Phobia, social

Nutt D, Baldwin D, Beaumont G, et al (1999). Guidelines for the management of social phobia/social anxiety disorder. Primary Care... 

Panic disorder Agoraphobia with panic disorder Agoraphobia without panic disorder Specific phobia Social phobia Generalised anxiety disorder Mild anxiety and depression disorder Obsessive compulsive disorder Acute stress disorder Post-traumatic stress disorder (PTSD) Adjustment disorder Panic disorder without agoraphobia Panic disorder with agoraphobia Agoraphobia Specific phobia Social phobia (also called social anxiety disorder) Generalised anxiety disorder Obsessive compulsive disorder Acute stress disorder Post-traumatic stress disorder (PTSD)... 

In this chapter, we consider categorical anxiety disorders as defined by the standardized diagnostic criteria of American Psychiatric Association s Diagnostic and Statistical Manual for Psychiatric Disorders [i.e., DSM-III (1980), DSM-III-R (1987), DSM-IV (1994)]. The subtypes of anxiety states included are panic disorder, agoraphobia, specific phobia, social phobia, generahzed anxiety/overanxious disorder, separation anxiety, and obsessive-compulsive disorder. 

Before the idea of anxiety disorders in children was established, studies tended to focus on behaviors that suggested an anxiety disorder. Much research prior to 1980 investigated the effects of certain medications on children and teens who refused to go to school. This refusal could be rooted in several types of disorders, including phobia, social anxiety disorder, and depression. 

III. Phobic disorders specific phobias, social phobia, and agoraphobia A. Clinical description of phobias and phobic disorders... 

Phobic Disorders Specific Phobias, Social Phobia, and Agoraphobia... 

Stein MB, Liebowitz MR, Lydiard RB, Pitts CD, Bushnell W, Gergel I (1998) Paroxetine treatment of generalized social phobia (social anxiety disorder) a randomized controlled trial. JAMA 280 708-713... 

Stein DJ, Berk M, Els C, Emsley RA, Gittelson L, Wilson D, Oakes R, Hunter B (1999)A double-blind placebo-controlled trial of paroxetine in the management of social phobia (social anxiety disorder) in South Africa. SAfrMedJ 89 402-406... 

Baldwin D, Bobes J, Stein DJ, Scharwachter I, Faure M (1999) Paroxetine in social phobia/social anxiety disorder. Randomized, double-blind, placebo-controlled study. Paroxetine Study Group. Br J Psychiatry 175 120-126... 

Paradigm alcohol for social phobia/social anxiety... 

Stein MB, Fyer AJ, Davidson JR, et al. Huvoxamine treatment of social phobia (social anxiety disorder) A double-blind, placebo-controlled study. Am J Psychiatry 1999 156 756-760. 

Jefferson JW. Benzodiazepines and anticonvulsants for social phobia (social anxiety disorder). J CUn Psychiatry 2001 62 50-53. 

Clinical uses include major depressions, anxiety states (panic, phobias, social), premenstrual dysphoric disorder, bulimia, OCD, and alcoholism. Withdrawal syndrome following discontinuance in depression nausea, headache, vertigo, malaise. 

Panic disorders, with or without agoraphobia, affect 1.6% of the adult population (>3,000,000 people) in the United States at some time in their lives. In panic disorder, brief episodes of fear are accompanied by multiple physical symptoms, such as terror, fear of dying, heart palpitations, difficulty in breathing, and dizziness. Panic attacks recur and the victim develops an intense fear of having another attack, which is termed anticipatory anxiety. In addition, the victim may develop irrational fears, called phobias, that relate to situations in which a panic attack has occurred. This condition may coexist with other phobias (agoraphobia, simple phobia, social phobia), depression, obsessive-compulsive disorder, alcohol and drug abuse, suicidal tendencies and irritable bowel syndrome. 

