Clinical Summary
Clinical Summary: Prevalence of Anxiety, Depressive Symptoms, and Substance Use in Schizophrenia
Patients with early-phase schizophrenia often present with anxiety, depressive symptoms, and substance use that can complicate assessment and treatment beyond psychosis alone. This study clarifies which comorbid symptoms track most closely with schizophrenia severity in a North Indian tertiary care sample, helping clinicians prioritize what to screen for and address early.
Design
cross-sectional observational study
N
One hundred seventy patients with early-phase schizophrenia (ICD-11 criteria; illness duration less than 5 years) were included.
Population
patients with a diagnosis of schizophrenia per International Classification of Diseases, Eleventh Revision (ICD-11) criteria14 for less than 5 years who were aged 18–60 years
Duration
over a period of 18 months (November 2023 to May 2025)
Key Findings
- Anxiety symptoms were present in 70.6% of participants, but associations with schizophrenia severity were weak: HAM-A correlated with PANSS total (ρ=0.219, P= .004), negative (ρ=0.174, P=.023), and general psychopathology scores (ρ=0.227, P=.003).
- Depressive symptoms were present in 16.5% of participants and showed stronger associations with schizophrenia severity across all PANSS domains: total (ρ=0.394), positive (ρ=0.242), negative (ρ=0.279), and general (ρ=0.439); all P<.001.
- Substance use was common, especially tobacco (31.2%), alcohol (12.9%), cannabis (11.8%), and opioids (5.3%), but no statistically significant correlation was observed between substance use and PANSS scores (P >.05 for all).
- The cohort was predominantly male (58.8%), with most patients showing gradual onset (94.1%) and a continuous fluctuating course (85.3%).
- All 170 participants had an AIMS score of 0, indicating no observed extrapyramidal symptoms in this prescreened sample.
Clinical Bottom Line
In early-phase schizophrenia, depressive symptoms had the clearest and most clinically meaningful relationship with symptom severity, whereas anxiety was common but only weakly associated with PANSS burden. Routine screening should therefore especially prioritize depression, while still assessing anxiety and substance use as part of integrated care.
Practice Implications
- Screen routinely for depressive symptoms in early-phase schizophrenia using a validated instrument such as the HAM-D, because depressive symptoms were present in 16.5% of patients and correlated with PANSS total (ρ=0.394) and general psychopathology (ρ=0.439); all P<.001.
- Interpret anxiety findings cautiously: anxiety symptoms were frequent at 70.6%, but HAM-A correlations with PANSS were weak (ρ=0.174–0.227), so anxiety severity should be assessed clinically rather than assumed to reflect schizophrenia severity.
- Continue substance use screening even when psychosis severity does not mirror substance involvement cross-sectionally, since tobacco (31.2%), alcohol (12.9%), cannabis (11.8%), and opioids (5.3%) were all reported despite no PANSS association (P >.05 for all).
- Do not generalize the absence of extrapyramidal symptoms from this sample to typical practice, because all 170 participants had an AIMS score of 0 in a cohort the authors note was prescreened and treated with atypical antipsychotics.
