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Esquizofrenia e ansiedade : um estudo clinico sobre ansiedade em pacientes esquizofrenicos
Wulf Hermann Dittmar
DATA DE PUBLICAÇÃO
A study on anxiety in schizophrenic patinets, envolving a cross sectional observation of 40 patients fulfilling the DSM-IV diagnostic criteria for schizophrenia, is reported. Theses patients were not in acute episode and the clinical follow-up was done in four day-hospitals in the municipality of São Paulo. Both sexes were included in the study, independently of age, time of disease, or mediaction being used. The variables included in the study s protocol were: I) anxiety state (Hamilton s Anxiety Scale); 2) categorization of an anxiety disorder (DSM-IV diagnostic criteria); 3) psychopathology (PANSS - Positive and Negative Syndrome Scale); 4) cognitive state (~1NSE - Mini Mental State Examination); 5) depressive symptoms (Calgary Scale for evaluation of depression in schizophrenic patients); 6) akathisia (Barnes Akathisia Rating Scale); 7) si de effects caused by the use of antipsychotic drug (Chouinard Scale for the evaluation of neuroleptic side effects); and 8) recent biographical events (a reduced version ofthe Holms-Rahe scale). Consistent anxiety signs and symptoms were found in most patients by using the Hamilton s Anxiety Scale (mean = 14.0; sd = 7.6). Psychic symptoms prevailed over the physical symptoms. An anxiety disorder (comorbidity) was diagnosed in most patients (52.5%), the most prevalent being panic with and without agoraphobia (35%); social phobia (27.5%), general anxiety (27.5%), obsessive-compulsive disorder (10%). Among patients with anxiety disorder diagnosis, than a single diagnosis (38%) was less fTequent than the description of more than one diagnosis. The an.xiety symptoms (anxiety state) are more present in patients with diagnosis of paranoid schizophrenia (295.30 - DSM-IV), and their correlation with the positive symptoms of P ANSS scale was identified. Correlation between anxiety and items P6 (Suspiciousness/ persecution) and P:: (Hallucinatory behavior) were found in the block of positive symptoms. Nagative symptoms did not show any particular correlation with anxiety symtoms but did not inibit their manifestation. A positive correlation was round in general psychopathology between anxiety and iem Gl6 (Active social avoidance). There was a large overlapping between depressive and anxiety symptoms and in most cases (52%) they were present in the same proportion. The use of neuroleptic drugs, by itself, dose not increase the anxiety levels, but a positive correlation was found between their side effects and the anxiety levels. Patients using benzodiazepines had significantly lower anxiety levels. Exept for general anxiety, more fTequent among the paranoid schizophrenia diagnosis, the other forms of anxiety disorders were found with the same fTequency among the various schizophrenia subtypes, The validation of comorbidity between schizophrenia and various anxiety disorders is discussed, particulary in relation to social phobia where the delirious component is undiniable, raising doubts about its diagnostic consistency