Specific Social Phobia Research Articles

Trastornos de ansiedad en pacientes hospitalizados en Medicina Interna

Anxiety symptoms and anxiety disorders are common among medical patients, however few studies differentiate both and consider the psychiatric comorbidity of anxiety disorders among such patients. To evaluate the presence of anxiety disorders among patients admitted to a medical ward. Random selection of 406 patients (mean age 56 years, 203 female), hospitalized in a medical ward of a public hospital, mainly for cardiovascular, genitourinary and digestive diseases. All were assessed using an structured interview for DSM-III-R. Twenty six percent of women and 13% of men had anxiety disorders. Fifteen percent of women and 6% of men had specific phobias, 7% of women and 4% of men had generalized anxiety, 5% of women and 0.5% of men had agoraphobia, 3% of women and 0.5% of men had social phobia, 1% of men and 0.5% of women had panic disorders and 0.5% of women had a post traumatic stress. Specific phobias and social phobias started during childhood. Anxiety and agoraphobia started during adulthood. Among patients with anxiety disorders, 43% of women and 34% of men did not have other psychiatric ailment, 34% of women and 19% of men had an associated depression and 34% of men had disorders due to use of alcohol. A high proportion of patients hospitalized in medical wards have anxiety disorders, that once identified it may help to treat the medical ailments.

Anxiety as an Aggravating Factor During Onset of Focal Dystonia in Musicians

Focal dystonia in musicians is a task-specific movement disorder that in many cases leads to the end of musical careers. In a recent study, perfectionism and anxious traits were found to be elevated in musicians with dystonia. Dynamics of different anxiety disorders and their possible role during the development of musician’s dystonia still are unclear. Dystonic musicians (n = 20) were investigated by means of self-estimation and compared with healthy musicians (n = 30) and musicians with chronic pain syndromes (n = 20). Participants completed a questionnaire focusing on different anxiety disorders, particularly with regard to their dynamics. Musicians with focal dystonia more often reported social phobia and specific phobias than healthy musicians. In the retrospective analysis, these differences already were present before onset of dystonia. Musicians who later developed focal dystonia more often suffered from specific phobias than musicians who later developed chronic pain. Musicians with chronic pain more often reported free-floating anxiety compared with healthy musicians. In the subscale stage fright, no significant differences were observed between the groups. The pattern of specific phobias and social phobia were reported to have been preexisting before the onset of dystonia. Anxiety and perfectionism may be aggravating factors during the development of musician’s dystonia.

Evolutionary Mechanisms of Fear and Anxiety

This article examines evolutionary mechanisms in human fear and anxiety, with a particular focus on specific phobias and social phobia. The contribution of evolutionary factors to the development of specific phobias has led to refinements and modifications of earlier conditioning theories. Evolutionary mechanisms further affect cognitive factors of fear and anxiety, such as self-related processes and social comparisons, as in the case of social phobia. Although not without controversy, an evolutionary theory of human fear and anxiety adds a unique perspective that could potentially lead to improved psychopathology models, nosological systems, and treatment strategies for anxiety disorders.

Treatment of social anxiety disorder with citalopram

Selective serotonin reuptake inhibitors (SSRIs) are used as treatment for generalized and specific social phobias (social anxiety disorders). The efficacy of citalopram, an SSRI, for the treatment of social anxiety disorders has not yet been fully evaluated. These cases suggest that citalopram may be an effective treatment for social anxiety disorder (social phobia). These cases are consistent with two other published reports with citalopram from outside the US. Randomized controlled studies are warranted.

Kava kava in the treatment of generalized anxiety disorder, simple phobia and specific social phobia

A 37-year-old female outpatient with generalized anxiety disorder, a simple phobia and a specific social phobia was treated with phytotherapy (Kava kava). Within 4 weeks, symptoms had improved by 75% and by 6 months an almost total remission of symptoms was observed. The herbal medicine was well tolerated. Kava has considerable potential value in the treatment of anxiety disorders.

Profile of a large sample of patients with social phobia: Comparison between generalized and specific social phobia

This study examines a large cohort of subjects with social phobia, as part of a larger naturalistic and longitudinal study of 711 subjects with anxiety disorders. We focused on 176 subjects who were in an episode of social phobia at intake. We were particularly interested in evaluating the diagnostic distinction between generalized and specific social phobia. We compared these two groups along demographic characteristics, comorbidities, psychosocial functioning (health, role functioning, social functioning, and emotional functioning) and global assessment scores. We found that generalized social phobics tended to have an earlier age of onset as compared to the specific group; however, this is not a statistically significant difference at this level of analysis. The two groups did not differ for the current comorbidities examined. We observed no differences in the treatment received by the two types of social phobia subjects, and the two groups functioned equally well in terms of health and fulfilling social roles. In addition, we examined adverse childhood events (i.e., death of a parent, childhood abuse) and found no evidence for any differential impact these events might have on the type of social phobia. Although we did observe significantly greater fear of public speaking among the specific compared to the generalized group, which may indicate a qualitative difference between the subtypes, our results suggest that for most parameters, generalized and specific social phobia represent a continuum of similar and overlapping entities. Depression and Anxiety 4:209–216, 1996/1997.© 1997 Wiley-Liss, Inc.

