Social anxiety disorder evaluation

Another study with citalopram evaluated its efficacy in the treatment of social anxiety disorder along with co-morbid major depression (Schneier etal., 2003). The outpatients (n= 21) were predominantly Hispanic (76%) and from New York. Response rates for the intent-to-treat sample were 66.7% for social anxiety disorder and 76.2% for major depression. Only one subject was known to have withdrawn secondary to severe side effects. The mean dose of the medication was 37.6 mg/day and there was no placebo control. The depressive symptoms tended to improve... 

There is something distinctly human about social anxiety. Mark Twain once remarked, Man is the only animal that blushes—or needs to. Although there are other mammalian species with complex social pecking orders, we, as humans, are particularly sensitive to how we are perceived by others. This sensitivity, when marked by a fear of evaluation by others, can become maladaptive. If that fear is transient and leads to little or no avoidance of social interactions, then it is considered normal shyness. However, when the social consequences of that fear become more pronounced, then the diagnosis of social phobia, now more commonly referred to as social anxiety disorder, is warranted. 

The Fear Questionnaire (FQ) is a 24-item self-rated scale used mainly for assessments in phobias. One component of the scale evaluates phobic behavior associated with a number of situations, whereas another component assesses symptoms of anxiety, depression and general distress caused by phobia (Marks and Mathews, 1979). The social phobia, strongly related to social anxiety, and most of the subscales are significantly related to neuroticism. The FQ has been utilized in several trials of social anxiety disorder. 

Cluster C patients may indeed present for psychotherapy and may improve with that treatment modality alone. However, the therapist should carefully consider the differential diagnosis between avoidant personality disorder and panic disorder or social anxiety disorder, for example, which responds well to SSRI therapy. And the therapist should particularly evaluate the Cluster C patient for obsessional signs and symptoms that may respond well to antiobsessional medication. 

In another study, Malsch and Kieser (2001) investigated the anxiolytic effects of WS 1490 compared to placebo in patients previously treated with a benzodiazepine. They evaluated the potential of the kava preparation as a replacement for the benzodiazepine, as well as the ability of the kava preparation to reduce benzodiazepine withdrawal symptoms. This was a five-week randomized, double blind placebo-controlled study in outpatients with non-psychotic anxiety (e.g., generalized anxiety disorder, social phobia, and simple phobia). Forty patients were included, and all had been on benzodiazepines (i.e., lorazepam, bromazepam, oxazepam, or alprazolam) for a mean duration of 20 months prior to entering the study. Of the 40 patients, 25 were males, and the mean age of the total sample was 40 years (range 21—75 years). 

How the different neurotransmitters may be involved in the initiation and maintenance of some brain disorders, such as Parkinson s disease, epilepsy, schizophrenia, depression, anxiety and dementia, as well as in the sensation of pain, is then evaluated and an attempt made to see how the drugs which are used in these conditions produce their effect by modifying appropriate neurotransmitter function (section C). The final section (D) deals with how neurotransmitters are involved in sleep and consciousness and in the social problems of drug use and abuse. 

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