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INTRODUCTION
Affective dysfunction (e.g., low mood, anxiety) is very prevalent in people diagnosed with psychosis, and constitutes a significant problem due to the pronounced impact upon the course and outcome of psychosis. Research has shown that affective disturbances are prominent even before the onset and development of psychotic symptoms, and their presence in those at high risk can be highly predictive of psychosis [1, 2]. Factor analytic studies of psychosis symptoms consistently point to a depression dimension in non?affective psychosis [3]. Depression is observed throughout the course [4], including the prodromal phase [1, 5] and following symptomatic recovery. Post?psychotic depression (PPD) has been reported in 30-50% of individuals [6, 7]. The relationship between anxiety and psychosis has also received considerable attention in the literature. High levels of anxiety and irritability usually predate the onset of psychosis [8] and persist throughout the course of the illness. Cossof and Hafner [9] reported a 43% prevalence of comorbid anxiety disorders in inpatients with schizophrenia. Freeman and colleagues [10, 11] have thoroughly investigated the fundamental role of anxiety in the development and maintenance of delusions, providing insight into the interaction between affective and psychotic symptoms.
Although the presence of depression and generalized anxiety in psychosis has been thoroughly examined, research on the nature and origins of social anxiety disorder in psychosis is limited. This is surprising as interpersonal difficulties, social avoidance, and withdrawal are the hallmarks of schizophrenia and exert a significant impact upon individuals' quality of life [12-14]. The relationship between social anxiety and psychotic symptoms, particularly paranoia, is not well understood. It is unclear whether social anxiety is driven by the presence of paranoia and persecutory thinking. Limited evidence on this area is inconclusive, which has led to social anxiety being under?recognized or simply rendered subordinate to psychotic symptoms. Investigating the phenomenology of social anxiety in psychosis and delineating the pathways that underlie its emergence will have significant clinical implications in terms of early identification and intervention. At present, psychological therapies such as cognitive behavioral therapy (CBT) are primarily focused on treating psychotic symptoms. Emotional problems, including social anxiety, are only treated as part or as a result of the psychotic experience. However, if emotional problems represent an independent dimension in psychosis associated with specific underlying...