Abstract
BackgroundLiterature on anxiety in schizophrenia is confined to well-established diagnostic syndromes and the diagnostic category of unspecified anxiety disorder has not been quantitatively verified in this population. This study examined whether anxiety that is not differentiated into the well-established syndromes is empirically discernible from syndromal anxiety and no anxiety in acute-phase schizophrenia.MethodsAfter sampling 111 acute-phase schizophrenia patients, they were stratified into three groups: syndromal anxiety; undifferentiated anxiety; and without anxiety disorder. The groups were compared statistically in two data sets on measures for anxiety, psychotic severity, depressive features, akathisia and medication use.ResultsOn two measures of anxiety and for both data sets, the groups were significantly different without evidence of a confounding influence by akathisia, medication, or psychotic severity. The undifferentiated group was different from the syndromal group on the Staden Schizophrenia Anxiety Rating Scale (S-SARS) for both data sets (mean difference = 7.46, p < 0.001; mean difference = 7.69, p < 0.002) and on the Hamilton Anxiety Rating Scale for the one data set (mean difference = 14.68, p < 0.001) but not for the replicative data set (mean difference = 1.49, p = 0.494). The undifferentiated anxiety group was different from the no anxiety group for the respective data sets on both anxiety scales (S-SARS: mean difference = 8.67, p < 0.001; mean difference = 8.64, p < 0.001)(HAM-A: mean difference = 6.05, p < 0.001; mean difference = 8.67, p = 0.002). When depressive features had a confounding effect, it was small relative to the group differences.ConclusionsThe results suggest some patients in acute-phase schizophrenia present with undifferentiated anxiety that is discernible from both syndromal anxiety and those without an anxiety disorder. This finding may serve as empirical grounds for clinicians to recognise undifferentiated anxiety in acute-phase schizophrenia, and for further research into the clinical importance of undifferentiated anxiety in this population.
Highlights
Literature on anxiety in schizophrenia is confined to well-established diagnostic syndromes and the diagnostic category of unspecified anxiety disorder has not been quantitatively verified in this population
Given that anxiety may be more difficult to recognise in the presence of acute psychotic symptoms, this study aimed to account for this by examining during an acute phase of schizophrenia whether undifferentiated anxiety presented symptomatologically distinct from syndromal anxiety and the absence of an anxiety disorder
The stratification of the groups was done by two means: either directly through the Structured Clinical Assessment for DSM-IV Axis I Disorders (SCID) [35, 36], or indirectly through statistical modelling based on the SCID for participants who did not have the SCID performed as their data originated from an earlier stage of the research project
Summary
Literature on anxiety in schizophrenia is confined to well-established diagnostic syndromes and the diagnostic category of unspecified anxiety disorder has not been quantitatively verified in this population. Naidu et al Ann Gen Psychiatry (2020) 19:26 is provided for in DSM-IV and DSM-5, respectively, as anxiety disorder not otherwise specified and unspecified anxiety disorder, which may be diagnosed concurrently with the diagnosis of schizophrenia [5, 6] This nosological provision has not been quantitatively verified before in acute-phase schizophrenia. Undifferentiated anxiety may be understood as a constellation of clinically significant anxiety features that do not meet diagnostic criteria for any of the typical anxiety syndromes. It may be understood as an anxiety feature that is not specific to any one syndromal anxiety disorder. It is conceivable that a patient may have clinical significant palpitations of anxiety, yet does not suffer from panic disorder, generalised anxiety disorder, or any of the other typical syndromes
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