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David Baxter

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Two elements of schizophrenia linked to social anxiety

Patients with schizophrenia spectrum disorders who show high levels of social anxiety also have significant delusions and impairments in flexibility of abstract thought, study findings show.

The researchers investigated these two elements, which are commonly found in schizophrenia, as possible factors explaining the high rates of social anxiety seen in patients with schizophrenia in the hope of better understanding the comorbid condition and how it may be treated.

They found that in patients with significant delusions and impairments in flexibility of abstract thought, the average levels of social anxiety were between 1.4- and 2.2-times higher than those of other patients.

They also possessed fewer of the resources necessary for interpersonal relationships as assessed by the Quality of Life Scale.

However, there was no evidence to suggest that patients with both delusions and impairments in abstract thought differed from other patients with regard to levels of negative symptoms, trait anxiety, or insight.

The findings emerge from a study of 71 participants with schizophrenia or schizoaffective disorder who completed the Positive and Negative Syndrome Scale, the Wisconsin Card Sorting Test to measure flexibility of abstract thought, the Quality of Life Scale, and the Liebowitz Social Anxiety Scale.

In all, 11 patients had significant delusions and impairments in flexibility of abstract thought.

The researchers suggest that the convergence of both delusions and deficits in flexibility of abstract thought may trigger social anxiety.

"Perhaps as persons have difficulties understanding the changing rules and requirements of social relations and difficulties in interpreting life events in a consensually valid manner, social interactions become confusing and feared," the investigators explain.

Alternatively, the team suggested that high levels of social anxiety could lead to delusional beliefs possibly lessening the ability to think flexibly about abstract matters or the involvement of other biological or socio-cultural variables that were not measured.

Paul Lysaker (Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, USA) and Jonathan Hammersley (Southern Illinois University, USA) say that interventions for social anxiety "could include methods that help persons not only manage their own fear and negative self appraisals but also learn to be more mindful of social situations and shifting social cues."

They add: "Cognitive interventions know to reduce delusional interpretations of life events could also be considered as useful here in that they may help persons develop alternative ways of understanding life events and thus reduce fear and confusions about the social landscape."

Schizophr Res 2006; 86: 147-153
 

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