Aripiprazole for the Treatment of Schizophrenia With Co-Occurring Social Anxiety

Abstract

Co-occurring social anxiety in patients with schizophrenia is common and often severe. Pharmacologic agents with serotonin receptor 1A agonist properties such as aripiprazole are believed to be effective anxiolytic drugs. This open-label study tested the hypothesis that a switchover to aripiprazole would reduce the severity of social anxiety in patients, who have schizophrenia with co-occurring social anxiety, treated with neuroleptic medications. Eligible consenting outpatients meeting the criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, for schizophrenia or schizoaffective disorder with co-occurring social anxiety symptoms completed baseline assessments, after which their neuroleptic medication was gradually cross-titrated over to a maximum of 30 mg of aripiprazole orally per day. Patients who completed the 2-month short-term study had the option to continue for 10 more months in the extension phase of the study. Complete baseline assessments were performed after 1, 2, 4, 6, 9, and 12 months. The study hypothesized that a switchover to aripiprazole would significantly improve social anxiety symptoms and quality of life ratings in the short term and that treatment continuation would help maintain and strengthen those effects, as assessed on the Liebowitz Social Anxiety and Sheehan Disability scales and on preselected specific global items of the Lehman Quality of Life Interview. Sixteen patients were enrolled in the short-term study, and 10 of them entered the extension phase study. Last observation carried forward analysis showed significant improvements from baseline to the end of month 2 and from baseline to the end of month 12 in social anxiety scores (Liebowitz Social Anxiety Scale total, avoidance, and anxiety), social disability scores (Sheehan Disability Scale total, work, social life, and family), and in the Lehman Quality of Life Interview overall function, average life in general, and emotional well-being scores and psychosis (Positive and Negative Syndrome Scale total) scores. These findings suggest that the switchover to aripiprazole effectively improved social anxiety, psychosis, and quality of life in patients with schizophrenia who were treated with neuroleptic medications. These improvements occurred within the first 8 weeks of treatment and persisted when treatment was continued for up to 1 year. Further studies are warranted to replicate these findings in controlled trials.