Original article Assessment of social anxiety in first episode psychosis using the Liebowitz Social Anxiety scale as a self-report measure K.L. Romm a, *, J.I. Rossberg a,b , A.O. Berg a , C.F. Hansen c , O.A. Andreassen a,b , I. Melle a,b a Psychosis Research Unit, Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway b Institute of Clinical Medicine, Section of Psychiatry, University of Oslo, 0318 Oslo, Norway c Department of Psychology, University of Oslo, Pb. 1094 Blindern, 0317 Oslo, Norway 1. Introduction Social anxiety is defined by a persistent fear of embarrassment or negative evaluation while engaged in social interaction or public performance and tends to be followed by avoidant behavior [20]. People with social anxiety has demonstrated to suffer impairment in both occupational roles and daily activities as well as in social relationships [39]. They additionally show a high prevalence of comorbid depression, dysthymia and other anxiety disorders [38,35]. Recently, there has been an increased awareness of social anxiety as a comorbid condition among patients with psychotic disorders. In fact, social anxiety disorder is by far the most common anxiety disorder in this group [8,30], and the disorder contributes significantly to reduced quality of life [13]. However, patients with psychotic disorders are in greater risk of going untreated as their social anxiety is not properly addressed. This is mostly due to lack of recognition of social anxiety as a separate construct in this group of patients [8]. Instead, clinicians tend to apply the following clinical misconception that withdrawal from social interaction is either due to negative symptoms (e.g. avolition or anhedonia) or a behavioral consequence of positive psychotic symptoms (e.g. hallucinations and delusions, in particu- lar suspiciousness/paranoid delusions) which makes focusing on social anxiety per se superfluous. Fortunately, there is now a growing body of evidence that patients both with and without current positive and negative symptoms have a persistent fear of social interaction, in addition to having cognitive schemata resembling those seen in individuals with social phobia in general [12,6]. Besides, recent studies have confirmed strong correlations between self-esteem and both general – and social anxiety in psychotic disorders [12,16], which is in line with the general description of social anxiety disorder [2]. In addition, the presence of social anxiety has been associated with higher levels of depression and hopelessness [24]. Considering the relationship between depression and hopelessness and the high suicide rate in European Psychiatry 26 (2011) 115–121 ARTICLE INFO Article history: Received 27 May 2010 Received in revised form 25 August 2010 Accepted 31 August 2010 Available online 30 October 2010 Keywords: First episode psychosis Schizophrenia Social phobia Social anxiety Liebowitz Social Anxiety Scale ABSTRACT Objective. – Social anxiety is a common problem in psychotic disorders. The Liebowitz Social Anxiety Scale, Self-Rating version (LSAS-SR) is a widely used instrument to capture different aspects of social anxiety, but its psychometric properties have not been tested in this patient group. The aims of the present study were to evaluate the psychometric properties of the LSAS-SR in patients with first episode psychosis, to investigate whether it differentiated between active and passive social withdrawal and to test which clinical factors contributed to current level of social anxiety. Method. – A total of 144 first episode psychosis patients from the ongoing Thematically Organized Psychosis (TOP) study were included at the time of first treatment. Diagnoses were set according to the Structured Clinical Interview (SCID-1) for DSM-IV. A factor analysis was carried out and the relationship of social anxiety to psychotic and general symptomatology measured by the Positive and Negative Syndrome Scale (PANSS) was evaluated. Possible contributors to social anxiety were analyzed using multiple hierarchic regression analysis. Results. – The factor analysis identified three subscales: public performance, social interaction and observation. All three subscales showed satisfactory psychometric properties, acceptable convergent and discriminate properties, and confirmed previous findings in social anxiety samples. Self-esteem explained a significant amount of the variance in social anxiety, even after adjusting for the effects of delusions, suspiciousness and depression. Conclusion. – The study shows that the LSAS-SR can be used in this patient group, that social anxiety is strongly related to both behavioral social avoidance and to self-esteem. The results support the use of this measure in assessment of social anxiety in both clinical settings and in research. ß 2010 Elsevier Masson SAS. All rights reserved. * Corresponding author. E-mail address: k.l.romm@medisin.uio.no (K.L. Romm). 0924-9338/$ – see front matter ß 2010 Elsevier Masson SAS. All rights reserved. doi:10.1016/j.eurpsy.2010.08.014