Profile of a large sample of patients with social phobia: comparison between generalized and specific social phobia.

This study examines a large cohort of subjects with social phobia, as part of a larger naturalistic and longitudinal study of 711 subjects with anxiety disorders. We focused on 176 subjects who were in an episode of social phobia at intake. We were particularly interested in evaluating the diagnostic distinction between generalized and specific social phobia. We compared these two groups along demographic characteristics, comorbidities, psychosocial functioning (health, role functioning, social functioning, and emotional functioning) and global assessment scores. We found that generalized social phobics tended to have an earlier age of onset as compared to the specific group; however, this is not a statistically significant difference at this level of analysis. The two groups did not differ for the current comorbidities examined. We observed no differences in the treatment received by the two types of social phobia subjects, and the two groups functioned equally well in terms of health and fulfilling social roles. In addition, we examined adverse childhood events (i.e., death of a parent, childhood abuse) and found no evidence for any differential impact these events might have on the type of social phobia. Although we did observe significantly greater fear of public speaking among the specific compared to the generalized group, which may indicate a qualitative difference between the subtypes, our results suggest that for most parameters, generalized and specific social phobia represent a continuum of similar and overlapping entities.

International study of expert judgement on therapeutic use of benzodiazepines and other psychotherapeutic medications: II. Pharmacotherapy of anxiety disorders

Objective: To assemble expert clinical experience and judgement in the treatment of anxiety and related disorders in a systematic, quantitative manner. Methods: A panel of internationally recognized Experts in treating anxiety and depression was constituted by multistage peer nomination. 90% completed a questionnaire. This report focuses on case vignettes of 7 anxiety disorders followed by questions about relevant therapeutic options. Results: Panelists usually recommended both psychological and pharmacological interventions. Most favored antidepressants, usually tricyclic, for agoraphobia, panic and OCD; beta-blockers for specific social phobia; and benzodiazepines for GAD and adjustment disorder. Some Experts favored polypharmacy, usually an antidepressant and a benzodiazepine. The majority usually advocated pharmacotherapy for 6 months or more. They recommended the same duration of treatment with benzodiazepines and other medications, except for GAD. Conclusions: The responses of the Expert Panel imply that: 1. (1) most anxiety disorders are serious and merit vigorous, prolonged pharmacotherapy; 2. (2) antidepressants and benzodiazepines are effective and safe for long-term treatment of these conditions. This outcome contrasts with the widespread apprehension about long-term pharmacotherapy, especially with benzodiazepines, and some regulatory views.

Recent developments in the psychopharmacology of social phobia.

The past 2 decades have witnessed an upsurge in the interest in anxiety disorders. Much research effort has been dedicated to panic disorder and obsessive-compulsive disorder. However, it is only very recently that we have begun to understand some of the basic principles about the psychopharmacology of social phobia. Drug classes thus far studied include beta-blockers, nonselective and irreversible monoamine oxidase inhibitors (MAOIs), and benzodiazepines. Beta blockers appear to be of use in specific social phobias, such as public speaking, whereas they are of little use in generalized social phobia. There is considerable evidence suggesting that MAOIs are effective in reducing both social anxiety as well as social avoidance in generalized social phobia. A disadvantage of the conventional irreversible MAOIs is their risk for hypertensive crises when combined with dietary tyramine. Thus far only a small number of studies with selective MAO-A inhibitors, such as moclobemide and brofaromine, have been conducted in social phobia, and the results indicate that both compounds are effective. Drugs exerting selective and specific actions on certain components of, for example, the serotonergic system, can now be studied, and it is hoped that the role of 5-hydroxytryptamine) and other neuronal systems in social phobia can be elucidated. In order to gain more information about selective serotonergic drugs, the first double-blind placebo-controlled study with fluvoxamine was recently published. Preliminary results indicate a reduction in social anxiety after a prolonged treatment period. Finally, the role of peptides in the treatment of social phobia is critically reviewed. The MSH/ACTH analog Org 2766 was investigated in patients suffering from social phobia.(ABSTRACT TRUNCATED AT 250 WORDS)

A prospective follow-along study of the course of social phobia

The goals of this study were to delineate the courses of social phobia and to determine whether the course of generalized and specific social phobia differed. In the Harvard/Brown Longitudinal Study of Anxiety Research Project, 66 specific and 74 generalized social phobic subjects were identified for whom adequate course data were available. These subjects had been followed prospectively with a standardized follow-along measure of psychopathology. The probability of remission was calculated for each individual group and both groups combined. Demographics were the same for both groups except that the specific social phobia group had a marginally higher mean score on the Global Assessment Scale. Complete remission for the combined group was not different from that for either subgroup and was 0.11 at 65 weeks. Social phobia appears to be a disorder with considerable long-term morbidity. Surprisingly, both subtypes took a comparably long time to remit and were similar in their high level of psychosocial dysfunction.

