Social Phobia

Manuel E. Tancer1, Thomas W. Uhde1
1Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, University Health Center, Detroit, USA

Tóm tắt

Social phobia is a common anxiety disorder characterised by marked fear and discomfort in situations involving possible scrutiny or evaluation by others. Over the last 10 years, several research groups have evaluated treatments for patients with social phobia. Well designed clinical trials support the efficacy of both pharmacotherapy and cognitive-behavioural therapy in the treatment of patients with social phobia. Among the pharmacological agents, 4 classes of drugs have been shown to be superior to placebo in double-blind, placebo-controlled trials (although no drug has US Food and Drug Administration approval for use in social phobia). Effective agents include: (i) the monoamine oxidase inhibitors phenelzine, moclobemide and brofaromine; (ii) the high potency benzodiazepines alprazolam and clonazepam; (iii) the selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitor fluvoxamine; and (iv) the 5-HT3-receptor antagonist ondansetron. A number of questions concerning the treatment of social phobia remain to be answered, such as: Future studies are needed to address these unresolved issues.

Từ khóa


Tài liệu tham khảo

Liebowitz MR, Gorman JM, Fyer AJ, et al. Social phobia. A review of a neglected anxiety disorder. Arch Gen Psychiatry 1985; 42: 729–36

Marks IM. The classification of phobic disorders. Br J Psychiatry 1970; 116: 377–86

American Psychiatric Association. Diagnostic and statistical manual for mental disorders. 3rd ed. American Psychiatric Press: Washington, DC, 1980

American Psychiatric Association. Diagnostic and statistical manual for mental disorders. 4th ed. American Psychiatric Press: Washington, DC, 1994

American Psychiatric Association. Diagnostic and statistical manual for mental disorders. 3rd ed., rev. American Psychiatric Press: Washington, DC, 1987

Pollard CA, Henderson JG. Four types of social phobia in a community sample. J Nerv Ment Dis 1988; 176: 440–5

Turner SM, Beidel DC, Townsley RM. Social phobia: a comparison of specific and generalized subtypes and avoidant personality disorder. J Abnorm Psychol 1992; 101: 326–31

Gelernter CS, Stein MB, Tancer ME, et al. An examination of syndromal validity and diagnostic subtypes in social phobia and panic disorder. J Clin Psychiatry 1992; 53: 23–7

Myers JK, Weissman MM, Tischler GL, et al. Six-month prevalence of psychiatric disorders in three communities: 1980–1982. Arch Gen Psychiatry 1984; 41: 959–67

Angst J, Dobler-Mikola A. The Zurich study: V. Anxiety and phobia in young adults. Eur Arch Psychiatry Clin Neurosci 1985; 235: 171–8

Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry 1994; 51: 8–19

Amies PZ, Gelder MG, Shaw PM. Social phobia: a comparative clinical trial. Br J Psychiatry 1983; 142: 174–9

Stein MB, Tancer ME, Gelernter SC, et al. Major depression in patients with social phobia. Am J Psychiatry 1990; 147: 637–9

Schneier FR, Martin LY, Liebowitz MR, et al. Alcohol abuse in social phobia. J Anxiety Disord 1989; 3: 15–23

Chambless DL, Chernly J, Caputo GC, et al. Anxiety disorders and alcoholism: a study with inpatient alcoholics. J Anxiety Disord 1987; 1: 29–40

Schneier FR, Johnson J, Hornig CD, et al. Social phobia: comorbidity and morbidity in an epidemiologic sample. Arch Gen Psychiatry 1992; 49: 282–8

Tyrer P, Candy J, Kelly D. A study of the clinical effects of phenelzine and placebo in the treatment of phobic anxiety. Psychopharmacologia 1973: 32: 237–54

Mountjoy CQ, Roth M, Garside RF, et al. A clinical trial of phenelzine in anxiety depressive and phobic neuroses. Br J Psychiatry 1977; 131: 486–92

