The emergence of social phobia during clozapine treatment and its responseto fluoxetine augmentation

Background: The underlying neurochemical basis of social phobia has yet to be fully explained, but there are suggestions of serotonergic and dopaminer gic dysfunction. The atypical neuroleptic clozapine has been reported to in duce anxiety symptoms, probably owing to its effect on serotonergic pathway s. We report 12 cases of schizophrenic patients who developed social phobia during clozapine treatment. Method: Patients were assessed using the Structured Clinical Interview for DSM-III-R, Patient Version, Scale for the Assessment of Negative Symptoms, Scale for the Assessment of Positive Symptoms, the Liebowitz Social Phobia Scale, and the Brief Psychiatric Rating Scale. They were reevaluated after 12 weeks of cotreatment with clozapine and fluoxetine. Results: In 8 of the 12 cases, symptoms responded (greater than or equal to 35% reduction in Liebowitz Social Phobia Scale score) with an adjunctive r egimen of fluoxetine. Conclusion: Data are discussed in light of neurochemical mechanisms and cog nitive adaptations that could explain the onset of anxiety spectrum disorde rs (such as social phobia) in clozapine-treated schizophrenic subjects duri ng remission of psychotic symptoms.