Social anxiety disorder in recent onset schizophrenia spectrum disorders: The relation with symptomatology, anxiety, and social rank

• We assess 42 schizophrenia patients for comorbid social anxiety disorder (SAD).
• Patients without SAD (SZ−) have worse cognitive symptoms than those with SAD (SZ+).
• SZ+ patients have lower social rank scores and higher social anxiety than SZ− patients
• Only SZ− patients show correlations between social anxiety and PANSS scores.

Social anxiety disorder (SAD) represents a common comorbidity in schizophrenia, but questions remain regarding how this comorbidity is related to symptomatology and self-perceptions. Forty-two patients with recent-onset schizophrenia were evaluated for SAD, and assessed with the Positive and Negative Syndrome Scale (PANSS), as well as the Social Comparison Scale (SCS), which assessed how participants perceived themselves in relation with others (i.e. social rank). Eighteen patients met criteria for SAD (SZ+) while 24 patients did not (SZ−). Analysis of symptoms using a five-factor model of the PANSS revealed that the SZ− group had more severe symptoms than SZ+ on the Cognitive/Disorganization factor. Further analyses of individual symptoms demonstrated that the SZ− group was more affected in attention, abstract thinking, and cognitive disorganization (Cognitive/Disorganization symptoms), while the SZ+ group was more severely affected in anxiety, suspiciousness/persecution, and active social avoidance. Interestingly, severity of social anxiety symptom ratings correlated with certain PANSS symptoms only in the SZ− group. Perception of social rank, which was reduced in SZ+, displayed a trend level correlation with the positive symptoms in SZ−. Overall, the results suggest that SZ+ and SZ− may have different clinical profiles that could be important to consider when tailoring treatments for these patients.