Schizophrenia spectrum disorders with comorbid panic: A systematic review

The classical description of panic psychosis is characterized by existence of paroxysmal panic anxiety concurrent with auditory hallucinations or paranoid delusions. Although there is a high prevalence of panic comorbidity in schizophrenia, there remains much uncertainty among clinicians.

We aim to describe the psychopathological manifestations and pathogenetic factors of subjects with schizophrenia spectrum disorders comorbid with panic disorder. Adequate diagnosis and treatment of these conditions can produce significant amelioration of co-morbidities and psychotic symptoms.

Studies included in the review were selected through electronic search in these databases: Medical Literature databases and Retrieval System Online (Medline), Latin American and Caribbean Health Sciences (LILACS) and the Cochrane Library. Included were clinical studies in which schizophrenia spectrum disorder subjects had their diagnoses confirmed according to criteria from systematized manuals, and who also were evaluated with standardized scales for psychiatric symptomatology (psychosis, diagnosis of panic disorder or panic attacks, anxiety and general symptoms).

We found a total of 449 results from electronic searches. Only twenty-five studies fully met the inclusion criteria for this review. Two main methodological approaches were identified: 1. Clinical studies which specifically focused on patients with Schizophrenia Spectrum Disorders (SSD) with comorbid Panic Disorder (PD) (N = 11); 2. Clinical studies which examined broader groups of SSD patients (N = 13) for Panic symptoms.

Comparative studies show that SSD patients with PD comorbidity usually have more severe psychotic symptomatology, more depressive symptoms, more suicide ideation, earlier onset, and worse outcome. Correlation analysis confirmed the association of panic with more depressive symptoms, early onset, and worse functioning. In addition, other risk factors such as early trauma, hypovitaminosis D and a cross familiar risk are considered.