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Social anxiety disorder in first-episode psychosis: incidence, phenomenology and relationship with paranoia
- Authors:
- MICHAIL Maria, BIRCHWOOD Max
- Journal article citation:
- British Journal of Psychiatry, 195(3), September 2009, pp.234-241.
- Publisher:
- Cambridge University Press
This study aimed to compare the phenomenology of social anxiety disorder in first-episode psychosis with that in a group without psychosis. The relationship between social anxiety and psychosis symptoms was investigated. A sample of people with first-episode psychosis (FEP group) was compared with a sample with social anxiety disorder without psychosis (SaD group). Of the individuals in the FEP group (n = 80) 25% were diagnosed with an ICD–10 social anxiety disorder (FEP/SaD group); a further 11.6% reported severe difficulties in social encounters. The FEP/SaD and SaD groups reported comparable levels of social anxiety, autonomic symptoms, avoidance and depression. Social anxiety in psychosis was not related to the positive symptoms of the Positive and Negative Syndrome Scale (PANSS) including suspiciousness/persecution. However, a significantly greater percentage of socially anxious v. non-socially anxious individuals with psychosis expressed perceived threat from persecutors, although this did not affect the severity of social anxiety within the FEP/SaD group. The majority of those in the FEP/SaD group did not have concurrent persecutory delusions. It is concluded that social anxiety is a significant comorbidity in first-episode psychosis. It is not simply an epiphenomenon of psychotic symptoms and clinical paranoia, and it has more than one causal pathway. For a subgroup of socially anxious people with psychosis, anticipated harm is present and the processes that underlie its relationship with social anxiety warrant further investigation.
Treatment of obsessive compulsive disorder and comorbid social phobia
- Author:
- SEIGEL Alan
- Journal article citation:
- Brief Treatment and Crisis Intervention, 3(1), Spring 2003, pp.55-81.
- Publisher:
- Oxford University Press
The purpose of this article is to help persons in the helping professions recognize the serious threats to self, family life, and work experienced by persons with obsessive compulsive disorder (OCD) and social phobia and help engage persons affected in focused, clinically responsible treatment. The articlel presents findings from epidemiological studies of the disorders presenting conjointly, illustrates comorbidity in clinical practice through case examples, and reviews clinically relevant information gleaned in the diagnostic assessment. Core triage decisions in initiating treatment are reviewed. Medication approaches and patient concerns regarding medication are overviewed. The article summarizes psycho-educational information regarding cognitive errors in OCD and social phobia that may be presented to the patient to help the patient limit anxiety evocative and depressive thought. The author provides illustrations of cognitive behavioural treatment in individual and group psychotherapy, transfer of training, treatment resistance, and adjunctive treatments, resources for consumers and practitioners, and emerging challenges in the field.