Abstract
BackgroundSocial Anxiety Disorder (SAD) is mainly characterized by an individual's intense concern about other people's opinion of the individual. Notably, among those with severe anxious symptoms, we can often observe self-referential feelings.ObjectiveFaced with little research directed toward the exploration of psychotic symptoms in SAD patients, we will approach the topic by describing three cases.DiscussionThree explanations seem possible for the psychotic manifestations in SAD. The first one depends on the individual's ability or inability to challenge the impression of being criticized by people. A second possibility would be the stressor and perpetuating role of SAD, which would make individuals more likely to present with more severe mental disorders such as delusional disorder (DD). The third explanation would be the possibility that SA is caused by a primary thought abnormality (psychotic self-reference) in some cases, instead of an affective disturbance (anxious insecurity), which led to intense concern about others' opinions. We also observed that antipsychotics did not produce significant improvement in any of the three cases. This result may be related to dopaminergic circuits and the D2 receptor hypoactivity.ConclusionThe differentiation between delusion and anxious concern may be inaccurate and may change throughout the disorder's evolution. New diagnostic subcategories or the enlargement of the social anxiety diagnostic is proposed to overcome the current diagnostic imprecision. There seems to be a symptomatic spectrum between SAD and DDs.
Highlights
Social Anxiety Disorder (SAD) is mainly characterized by an individual’s intense concern about other people’s opinion of the individual
There seems to be a symptomatic spectrum between SAD and DDs
In light of these findings, the social relationships and affective importance criteria seem to be weakened. This weakening is due to a wide variability in affective indifference among schizophrenic patients, which is even wider among individuals with cluster A personality disorders or with higher affective preservation, like delusional disorder (DD) patients
Summary
Three explanations seem possible for the psychotic manifestations in SAD. The first one depends on the individual’s ability or inability to challenge the impression of being criticized by people. The less insight, the greater the belief that the idea is a reality, the more the experience resembles a delusional self-reference This delusion was present in the first case in which the patient gradually developed a conviction that he was harassed by the neighbors while he repeatedly exposed himself to situations that reinforced this feeling. A second possibility would be the stressor and perpetuating role of SAD, which would make individuals more likely to present with more severe mental disorders such as DD This occurrence seems consistent with the third case. A series of case reports corroborate the lower efficacy of using antipsychotics in SAD, even with the occurrence of delusions They observed better effectiveness of selective serotonin and serotonin and norepinefrine reuptake inhibitors on conviction-subtype TK patients [12,15,16,17,18]. Despite the poor response to antipsychotics prescribed, the condition can not be considered refractory, once the prescription of other atypical antipsychotic could generate satisfactory therapeutic response
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