What are approaches for treating or managing anxiety in patients with schizophrenia who are taking clozapine?

Treatment of anxiety in people with schizophrenia depends on the nature of the anxiety. It is important to exclude causes of anxiety, such as caffeine or other stimulants, or unmanaged medical disorders. If these are excluded, in patients with schizophrenia anxiety symptoms are often secondary to persistent psychosis. In a patient taking clozapine, management of persistent psychosis is described here. A common strategy is to increase the clozapine dosage. Note that an adequate clozapine dose is determined by clinical response, not solely blood levels. Benzodiazepines have been used successfully for anxiety in schizophrenia, though with sufficient clozapine treatment are often not needed. Lamotrigine augmentation of clozapine has been used with some success for comorbid depression and anxiety. Choice of psychosocial treatment for anxiety depends on the nature of the anxiety. For example, social anxiety may improve with rehabilitation, such as interventions that include social skills training, with increasing exposure to social situations.

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