The DSM-IV-TR manual (American Psychiatric Association 2000) uses anxiety as a general term for a range of more specific anxiety disorders, which includes panic attacks, generalized anxiety disorder, specific phobias, social phobias, obsessive compulsive disorder and post traumatic stress disorder. However there is currently no literature applying these criteria to work and career anxiety, and nothing in the DSM-IV-TR which relates these disorders specifically to the work situation. Thus, the present chapter extrapolates the existing classifications of anxiety to the workplace from other settings. 

Antidepressants are small heterocyclic molecules entering the circulation after oral administration and passing the blood-brain barrier to bind at numerous specific sites in the brain. They are used for treatment of depression, panic disorders, generalized anxiety disorder, social phobia, obsessive compulsive disorder, and other psychiatric disorders and nonpsychiatric states. 

HT has been implicated in the etiology of numerous disease states, including depression, anxiety, social phobia, schizophrenia, obsessive compulsive disorders,... 

Indeed, 5-HT is also a substrate for the 5-HT transporter, itself an important player in the treatment of depression, and more recently for the whole range of anxiety disorders spectrum (GAD, OCD, social and other phobias, panic and post-traumatic stress disorders). It is the target for SSRIs (selective serotonin reuptake inhibitors) such as fluoxetine, paroxetine, fluvoxamine, and citalopram or the more recent dual reuptake inhibitors (for 5-HT and noradrenaline, also known as SNRIs) such as venlafaxine. Currently, there are efforts to develop triple uptake inhibitors (5-HT, NE, and DA). Further combinations are possible, e.g. SB-649915, a combined 5-HTia, 5-HT1b, 5-HT1d inhibitor/selective serotonin reuptake inhibitor (SSRI), is investigated for the treatment of major depressive disorder. 

Rees CS, Richards JC, Smith LM (1998). Medical utilisation and costs in panic disorder a comparison with social phobia. J Anxiety Disordl2A2 -55. 

Pharmacologically, a principal point relates to the cost-effectiveness of the newer indications for SSRIs in the less common disorders such as obsessive—compulsive disorder and social phobia. These conditions do place a disproportionate burden on health-care systems, and clinical trials of the newer indications are convincing. However, no cost-effectiveness study has yet been petformed to assess this, and prescribing will continue to be based on individual clinical need. 

PHOBIC DISORDERS profound fear of, and avoidance of, a dreaded object or situation. Agoraphobia. Fear of places or situations from which escape is difficult—can occur with or without a history of panic disorder Social phobia. Fear of social or performance situations Specific phobia. Fear of a specific object or situation... 

Anxiety disorders, including panic disorder, obsessive-compulsive disorder, and social phobia... 

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%. 

Anxiety disorders represent a diverse class of illnesses, with varied ages of onset. For example, according to the NCS-R epidemiologic study,3 PD and GAD had a median age of onset of 24 and 31 years, respectively, whereas specific phobia and social anxiety disorder (SAD) tend to develop much earlier (median age of onset 7 and 13 years, respectively). Although GAD and PD may not manifest fully until adulthood, as many as half of adult anxiety patients report subthreshold symptoms during childhood.6... 

Often occurs in context of other anxiety disorders. The feared social or performance situation can be limited to a specific social interaction (e.g., public speaking) or generalized to most any social interaction. Differs from specific phobia, in which the fear and anxiety are limited to a particular object or situation (e.g., insects, heights, public transportation). 

Pharmacotherapy of SAD should lead to improvement in physiologic symptoms of anxiety and fear, functionality, and overall well-being.26 Many patients may not achieve full remission of symptoms but should have significant improvement. Monitor patients weekly during acute treatment (e.g., initiation and titration of pharmacotherapy). Once patients are stabilized, monitor monthly. Inquire about adverse effects and SAD symptoms at each visit. To aid in assessing improvement, ask patients to keep a diary to record fears, anxiety levels, and behaviors in social situations.26 You may administer the Leibowitz Social Anxiety Scale (LSAS) to rate SAD severity and change, and the Social Phobia Inventory can be used as a self-assessment tool for SAD patients. 

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. 

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. 

Kessler, R. C., Stein, M. B., Berglund, P. (1998). Social phobia subtypes in the National Comorbidity Survey. American Journal of Psychiatry, 155, 613—619. 

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