Braga Raphael J, Petrides Georgios, Figueira Ivan
Psychiatry Research Department, The Zucker Hillside Hospital, North Shore-LIJ Health System-Glen Oaks, New York, NY 11004, USA.
Compr Psychiatry. 2004 Nov-Dec;45(6):460-8. doi: 10.1016/j.comppsych.2004.07.009.
Data regarding the co-occurrence of anxiety symptoms or syndromes in schizophrenia is scant. Hierarchical assumptions embedded in diagnostic systems and methodologic difficulties hamper the development of studies on accessory symptomatology outside of the core positive-negative-disorganized symptoms. Recent studies have repeatedly challenged these assumptions by presenting data on comorbid disorders in schizophrenia. We review the current knowledge about anxiety comorbidity in schizophrenia, and its relative prevalence, relevance, and treatment. A computerized search of the literature published from 1966 to July 2003 was conducted on Medline using the word "schizophrenia" and the words from the names of each anxiety disorder listed in DSM-IV, one at a time. Only studies including exclusively the diagnosis of schizophrenia were included. Only 15 studies were dedicated to the subject of anxiety comorbidity prevalence in schizophrenia. The most studied comorbidities were obsessive-compulsive disorder (OCD) and panic disorder, and most reports suggested them to be highly prevalent in schizophrenia. Posttraumatic stress disorder (PTSD) was the least studied (N = 2). Except for two pharmacologic studies in OCD, there were no double-blind randomized controlled trials regarding the treatment of anxiety in schizophrenia. Most case reports and open label trials tried conventional treatment for anxiety disorders with some degree of success. The literature indicates that anxiety comorbidities are prevalent in schizophrenia and conventional treatment for anxiety can help alleviate the symptoms in those patients. However, the body of data provided by research so far is still far from allowing evidence-based conclusions. Large studies with operationalized criteria, as well as comprehensive assessments of treatment response and outcome are needed to clarify the relationship between anxiety disorders and schizophrenia.
关于精神分裂症中焦虑症状或综合征共现的数据很少。诊断系统中隐含的层级假设以及方法学上的困难阻碍了对核心阳性-阴性-紊乱症状之外的附属症状学研究的开展。近期的研究通过呈现精神分裂症中共患疾病的数据，多次对这些假设提出了挑战。我们回顾了目前关于精神分裂症中焦虑共病的知识，及其相对患病率、相关性和治疗情况。利用“精神分裂症”一词以及《精神疾病诊断与统计手册》第四版（DSM-IV）中列出的每种焦虑症名称中的词汇，于2003年7月在Medline上对1966年至2003年7月发表的文献进行了计算机检索。仅纳入了专门诊断为精神分裂症的研究。仅有15项研究致力于精神分裂症中焦虑共病患病率这一主题。研究最多的共病是强迫症（OCD）和惊恐障碍，大多数报告表明它们在精神分裂症中高度流行。创伤后应激障碍（PTSD）的研究最少（N = 2）。除了两项关于强迫症的药物研究外，没有关于精神分裂症中焦虑治疗的双盲随机对照试验。大多数病例报告和开放标签试验尝试了对焦虑症的常规治疗，并取得了一定程度的成功。文献表明，焦虑共病在精神分裂症中很普遍，对焦虑的常规治疗有助于缓解这些患者的症状。然而，迄今为止研究所提供的数据仍远不足以得出基于证据的结论。需要开展具有可操作标准的大型研究，以及对治疗反应和结果进行全面评估，以阐明焦虑症与精神分裂症之间的关系。