Solyom C, Solyom L, LaPierre Y, et al. Phenelzine and exposure in the treatment of phobias. Biol Psychiatry 1981; 16: 239–47

Gelernter CS, Uhde TW, Cimbolic P, et al. Cognitive-behavioral and pharmacological treatments of social phobia: a controlled study. Arch Gen Psychiatry 1991; 48: 938–45

Liebowitz MR, Schneier F, Campeas R, et al. Phenelzine vs atenolol in social phobia: a placebo-controlled comparison. Arch Gen Psychiatry 1992; 49: 290–300

Versiani M, Nardi AE, Mundim FD, et al. Pharmacotherapy of social phobia. A controlled study with moclobemide and phenelzine. Br J Psychiatry 1992; 160: 353–60

van Vliet IM, den Boer JA, Westenberg HGM. Psychopharmacological treatment of social phobia: clinical and biochemical effects of brofaromine, a selective MAO-A inhibitor. Eur Neuropsychopharmacol 1992; 2: 21–9

Liebowitz MR, Fyer AJ, Gorman JM, et al. Phenelzine in social phobia. J Clin Psychopharmacol 1986; 6: 93–8

Versiani M, Mundim FD, Nardi AE, et al. Tranylcypromine in social phobia. J Clin Psychopharmacol 1988; 8: 279–83

Davidson JRT, Potts N, Richichi E, et al. Treatment of social phobia with clonazepam and placebo. J Clin Psychopharmacol 1993; 13: 423–8

Lydiard RB, Laraia MT, Howell EF, et al. Alprazolam in the treatment of social phobia. J Clin Psychiatry 1988; 49: 17–9

Reich J, Yates W. A pilot study of treatment of social phobia with alprazolam. Am J Psychiatry 1988; 145: 590–4

Ontiveros A, Fontaine R. Social phobia and clonazepam. Can J Psychiatry 1990; 35: 439–41

Munjack DJ, Baltazar PL, Bohn PB, et al. Clonazepam in the treatment of social phobia. J Clin Psychiatry 1990; 51 Suppl.: 35–40

Reiter SR, Pollack MH, Rosenbaum JF, et al. Clonazepam for the treatment of social phobia. J Clin Psychiatry 1990; 51: 470–2

Davidson JRT, Ford SM, Smith RD, et al. Long-term treatment of social phobia with clonazepam. J Clin Psychiatry 1991; 52 Suppl.: 16–20

Turner SM, Beidel DC, Jacob RG. Social phobia: a comparison of behavior therapy and atenolol. J Cons Clin Psychol 1994; 62: 350–8

Falloon IRH, Lloyd GG, Harpin RE: The treatment of social phobia: real-life rehearsal with non professional therapists. J Nerv Ment Dis 1981; 169: 180–4

Gorman JM, Liebowitz MR, Fyer AJ, et al. Treatment of social phobia with atenolol. J Clin Pyschopharmacol 1985; 5: 298–301

Clark DB, Agras WS. The assessment and treatment of performance anxiety in musicians. Am J Psychiatry 1991; 148: 598–605

Munjack DJ, Brusns J, Baltazar PL, et al. A pilot study of buspirone in the treatment of social phobia. J Anxiety Disord 1991; 5: 87–98

Schneier FR, Saoud JB, Campeas R, et al. Buspirone in social phobia. J Clin Psychopharmacol 1993; 13: 251–6

van Vliet IM, den Boer JA, Westenberg HGM. Psychopharmacological treatment of social phobia; a double-blind placebo controlled study with fluvoxamine. Psychopharmacology 1994; 115: 128–34

Sternbach H. Fluoxetine treatment of social phobia. J Clin Psychopharmacol 1990; 10: 230–1

Schneier FR, Chin SJ, Hollander E, et al. Fluoxetine in social phobia. J Clin Psychopharmacol 1992; 12: 62–4

Black B, Uhde TW, Tancer ME. Fluoxetine for the treatment of social phobia. J Clin Psychopharmacol 1992; 12: 293–5

