Liebowitz Social Anxiety Scale

Patients with SAD should be monitored for symptom response, adverse effects, and overall functionality and quality of life. Patients should be seen weekly during dosage titration and monthly once stabilized. Patients should be asked to keep a diary to record symptoms and their severity. The clinician-related Liebowitz Social Anxiety Scale and the patient-rated Social Phobia Inventory can be used to monitor severity of symptoms and symptom change. 

Sertraline. Sertraline, the second SSRI to receive FDA approval for depression, has also been suggested as a treatment for social phobia. Katzelnick et al. (1994) carried out a double-blind, placebo-controlled, crossover study comparing sertraline and placebo. Twelve subjects were randomized to either sertraline or placebo for 12 weeks. The agent was then tapered and the subjects received no treatment for 2 weeks. They were then switched to the other treatment arm for an additional 12 weeks. Using the Liebowitz Social Anxiety Scale, analysis revealed statistically significant improvement with sertraline treatment but not with placebo. Forty-two percent of patients were rated as moderately or markedly improved while receiving the sertraline ther-... 

The initial study of clonazepam in social phobia conducted by Versiani et al. [1989] showed an overall benefit of the drug. This 8-week, open trial of 40 subjects displayed statistically significant lowering of scores on the efficacy variables, which included the Clinical Global Improvement and Severity Scales [Guy 1976], Liebowitz Social Anxiety Scale [liebowitz 1987], Hamilton Anxiety Scale [M. Hamilton 1959], and the Sheehan Disability Scale [D. V. Sheehan 1986]. The mean dose of clonazepam was 3.9 mg/day [SD 0.5 mg]. Subjects in this study reported high rates of side effects, including sleepiness [67.5%], loss of libido [67.5%], and memory problems [35%]. 

In contrast to experience with depression, placebo response rates of trials in social phobia show a rather constant pattern during the past decade between 9 and 29% of patients were characterized as placebo responders as measured by the Liebowitz Social Anxiety Scale (Kobak et al., 2002). 

The Liebowitz Social Anxiety Scale (LSAS) measures fear, anxiety and avoidant behavior in 24 commonly feared social situations and performances. There are 13 performance-related items and 11 items that rate the social situations (Heimberg et al, 1999). The LSAS is the standard established outcome measure in most of the pivotal trials for social anxiety. Cut-offs of 30 for social anxiety disorder and 60 for its generalized subtype on the LSAS total scores represent a balance of specificity and sensitivity. There are two valid versions of the LSAS a clinician-administered version and a self-rating version (Fresco et al.. 2001). 

Fresco, D.M., Coles, M.E., Heimberg, R.G., et al. The Liebowitz Social Anxiety Scale a comparison of the psychometric properties of self-report and clinician administered formats. Psychol. Med. 31(6), 1025-1035, 2001. 

During the acute phase of treatment, patients should be seen weekly while the drug dosage is titrated. Once the patient responds and the dosage is stabilized, the patient can be seen monthly. At each visit, the patient should be asked about adverse effects and improvement in symptoms. The patient should be instructed to keep a diary to record fear levels, physical symptoms, cognitions, and anxious behaviors in actual exposures to social situations. The Liebowitz Social Anxiety Scale is a clinician-rated scale that rates clinical severity and change in SAD that can be used to monitor response. Patients can use the Social Phobia Inventory for self-assessment of SAD symptoms. Full remission is a complete resolution of symptoms across the three... 

SAD domains that is maintained for 3 months or a Liebowitz Social Anxiety Scale score of <30. ... 

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