Specific 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. 

Propranolol Blocks NE beta receptors None Specific social anxiety disorder Agitation Lithium tremor Akathisia... 

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... 

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)... 

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. 

Panic disorder Generalised anxiety disorder Social anxiety disorder Specific phobias... 

The section for emotional disorders in children spans across the following diagnoses separation anxiety disorder social anxiety disorder of childhood phobic anxiety disorder of childhood generalized anxiety disorder of childhood other emotional disorders (with onset specific to childhood) and sibling rivalry disorder. 

The word phobia comes from the Greek word for fear phobos, and refers to an inappropriately intense and irrational fear toward some object or situation. Most adults who experience phobias recognize that the fear is irrational. Most phobias fall into the category of specific (sometimes called simple ) phobias. The more complex social phobia (also called social anxiety disorder ) will be discussed later. 

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). 

Roy-Byme, P., Cowlty, D.S. Pharmacological treatments for panic disorder, generalized anxiety disorder, specific phobia, and social anxiety disorder. In Nathan, P.E., Gorman, J.M. (eds) A Guide to Treatments that Work. Oxford University Press, Oxford, 2002, pp. 337-365. 

Phobia is fear, and there are several disorders that are classified as phobias. Here we will briefly discuss agoraphobia, specific phobias, and social phobia, also known as social anxiety disorder. 

United States, the 1-year prevalence rate for anxiety disorders was 13.3% in persons aged 18 to 54 years and 10.6% in those over age 55 years. Specific phobias were the most common anxiety disorder, with a 12-month prevalence of 8% however, patients were not seriously impaired in terms of daily functioning, and few persons sought treatment. The 1-year prevalence of generalized anxiety disorder (GAD) was 2.8%, that of panic disorder was 1.7%, and that of social anxiety disorder (SAD) was 3.7%. ... 

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision classifies anxiety disorders into several categories generalized anxiety disorder, panic disorder (with or without agoraphobia), social anxiety disorder, specific phobia, OCD, PTSD, and acute stress disorder (ASD). The characteristic features of these illnesses are anxiety and avoidance behavior. Generalized anxiety disorder, panic disorder, and social anxiety disorder are discussed in Chap. 69. 

Psychiatrists prescribe antipsychotics to treat mental illnesses that cause patients to experience marked breaks with reality (psychosis). The most common of such disorders is schizophrenia, which is a chronic, disabling, persistent, and severe brain disease that sigpiificantly impairs brain functioning and affects 1 percent of the world s population, including 3 million people in the United States alone. Antipsychotic medications are referred to as typical or atypical. Psychiatrists prescribe anxiolytics (antianxiety medications) to treat anxiety disorders, which include panic disorder, generalized anxiety disorder, specific phobias, obsessive-compulsive disorder, social anxiety disorder, and posttraumatic stress disorder. Psychiatrists prescribe antidepressants and mood stabilizers to treat the symptoms of mood disorders, the most common and severe of which are major depression and bipolar disorder. 

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. 

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). 

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. 

Study (country) reference Assessment instrument n Age Time frame Anxiety disorder (any) Panic disorder Agora- phobia Subtypes Specific Social phobia phobia GAD OCD PTSD... 

Looking now into the prevalence rates reported from the several studies, lifetime prevalence rates for all anxiety disorders lumped together in the different studies range between 5.6% and 28.7%. The estimated median of the included studies is 15.1%. Lifetime prevalence estimates describe the proportion of persons in the population who have developed the disorder under consideration at least once in their life. Based on this estimated median, anxiety disorders occur in approximately 1 in 7 persons in the general population at some point in their life. Looking closer at specific anxiety disorders, it becomes evident that the high hfetime prevalence of anxiety disorders is mostly due to the high frequency of simple phobia and social phobia. 

Several SSRls have been PDA approved for one or more specific anxiety diagnoses [e.g., paroxetine for social anxiety, generalized anxiety disorder (GAD)... 

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