allebeck, P. Premorbid adjustment and personality in people with schizophrenia. Br J Psychiatry. 1998;172:308313.
29.Krabbendaum, L, Janssen, I, Bijl, RV, Volleberg, WAM, Van Os, J. Neuroticism and low self esteem as risk factors for psychosis. Soc Psychiatry Psychiatr Epidemiol. 2002;37:16.
30.Gumley, A, O'Grady, M, Power, K, Schwannauer, M. Negative beliefs about self and illness: a comparison of individuals with psychosis with or without comorbid social anxiety disorder. Aust N Z J Psychiatry. 2004;38:960964.
31.Cannon, M, Walsh, E, Hollis, C, et al.Predictors of later schizophrenia and affectives psychosis among attendees at a child psychiatry department. Br J Psychiatry. 2001;178:420426.
32.Wittchen, HU, Fuetsch, M, Sonntag, H, Muller, N, Liebowitz, M. Disability and quality of life in pure and comorbid social phobia-findings from a controlled study. Eur Psychiatry. 1999;14:118131.
33.Katzelnick, DJ, Kobak, KA, DeLeire, T, et al.Impact of generalized social anxiety disorder in managed care. Am J Psychiatry. 2001;158:19992007.
34.Boylan, KR, Bieling, PJ, Marriott, M, Begin, H, Young, LT, MacQueen, GM. Impact of comorbid anxiety disorders on outcome in a cohort of patients with bipolar disorder. J Clin Psychiatry. 2004;65:11061113.
35.Valenca, AM, Nardi, AE, Nascimento, I, et al.Do social anxiety disorder patients belong to a bipolar spectrum subgroup? J Affect Disord. 2005;86:1118.
36.Baker, RW, Chengappa, KN, Baird, JW, Steingard, S, Chirst, MA, Schooler, NR. Emergence of obsessive-compulsive symptoms during treatment with clozapine. J Clin Psychiatry. 1992;53:439442.
37.Patel, B, Tandon, R. Development of obsessive-compulsive symptoms during clozapine treatment. Am J Psychiatry. 1993;150:836.
38.Eales, MJ, Layeni, O. Exacerbation of obsessive-compulsive symptoms associated with clozapine. Br J Psychiatry. 1994;164:687688.
39.Kopala, L, Honer, WG. Risperidone, serotoninergic mechanisms, and obsessive-compulsive symptoms in schizophrenia. Am J Psychiatry. 1994;151:17141715.
40.Remington, G, Adams, M. Risperidone and obsessive-compulsive symptoms. J Clin Psychopharmacol. 1994;14:358359.
41.Morrison, D, Clark, D, Goldfarb, E, McCoy, L. Worsening of obsessive-compulsive symptoms following treatment with olanzapine. Am J Psychiatry. 1998:155:855.
42.Rahman, MS, Grace, JJ, Pato, MT, Priest, B. Sertraline in the treatment of clozapine-induced obsessive-compulsive behavior. Am J Psychiatry. 1998;155:16291630.
43.Mottard, JP, de la Sablonniere, JF. Olanzapine-induced obsessive-compulsive disorder. Am J Psychiatry. 1999:156:799800.
44.Biondi, M, Fedele, L, Arcangeli, T, Pancheri, P. Development of obsessive-compulsive symptoms during clozapine treatment in schizophrenia and its positive response to clomipramine. Psychother Psychosom. 1999:68:111112. Haan, L, Beuk, N, Hoogenboom, B, Dingemans, P, Linszen, D. Obsessive-compulsive symptoms during treatment with olanzapine and risperidone: a prospective study of 113 patients with recent-onset schizophrenia or related disorders. J Clin Psychiatry. 2002;63:104107.
46.Lykouras, L, Alevizos, B, Michalopoulou, P, Rabavilas, A. Obsessive-compulsive symptoms induced by atipical antipsychotics. A review of the reported cases. Prog Neuropsychopharmacol Biol Psychiatry. 2003;27:333346.

Comorbidity with Axis I Anxiety Disorders in Remitted Psychotic Patients 1 Year After Hospitalization

  • Antonio Ciapparelli, Rosemma Paggini, Donatella Marazziti, Claudia Carmassi, Maria Bianchi, Claudia Taponecco, Giorgio Consoli, Valentina Lombardi, Gabriele Massimetti and Liliana Dell'Osso...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.