Van Ameringen M, Mancini C, Streiner DL. Fluoxetine in efficacy social phobia. J Clin Psychiatry 1993; 54: 27–32

Van Ameringen M, Mancini C, Streiner D. Sertraline in social phobia. J Affect Dis 1994; 31: 141–5

Ringold A. Paroxetine efficacy in social phobia [letter]. J Clin Psychiatry 1994; 55: 363–4

Bell J, DeVeaugh-Geiss J. Multicenter trial of a 5-HT3 antagonist, ondansetron, in social phobia. Presented at the 33rd Annual Meeting of the American College of Neuropsychopharmacology; 1994 Dec 12–16: San Juan, Puerto Rico

Den Boer JA, Westenberg HGM, De Vries H. The MSH/ACTH analog ORG 2766 in anxiety disorders. Peptides 1992; 13: 109–12

Goldstein S. Treatment of social phobia with Clonidine. Biol Psychiatry 1987; 22: 369–72

Uhde TW, Stein MB, Vittone BJ, et al. Behavioral and physiologic effects of short-term and long-term administration of Clonidine in panic disorder. Arch Gen Psychiatry 1989; 46: 170–7

Emmanuel NP, Lydiard RB, Ballenger JC. Treatment of social phobia with bupropion. J Clin Psychopharmacol 1991; 4: 276–7

Allsopp LF, Cooper GL, Poole PH. Clomipramine and diazepam in the treatment of agoraphobia and social phobia in general practice. Curr Med Res Opin 1994; 9: 64–70

Benca R, Matuzas W, Al-Sadir J. Social phobia, MVP, and response to imipramine. J Clin Psychopharmacol 1986; 6: 50–1

Uhde TW, Tancer ME. Social phobia: pharmacotherapy and behavioral therapy. In: Beitman BD, Klerman G, editors. Integrating pharmacotherapy and psychotherapy. Washington, DC: American Psychiatric Press, 1991: 231–52

Heimberg RG, Barlow DH. Psychosocial treatments for social phobia. Psychosomatics 1988; 29: 27–37

Hope DA, Holt CS, Heimberg RG. Social phobia. In: Giles TR. Handbook of effective psychotherapy. New York: Plenum Press, 1993: 227–51

Heimberg RG, Salzman DG, Holt CS, et al. Cognitive behavioral group treatment for social phobia: effectiveness at 5-year follow-up. Cognitive Ther Res 1993; 17: 325–39

Heimberg RG, Barlow DH. New developments in cognitive-behavioral therapy for social phobia. J Clin Psychiatry 1991; 52 Suppl.: 21–30

Stein MB, Shea CA, Uhde TW. Social phobic symptoms in patients with panic disorder: practical and theoretical considerations. Am J Psychiatry 1989; 146: 235–8

Carrasco JL, Hollander E, Schneier FR, et al. Treatment outcome of obsessive-compulsive disorder with comorbid social phobia. J Clin Psychiatry 1992; 53: 387–91

Schneier FR, Spitzer RL, Gibbon M, et al. The relationship of social phobia subtypes and avoidant personality disorder. Compr Psychiatry 1991; 32: 1–5

Turner SM, Beidel DC, Dancu CV, et al. Psychopathology of social phobia and comparison to avoidant personality disorder. J Abnorm Psychol 1986; 4: 389–94

Deltito JA, Perugi G. A case of social phobia with avoidant personality disorder treated with MAOI. Compr Psychiatry 1986; 27: 255–8

Deltito JA, Stam M. Psychopharmacology treatment of avoidant personality disorder. Compr Psychiatry 1989; 30: 498–504

Black B, Uhde TW. Elective mutism as a variant of social phobia. J Am Acad Child Adolesc Psychiatry 1992: 31: 1090–4

Black B, Uhde TW. Treatment of elective mutism with fluoxetine: a double-blind, placebo-controlled study. J Am Acad Child Adolesc Psychiatry 1994; 33: 1000–6