Generalized social anxiety disorder

Drugs Used in the Treatment of Generalized Social Anxiety Disorder... 

Avoidant Personality Disorder (APD). APD is virtually indistinguishable from the generalized subtype of social anxiety disorder. APD is typically diagnosed when the social inhibition pervades almost all social interaction and has been present since childhood. Some have suggested that it is, in fact, the most severe manifestation of generalized social anxiety disorder and does not warrant inclusion as a separate diagnostic entity. 

Early controlled studies demonstrated the effectiveness of irreversible MAOIs, particularly phenelzine and tranylcypromine, for generalized social anxiety disorder. Prior to the advent of the SSRIs, MAOis were considered the gold standard treatment for social anxiety disorder. The best studied of the MAOis, phenelzine, has proved snperior to both beta blockers and the benzodiazepine alprazolam in treating generalized social anxiety disorder. 

Specific Sociai Anxiety Disorder, Acute Phase Treatment. Different strategies have evolved for treating specific social anxiety disorder versus generalized social anxiety disorder. Less complicated is the management of the specific subtype. Exposure-based psychotherapy is a mainstay of treatment, and as-needed medication doses prior to scheduled performances are also widely used. Preferred agents for performance anxiety are alprazolam or propranolol. 

Serotonin-Boosting Antidepressants. The SSRIs have also been studied in the treatment of generalized social anxiety disorder, and paroxetine, sertraline, and venlafaxine are effective. Preliminary data suggests that the serotonin-boosting atypical antidepressants (mirtazapine and nefazodone) may also be helpful. Like the MAOIs, they appear to be effective at doses comparable to those used to treat depression. They may help avoidant patients to gradually increase their social interaction and become more assertive. 

The generalized form of social anxiety disorder, on the other hand, is thought to be due to problems with dopamine and serotonin systems. Interestingly, people with Parkinson s disease, which is characterized by low levels of dopamine, are more likely to develop generalized social anxiety disorder. 

Stein MB, Seedat S, Gelernter J. Serotonin transporter gene promoter polymorphism predicts SSRI response in generalized social anxiety disorder. Psy chopharmacol 2006 187 68-72. 

An adequate trial of antidepressants in generalized social anxiety disorder lasts at least 8 weeks, and maximal benefit may not be seen until 1 2 weeks. 

The three principal domains in which improvement should be observed in generalized social anxiety disorder include symptoms, functionality, and well being or overall improvement. 

Stein MB. Long-term treatment of generalized social anxiety disorder with venlafaxine XR [poster]. 23rd Annual Congress of the Anxiety Disorder Association of America, Toronto, May 2003. 

Liebowitz MR, DeMartinis NA, Weihs K, et al. Efficacy of sertraline in severe generalized social anxiety disorder Results of a double-blind, placebo-controlled study. J Clin Psychiatry 2003 64 785-792. 

Liebowtiz MR, Stein MB, Tancer M, et al. A randomized, double-blind, fixed-dose comparison of paroxetine and placebo in the treatment of generalized social anxiety disorder. J CUn Psychiatry 2002 63 66-74. 

OCD, panic disorder, general anxiety disorder, social anxiety disorder, post-traumatic stress syndrome Depression, OCD, panic disorders, post-traumatic stress disorder... 

The anxiety disorders are common and surprisingly disabling conditions. Studies on the health economics of generalized anxiety disorder, panic disorder, social anxiety disorders and obsessive compulsive disorder document the cost to the individual and to society. Attention has focused on the major psychiatric disorders such as depression, schizophrenia and the dementias. Studies suggest that many anxiety disorders are of early onset and too often chronic they are quite common and impose a heavy burden on society. More studies will be needed to discern the fine grain in the survey material and to identify more precisely the location and type of societal costs. These factors will vary from country to country, from district to district, between men and women and between various age groups. 

Describe pathophysiologic findings in generalized anxiety, panic, and social anxiety disorder patients. 

With a lifetime prevalence of 28.8%, anxiety disorders collectively represent the most prevalent Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR)2 class of disorders, with specific phobia (12.5%) and social anxiety disorder (12.1%) being the most common.3 Recent reports from the National Comorbidity Survey Revised (NCS-R) estimate the lifetime and 1-year prevalence of generalized anxiety disorder (GAD) for those 18 years of age and older to be 5.7% and 3.1%, respectively.3,4 Rates for panic disorder (PD) are slightly lower, with an estimated 12-month prevalence of 2.7% and lifetime prevalence of 4.7%. 

CHAPTER 37 / GENERALIZED ANXIETY DISORDER, PANIC DISORDER, AND SOCIAL ANXIETY DISORDER 607... 

Reprinted, with permission, from Kirkwood CK, Melton ST. Anxiety disorders I. Generalized anxiety, panic, and social anxiety disorders. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw Hill 2005 1294. 

Chap. 37 - Generalized Anxiety Disorder, Panic Disorder, and Social Anxiety Disorder Universal Program Number ... 

The development of mild forms of anxiety and neuroveg-etative and/or cognitive responses to stress may represent an adaptive evolutionary step against environmentally (external) or self-triggered (internal) threats, but maladaptive reactions have also emerged in human evolution. Thus, anxiety disorders are maladaptive conditions in which disproportionate responses to stress, or even self-evoked responses, are displayed. Anxiety disorders are one of the most frequent psychiatric illnesses, and have a lifetime prevalence of 15- 20% [1, 89]. The most common presentations are generalized anxiety disorder, with a lifetime prevalence rate of close to 5% [1, 89] social anxiety disorder, with very variable lifetime prevalence rates ranging from 2 to 14% [90] panic disorder, with rates from 2 to 4% [1,89] and post-traumatic stress disorder (PTSD), with a prevalence rate close to 8%. Specific phobias, acute stress and obsessive-compulsive behavior are other clinical presentations of anxiety disorders. 

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