Anxiety outweighs cannabis links in early schizophrenia care

Background: Schizophrenia is a chronic and debilitating psychiatric disorder often accompanied by comorbid conditions, notably anxiety, depressive symptoms, and substance use disorders. These comorbidities further complicate the clinical profile, reduce treatment compliance, and worsen prognosis, particularly in first-episode schizophrenia, which is less discussed in the Indian context. While extensive research exists globally, data from the Indian context, particularly on early-phase schizophrenia, remain sparse. Methods:This cross-sectional observational study was conducted over 18 months (November 2023 to May 2025) in the department of psychiatry of a tertiary care teaching hospital in Northern India. The study included 170 patients aged 18-60 years, diagnosed with schizophrenia of less than 5 years duration per International Classification of Diseases, Eleventh Revision criteria. Assessment tools included the Positive and Negative Syndrome Scale (PANSS), Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), and World Health Organization Alcohol, Smoking and Substance Involvement Screening Test Version 3.0 for substance use evaluation. Results: Results revealed that 32.9% of patients had moderate to severe anxiety symptoms (HAM-A score &#x2265; 25), and 16.5% had moderate to severe depressive symptoms (HAM-D score &#x2265; 20). Substance use was common, particularly tobacco (31.2%), alcohol (12.9%), cannabis (11.8%), and opioids (5.3%); however, substance use did not correlate highly with the severity of schizophrenia as measured by the PANSS. Significant positive correlations emerged between anxiety (HAM-A) and PANSS total, negative, and general psychopathology scores, while depressive symptoms (HAM-D) correlated moderately with all PANSS components (&#x3c1;=0.242-0.439, P<.001). However, substance use showed no significant correlation with schizophrenia severity. Conclusion: These findings highlight the critical need for early screening and comprehensive management for anxiety and depressive symptoms in schizophrenia, as their presence significantly correlates with illness severity and may influence long-term functional outcomes. Trial Registration: Clinical Trials Registration-India identifier: CTRI/2023/11/059495. Prim Care Companion CNS Disord 2026;28(4):26m04210. Author affiliations are listed at the end of this article.