A Possible Link between Anxiety and Schizophrenia and a Possible Role of Anhedonia

Abstract

In the prodromal phase of schizophrenia, severe alterations of the visual appearance of the environment have been found, accompanied by a state of intense anxiety. The present study considers the possibility that these alterations really exist in the appearance of objects, but that healthy people do not see them. The image of the world that we see is continuously deformed and fragmented by foreshortenings, partial overlapping, and so on and must be constantly reassembled and interpreted; otherwise, it could change so much that we would hardly recognize it. Since pleasure has been found to be involved in visual and cognitive information processing, the possibility is considered that anhedonia (the reduction of the ability to feel pleasure) might interfere with the correct reconstruction and interpretation of the image of the environment and alter its appearance. The possibility is also considered that these alterations might make the environment hostile, might at times evoke the sensation of being trapped by a predator, and might be the cause of the anxiety that accompanies them. According to some authors, they might also induce delusional ideas, in an attempt to restore meaning in a world that has become chaotic and frightening.

Efficacy of Olanzapine in Anxiety Dimension of Schizophrenia: A Systematic Review of Randomized Controlled Trials

“…Nevertheless, it is not clear whether the observed superiority is independent of its reduced liability to produce akathisia (which may look like anxiety) or its intrinsic anxiolytic effect [ 5 , 65 ]. Moreover, psychometric tools used to measure anxiety do not make it possible to discriminate between anxiety as a primary phenomenon and anxiety as secondary response to psychotic symptoms [ 66 , 67 ], nor differentiate “Anxiety” from “Angst” (German translation of “Anguish”) [ 68 ]. Additional studies having as primary outcome anxiety dimension and more appropriate assessment scales are needed to clarify the issue.…”

Spatial working memory, not IQ or executive function, discriminates early psychosis and clinically vulnerable creative individuals

“…It may be for the creative individual, with intact spatial working memory, creative product occurs. For the early psychosis individual with impaired spatial working memory (ie, impaired visual memory and problem solving ability), this may lead to inappropriate salience assignment and delusions (Grillo, 2018).…”

“…The assertion that deficits in spatial working memory may be an early risk factor for psychosis and a more reliable neurocognitive marker for psychosis, compared to other cognitive factors, (Carrión et al, 2018), has been supported in other studies (Badcock, Michiel, & Rock, 2005; Brewer et al, 2006; Pirkola et al, 2005). In addition to this, a number of recent reviews have proposed that aberrations in visual functioning, such as deficits in spatial working memory are associated with early psychosis (Landgraf & Osterheider, 2013; Uhlhaas & Mishara, 2007), which may in turn drive delusion formation (Grillo, 2018). Further research into these visuo‐cognitive impairments is needed.…”

Painting Schizophrenia: An Empirical Investigation of the Self-Portraits and Portraits of Edvard Munch

“…These correlations are consistent with changes in how the world is experienced by patients. A world literally seen as strange can be experienced as unsafe, threatening, underpinning anxiety, paranoia, hallucination and resulting responses (Grillo, 2018). Persecutory delusions, for example, are associated with increased risk of violence and social isolation (Coid et al, 2013;Fett et al, 2002).…”