Comorbid Schizophrenia and Panic Anxiety: Panic Psychosis Revisited

Abstract

Years of accumulating research show high schizophrenia comorbidity with panic anxiety. Recent research has shown that auditory hallucinations have paroxysmal onset, concurrent with abrupt onset panic anxiety in patients with schizophrenia who hear voices. Fixed-dose adjunctive alprazolam or clonazepam (antipanic benzodiazepines) can substantially relieve positive and negative symptoms and panic in some schizophrenia cases. Clinical experience and limited research suggest a more uniform and pronounces benefit in patients with schizophrenia who also have panic premorbidly, concurrently, and/or with voices. Although more research is needed, there could be a distinct panic psychosis diagnosis. This is consistent with an evolutionary theory postulating five core psychoses. With appropriate medication and skilled psychotherapy, many can improve to their premorbid baseline and remain there for extended periods. Perhaps the major impediments to clinical improvement are the difficulty of diagnosing panic in psychosis, failure to use fixed dose and sufficient clonazepam, and limited use of skilled psychotherapy. [ Psychiatr Ann . 2018;48(12):561–565.]