Angst: Origins of Anxiety and Depression by Kahn Jeffrey P

Author:Kahn, Jeffrey P. [Kahn, Jeffrey P.]
Language: eng
Format: epub
Publisher: Oxford University Press
Published: 2012-09-24T20:00:00+00:00

CAN THE USUAL SUSPECTS TAKE US OVER THE EDGE?

Just as Major Depressive Disorder (MDD) is a catch-all for depressive disorders, and Generalized Anxiety Disorder (GAD) for anxiety disorders, Schizophrenia can be viewed as a catch-all for psychotic disorders, as well as a paradigmatic example of psychosis. As it happens, the same five social instincts that lead to specific anxiety and depressive disorders may also help define specific subtypes of Schizophrenia. However, whereas we already have the diagnostic tools to fine-tune depressive and anxiety disorders, we are only now starting to do the same with psychosis and Schizophrenia.82

Although the mixed-illness nature (“heterogeneity”) of Schizophrenia has long been known, progress has been slow in peeling away distinct kinds of psychosis. One major step was the discovery that some Schizophrenia is actually that late and serious form of syphilis in the brain (“neurosyphilis”). This recognition led to syphilis screening in psychotic patients and effective treatment with penicillin and other antibiotics. Although Mania (now part of what is known as Bipolar I Disorder) has long been recognized as a distinct illness, more recent work recognized the occurrence of a more psychotic form of Mania that has often been confused with Schizophrenia. Other diagnoses pulled out of the Schizophrenia category include Psychotic Depression (a form of Melancholia), and Paranoid Delusional Disorder, not to mention various psychoses caused by medication, substance abuse, and physical illness.

Still, the nature and relationship of these psychoses is not well understood, and more research is needed. For example, research suggests that a “harm avoidance” personality style (which has four subtypes that seem to correspond nicely to four of our social instincts), is higher in schizophrenic patients, and also in their relatives.83 Although most Schizophrenia research focuses similarly on the overall diagnostic category as a whole, some researchers continue to look for valid subtypes of the “Schizophrenias.” One way of looking at Schizophrenia subtypes is by looking at other syndromes that occur together with it (co-morbidity).84 Not that long ago, those other syndromes were supposed to be ignored in Schizophrenia, on the basis of the theory that Schizophrenia is so overwhelming that the multiplicity of symptoms merely reflects a multifaceted disease.

More recently, scattered researchers have started to note that anxiety disorders are common even in correctly diagnosed Schizophrenia. Even voices in “normal” people happen more often in those with anxiety or depressive disorders.85 Most recently, researchers have started to identify co-morbid anxiety disorders in a systematic way, with specialized diagnostic interviews and techniques.86,87,88 One study of early-stage Schizophrenia spectrum patients suggested that 9.3% had Panic Anxiety, 48.1% had Social Anxiety, 14.3% had OCD, and at least 84.9% had at one or more anxiety disorders that preceded psychosis onset. In another study, of people with established Schizophrenia, 24% had Panic Anxiety, 17.7% had Social Anxiety, and 24% had OCD.89 Those might even be underestimates.90 We will try to follow in these promising footsteps, as we present our usual suspects in the same order that we introduced them.

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