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The Anxiety-Psychosis Spectrum

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The Anxiety-Psychosis Spectrum Introduction The Anxiety-Psychosis Spectrum By Stefano Pallanti, MD The more pervasive an archetype is, the larger is the risk inhibitors) to which it responds, as well as alterations in the that it becomes a myth that legitimizes itself. therapy of the so-called main disorder. Recent data6 have —Black M. Metaphor and Thought.1979.1 shown that patients with chronic schizophrenia suffering from comorbid panic attacks tend to be taking neuroleptics in The aim of this issue is to enhance clinicians' awareness larger doses than patients without comorbid panic attacks. about the presence of anxiety disorders in psychotic patients and The close similarity between an obsessive and a schizoid the importance of detection during assessment and treatment. pattern on the Axis II, described in this issue by Rossi and The general convention in the Diagnostic and Statistical colleagues, makes the importance of the anxiety- Manual of Mental Disorders (DSM) is to establish a diagnostic schizophrenic spectrum relation both more convincing and hierarchy in various situations, such as when the symptoms of more complex, while also generating a broader debate about a mental disorder are the same as a medical or substance- obsession and psychosis. induced comorbid disorder, when it is clinically difficult to Also in this issue, Pallanti and colleagues describe the determine the boundary between one disorder and another emergence of social phobic symptomatology with clozapine as (eg, panic disorder vs social phobia), and when a more perva- an example of pharmacological dissection in the nosographi- sive disorder (eg, schizophrenia) has among its defining or cal domain of schizophrenia, and pose the question of the associated symptoms the defining symptoms of a less perva- boundary between behavioral extrapyramidal side effects and sive disorder (eg, dysthymic disorder). the modification of the psychological condition. With the appearance of the third edition of the DSM in Strik summarizes the European concept of cycloid psy- 1980, the classic distinctions between neurosis and psychosis chosis, in which the relationship between anxiety and schiz- were effectively overcome, which implicitly involved both a ophrenic symptomatology is documented by a diagnostic hierarchy, whereby neurosis was less serious than psychosis, category7 that helps to distinguish between syndromic disor- and also different physiopathological mechanisms—conflict der and structural deformation. for neurosis and defect for psychosis. This edition did not try Iindley and colleagues present the relationship between anxi- to describe mental disorders naturalistically and did not ety and psychosis that is rendered even more complex by the declare its approach to be atheoretical; however, a number of description of psychotic features in patients with posttraumatic unstated archetypal concepts still exist, and their pervasive- stress disorder, which has important nosographic and therapeutic ness has continued to influence the judgements of clinicians. implications. Finally, Galderisi and colleagues discuss recent By archetype, we mean a theoretical, nonempirically derived evidence on abnormalities of brain hemispheric organization in influence on the organization of explicitly declared concepts in panic disorders. a hidden, unobtrusive way.1 All of these observations have provided us with good reason Such concepts partly explain the slowness to perceive the to title this issue "The Anxiety-Psychosis Spectrum"—a con- clinical relevance of anxiety disorders in the so-called psy- cept that emphasizes, theoretically and clinically, the need to chotic disorders. Especially when the principal diagnosis is differentiate between the level of cognitive and structural an Axis I disorder (indicated by listing it first), the remaining alterations and that of symptomatological expressions. B33 disorders are listed in order of clinical focus, and multiple diagnosis can also be reported in a multiaxial fashion; REFERENCES Because schizophrenia is prevalently a life-long, pervasive 1. Black M. Metaphor and Thought. Ortony A, ed. New York, NY; 1979. condition, the exclusion criterion "does not occur exclusively 2. Labbate LA, Young PC, Arana GW. Panic disorder in schizophrenia. Can J during the course of represents a potential diagnostic bias. Psychiatry. 1999;44(5):488-490. 3. Himmelhoch JM. The paradox of anxiety syndromes comorbid with bipolar illness- Comorbid anxiety disorders and drug-precipitated anxi- es. In: Goldberg JF, Harrow, eds. Bipolar Disorder—Clinical Course and Outcome. ety disturbances in bipolar and schizophrenic disorders Washington DC: American Psychiatric Association Press; 1999:237-258. 2 5 have been extensively reported. These diagnoses in schiz- 4. Levkovitch Y, Kronnenberg Y, Gaoni B. Can clozapine trigger OCD? J Am ophrenic patients are useful and must be conducted in such ' Acad Child Adolesc Psychiatry. 1995;34(3):263. a way as to overcome hierarchies in the DSM, because the 5. Cassano GB, Pini S, Saettoni M, et al. Occurrence and clinical correlates of frequency of comorbid anxiety disorders in schizophrenia is psychiatric comorbidity in patients with psychotic disorders. J Clin high and can emerge in symptom-free clinical phases, when Psychiatry. 1998;59(2):60-68. 6. Higuchi H, Kamata M, Yoshimoto M, et al. Panic attacks in patients with patients may be able to regain social functioning and chronic schizophrenia: a complication of long-term neuroleptic treatment. resume work and relationships. Psychiatry Clin Neurosci. 1999;3(l):91-94. Comorbidity for anxiety disorder in schizophrenia requires 7. Sigmund D, Mundt C. The cycloid type and its differentiation from core schiz- specific treatments (ie, selective serotonin reuptake ophrenia: a phenomenological approach. Compr Psychiatry. 1999;40(l):4-18. Dr. Pallanti is director of the Institute of Neurosciences at the University of Florence Medical School in Italy, as well as visiting professor at Mount Sinai School of Medicine in New York, NY. Please address reprint requests to Dr. Pallanti at: Instituto di Neuroscienze, Viale Ugo Bassi 1, 50137 Florence, Italy. DownloadedVolume from5 - Numbehttps://www.cambridge.org/corer 9 • September 200.0 IP address: 170.106.35.234, on 29 Sep 202122 at 04:36:43, subject to the Cambridge Core terms ofC use, N available8 SPECTRUM at S https://www.cambridge.org/core/terms. https://doi.org/10.1017/S1092852900021611.
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