Veras André B, do-Nascimento Júlia S, Rodrigues Regis L, Guimarães Ana Carolina A, Nardi Antonio E
Panic & Respiration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, INCT Translational Medicine (CNPq), Brazil.
Int Arch Med. 2011 Apr 10;4(1):12. doi: 10.1186/1755-7682-4-12.
Social 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.
Faced with little research directed toward the exploration of psychotic symptoms in SAD patients, we will approach the topic by describing three cases.
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. 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.
The 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.
社交焦虑障碍（SAD）的主要特征是个体强烈关注他人对自己的看法。值得注意的是，在那些有严重焦虑症状的患者中，我们常常可以观察到自我参照性感受。
鉴于针对社交焦虑障碍患者精神病性症状探索的研究较少，我们将通过描述三个病例来探讨这一话题。
对于社交焦虑障碍中的精神病性表现，似乎有三种可能的解释。第一种取决于个体是否有能力挑战被他人批评的印象。第二种可能性是社交焦虑障碍的应激源及持续作用，这会使个体更有可能出现更严重的精神障碍，如妄想障碍（DD）。第三种解释是在某些情况下，社交焦虑是由原发性思维异常（精神病性自我参照）而非情感障碍（焦虑性不安全感）引起的，这导致了对他人意见的强烈关注。我们还观察到，在这三个病例中，抗精神病药物均未产生显著改善。这一结果可能与多巴胺能回路及D2受体低活性有关。
妄想与焦虑性担忧之间的区分可能不准确，且可能在疾病演变过程中发生变化。建议设立新的诊断亚类或扩大社交焦虑诊断范围，以克服当前诊断的不精确性。社交焦虑障碍和妄想障碍之间似乎存在症状谱。
