Background: Comorbid anxiety disorders in psychotic illness are reported in the international literature as highly prevalent and have a significant negative impact on patient outcomes. Local literature describing such comorbidity in the South African population is limited and clinically, anxiety symptoms are seldom recognised or treated in patients with psychotic disorders. More data on prevalence rates across psychotic disorder diagnoses, as well as sociodemographic correlates would aid recognition, diagnosis, and treatment, and potentially improve clinical outcomes in this population. Method: We performed a secondary analysis of an existing database which comprised data from participants of three previous studies. The sample was made up of patients from Valkenberg Hospital and healthcare facilities in its catchment area. All patients had a diagnosis of a psychotic disorder. Socio-demographic information was collected using a structured questionnaire. Clinical information and diagnosis was determined using the Structured Clinical Interview for DSM (SCID-I). Rates of comorbid anxiety disorders were compared across various sociodemographic categories. Results: The overall prevalence of any anxiety disorder in the entire sample (N=226) was 14.6% (n=33), 95% CI [10.27-19.89%]. The most common anxiety disorder comorbidities were, in descending order, panic disorder (n=12, 5.31%; 95% CI [2.77-9.09%]), PTSD (n=9, 3.98%; 95% CI [1.84-7.42%]), specific phobia (n=7, 3.10%; 95% CI [1.25-6.28%]), anxiety disorder not otherwise specified (n=7, 3.10%; 95% CI [1.25-6.28%]), social phobia (n=4, 1.77%; 95% CI [0.48%-4.47%]), generalised anxiety disorder (n=4, 1.77%; 95% CI [0.48-4.47%]), substance-induced anxiety disorder (n=4, 1.77%; 95% CI [0.48-4.47%]) and obsessive compulsive disorder (n=2, 0.88%; 95% CI [0.11-3.16%]). There was a significant association between diagnosis and the presence of post-traumatic stress disorder (PTSD), with the schizoaffective disorder group having a higher rate of PTSD (13.3% vs. 3.3% in schizophrenia, 3.2% in substance-induced mood/psychotic disorder and 0% in bipolar I disorder) (Fisher's exact test, p=0.039). In turn, there was a trend level association between diagnosis and the presence of panic disorder (PD), with schizoaffective disorder patients having higher rates of PD (16.6% vs. 4.1% in schizophrenia spectrum, 3.2% in substance-induced mood/psychotic disorder and 2.2% in bipolar I disorder) (Fisher's exact test, p=0.052). A significant association was found between level of education and the presence of PTSD, with higher rates of PTSD in patients with seven or less years of education (8.8%) compared to lower rates in those with 8-12 years of education (5.3%) and > 12years of education (0%) (Fisher's exact test, p=0.020). Conclusion: The overall prevalence of anxiety disorders in psychotic illness was lower than what has been described in previous literature. Prevalence rates of individual anxiety disorders were also lower than previously published literature. Possible reasons for this include use of the SCID which utilises a strict diagnostic hierarchy, that the majority of the sample were in-patients, no use of self-report questionnaires or other anxiety-specific diagnostic instruments, or possible geographical and/or ethnic differences in South African patients. The most frequent comorbid anxiety disorders in our study were panic disorder and PTSD. This is out of keeping with other literature which has mostly found obsessive compulsive disorder and social anxiety disorder to be the most common anxiety comorbidities in psychotic illness. Further research into comorbid anxiety in psychotic disorders is needed, particularly amongst South African populations.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uct/oai:localhost:11427/27379 |
| Date | January 2017 |
| Creators | Reid, Kirsten |
| Contributors | Milligan, Peter D, Temmingh, Henk |
| Publisher | University of Cape Town, Faculty of Health Sciences, Department of Psychiatry and Mental Health |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Master Thesis, Masters, MMed |
| Format | application/pdf |
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