Responses To Yohimbine in Social Phobia

A recent report by Tancer et al.(1993) observed that the growth hormone response to clonidine was blunted in social phobics relative to controls. The current project aimed to further evaluate NE functioning in social phobia (SP) patients by administration of an IV challenge dose of the alpha 2 adrenoreceptor antagonist, yohimbine. METHOD: Six medication-free patients with a principal DSM-III-R diagnosis of SP (4 males, 2 females), without a history of spontaneous panic attacks, participated in the protocol. Two of the six patients met criteria for the specific SP subtype. Patients received 2 challenge tests approximately 1 week apart. On one test day yohimbine 0.4 mg/kg IV was infused, while a saline placebo was administered on the second day. Tests were administered in a double-blind, balanced manner. Within challenge measures included the Social Anxiety Questionnaire (SAQ) (0-10 intensity scale), a clinician-rated instrument designed to be sensitive to changes in social anxiety symptoms and a visual analog anxiety scale (VAS) rated by patients (0-100 mm scale). In addition blood samples were drawn serially for analysis of the NE metabolite, 3-methoxy-4-hydroxyphenylglycol (MHPG). RESULTS: The mean peak change from baseline score in SAQ intensity was = 2.8±1.6 during the yohimbine test and = 0±0 (paired t-test t=3.8, df=4, p<0.05) during the placebo. The mean peak change±SD from baseline score in VAS anxiety was =10±12 mm for yohimbine vs 3±11 mm for placebo (t=0.89, df=5, p=0.42). Peak behavioral effects were noted 15 minutes post-yohimbine infusion. Peak change scores for plasma MHPG were = 2.1±0.9 ng/ml following yohimbine vs 0.7±0.9 ng/ml following placebo (t=2.7, df=4, p<0.06). CONCLUSIONS: These data suggest that yohimbine exacerbates social anxiety intensity and that this behavioral change is paralleled by concomitant increases in plasma levels of the NE metabolite, MHPG. Presynaptic dysfunction in the brain NE system may play a role in the pathophysiology of social phobia. Further studies are indicated to delineate the nature of this abnormality and its implications for treatment.

Recent developments in the psychopharmacology of social phobia

SummaryThe last two decades have witnessed an upsurge in the interest in anxiety disorders. Much research effort has been dedicated to panic disorder and obsessive compulsive disorder. However, it is only very recently that we have begun to understand some of the basic principles about the psychopharmacology of social phobia. Drug classes so far studied include beta-blockers, non-selective and irreversible MAO-inhibitors (MAOI's) and benzodiazepinen. Beta-blockers appear to be of use in specific social phobias, like public speaking. There is considerable evidence suggesting that MAOI's are effective in reducing both social anxiety as well as social avoidance. A disadvantage of the conventional irreversible MAOI's is their risk for hypertensive crises when combined with dietary tyramine.So far only a small number of studies with selective MAOI-A inhibitors such as moclobemide and brofaromine have been conducted in social phobia, and the results indicate that both compounds are effective.Drugs exerting selective and specific actions on certain components of e.g. the serotonergic system can now be studied and it is hoped that the role of serotonin and other neuronal systems in social phobia can be elucidated.In order to gain more information about selective serotonergic drugs the first double blind placebo-controlled study with fluvoxamine in social phobia is here reported. Preliminary results indicate a reduction of social anxiety.Finally the role of peptides in the treatment of social phobia is critically reviewed. The MSH/ACTH analog Org 2766 was investigated in patients suffering from social phobia. No anxiolytic effects of this peptide could be observed.

Major depression in patients with social phobia

The authors examined the longitudinal course of affective illness retrospectively in 63 patients with social phobia and 54 patients with panic disorder. Significantly fewer (35%) of the patients with social phobia than patients with panic disorder (63%) had experienced at least one major depressive episode. Patients with generalized social phobia and patients with specific social phobia had comparable past rates of major depression (37% and 30%, respectively). The clinical and theoretical implications of these findings are discussed within the context of current concepts regarding the development of depressive symptoms in patients with anxiety disorders.