Haidl Theresa Katharina, Rosen Marlene, Ruhrmann Stephan, Klosterkötter Joachim
Universitätsklinikum Köln, Klinik und Poliklinik für Psychiatrie und Psychotherapie.
Fortschr Neurol Psychiatr. 2019 May;87(5):284-297. doi: 10.1055/a-0602-4332. Epub 2018 Jul 13.
In recent years an increased comorbidity of schizophrenic disorders with anxiety disorders has been reported. Thus, among patients with a disorder from the schizophrenia spectrum, a general anxiety disorder was found in 38.3 % of patients, with 14.9 % of these with social phobia (SP). Especially social anxiety (SA) is of particular importance because it is often associated with depression and can contribute to psychosocial disabilities in patients with psychosis.Anxiety disorders already seem to occur prior to the first psychotic manifestation in the clinical high-risk state (CHR). Therefore, the questions arise as to whether this comorbidity is also dominated by SP in this patient group and, if so, what its consequences are on early detection and prevention of psychotic disorders. To clarify these questions, the present paper provides a systematic review of all published studies on social anxiety (SA) in the CHR.A total of 124 studies were included comprising 1702 CHR individuals, 445 healthy controls, 67 relatives / siblings of patients with psychotic disorders and 95 patients with a psychosis. In the most meaningful study, anxiety disorders were generally highly significant in CHR individuals (51 %) compared to control subjects from the normal population (4 %). Among those with anxiety disorders, 14.4 % suffered from SP compared to 0.36 % in normal controls and thus SP was almost as frequent as the prevalence of this type of anxiety disorders in the schizophrenic spectrum (14.9 %). Also, the degree of SA in CHR individuals (SIAS score = 34.4, SD = 6.11) (SIAS-Score = 22.1, SD = 8.7), measured with the Social Interaction and Anxiety Scale (SIAS) in 9 studies, was almost as high as in psychotic patients (SIAS score = 35.0, SD = 9.56) and healthy controls (SIAS score = 14.,6; SD = 7,28). This degree of SA was also related to the attenuated psychotic symptomatology of the CHR individuals. However, the only study investigating the relationship between SA and a possible transition to a first psychotic manifestation did not reveal any predictive power. The feared psychosocial loss of function, which is already present in CHR, seems to be connected not only to the strong SA, but also to the similarly frequent comorbid depressive disorders.Moreover, one study has already provided some evidence that it is promising to address the SA as well as functional impairments in the CHR through newly developed specialized cognitive behavioural therapies.
近年来，有报道称精神分裂症谱系障碍与焦虑症的共病情况有所增加。因此，在患有精神分裂症谱系障碍的患者中，38.3%的患者存在广泛性焦虑障碍，其中14.9%伴有社交恐惧症（SP）。尤其是社交焦虑（SA）尤为重要，因为它常与抑郁症相关，并且会导致精神病患者出现心理社会功能障碍。焦虑症似乎在临床高危状态（CHR）首次出现精神病症状之前就已发生。因此，出现了这样的问题：在这一患者群体中，这种共病是否也以SP为主导？如果是，那么它对精神病性障碍的早期发现和预防会有什么后果？为了阐明这些问题，本文对所有已发表的关于CHR中社交焦虑（SA）的研究进行了系统综述。
总共纳入了124项研究，包括1702名CHR个体、445名健康对照、67名精神病患者的亲属/兄弟姐妹以及95名精神病患者。在最有意义的研究中，与正常人群的对照对象（4%）相比，CHR个体中焦虑症总体上具有高度显著性（51%）。在患有焦虑症的个体中，14.4%患有SP，而正常对照中这一比例为0.36%，因此SP的发生率几乎与精神分裂症谱系中这类焦虑症的患病率（14.9%）相同。此外，在9项研究中使用社交互动焦虑量表（SIAS）测量的CHR个体的SA程度（SIAS分数 = 34.4，标准差 = 6.11）（SIAS分数 = 22.1，标准差 = 8.7）几乎与精神病患者（SIAS分数 = 35.0，标准差 = 9.56）和健康对照（SIAS分数 = 14.6；标准差 = 7.28）一样高。这种SA程度也与CHR个体的精神病症状减轻有关。然而，唯一一项研究SA与向首次精神病症状转变之间关系的研究并未发现任何预测能力。CHR中已经存在的令人担忧的心社会功能丧失似乎不仅与强烈的SA有关，还与同样常见的共病抑郁症有关。
此外，一项研究已经提供了一些证据，表明通过新开发的专门认知行为疗法来解决CHR中的SA以及功能障碍是有前景的。
