Social anxiety and ideas of reference in early psychosis

Abstract

An increased prevalence of social anxiety disorder is observed in patients with psychosis (16%–38%, compared with 13% in the general population). Despite important treatment implications, previous attempts in understanding the comorbidity have been inconclusive. This study aims to explore the relationship between social anxiety and other psychopathological characteristics in psychotic disorders, with a conceptually driven focus on the possible linkage between social anxiety and the subthreshold symptom ideas of reference. A consecutive sample of 137 outpatients with early psychosis was assessed for social anxiety using the Liebowitz Social Anxiety Scale (LSAS), and for ideas of reference using a new instrument Ideas of Reference Interview Schedule (IRIS). Positive symptoms, negative symptoms, depression and insight were measured using the Scale for the Assessment of Positive Symptoms in Schizophrenia (SAPS), the Scale for the Assessment of Negative Symptoms in Schizophrenia (SANS), Calgary Depression Scale for Schizophrenia (CDSS) and the Scale to Assess Unawareness of Illness (SUMD). To identify potential explanatory variables for social anxiety, univariate analyses were first carried out between LSAS and age, sex and all symptom subscales. Variables that displayed simple correlation with LSAS (based on a lax criterion of P < .1) were then entered as independent variables into a stepwise multiple regression analysis to determine the symptoms specifically correlated with LSAS. Results suggested a three-factor model, with IRIS included as the strongest explanatory factor, while avolition and blunting were also related (adjust R2 = 0.18; P = .00). The association observed between social anxiety and negative symptoms is consistent with previous findings. This is the first study to demonstrate that a proportion of social anxiety covaries with ideas of reference. The nature of their relationship and the extent to which ideas of reference may explain for the excess of social anxiety prevalence in early psychosis need to be further investigated.