Social phobia or social anxiety disorder: what's in a name?

Measuring the neglected anxiety disorder: validation of the social anxiety spectrum-short version (SHY-SV) questionnaire

BACKGROUND

In the recent years, a growing body of literature stressed the importance of a dimensional perspective on mental disorders. In particular, since its conceptualization, one of the main concerns in the field of Social Anxiety Disorder (SAD) has been the definition of a diagnostic threshold, leading to the suggestion that SAD may be more properly classified as a spectrum of severity rather than a discrete disorder based on subjectively determined threshold. The purpose of the current research is to evaluate the psychometric qualities of the Social Anxiety Spectrum - Short Version (SHY-SV), a novel questionnaire designed to measure the complete range of social anxiety symptoms, from overt manifestations to subthreshold ones.

METHODS

42 subjects with a clinical diagnosis of social anxiety disorder (SAD) according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 43 subjects with a clinical diagnosis of Obsessive-Compulsive Disorder (OCD) and 60 individuals without current or lifetime mental disorders (HC) were recruited from the Psychiatric Clinic of the University of Pisa. Subjects were assessed with the SCID-5, Liebowitz Social Anxiety Scale (LSAS) and the SHY-SV.

RESULTS

SHY-SV showed strong internal consistency, and both the total and domain scores had great test-retest reliability. The Pearson's coefficients for the SHY-SV domain scores ranged from 0.391 to 0.933, and they were positively and significantly correlated with one another (p 0.001). All the SHY-SV domain scores were highly correlated with the SHY-SV total score. Results from of the correlation coefficients between SHY-SV and alternative measures of SAD were all significant and positive. Significant differences among diagnostic groups on both SAD-SV domains and total scores were found. SAD-SV total score increased significantly and progressively from HCs, to the OCD up to the SAD group which showed the highest values.

CONCLUSION

The SHY-SV demonstrated significant convergent validity with other dimensional SAD measures, great internal consistency, and test-retest reliability. With an increasing score gradient from healthy controls to patients with OCD to those with SAD, the questionnaire performed differently in each of the three diagnostic categories.

Mediating effects of self-esteem on the relationship between mindful parenting and social anxiety level in Chinese adolescents

This study aimed to investigate the relationship between mindful parenting and social anxiety level in Chinese adolescents and to explore the mediating roles of self-esteem between mindful parenting and social anxiety level. A total of 302 adolescents and their main caregivers were investigated by using the Chinese version of the Mindful Parenting Scale, Self-Esteem Scale and the Center for Epidemiological Studies Depression Scale and the Social Anxiety Scale. Related analysis was used to investigate the relationship between mindful parenting, self-esteem and social anxiety level. Mindful parenting and self-esteem were significantly associated with social anxiety level. Self-esteem mediated the relationship between mindful parenting and social anxiety level. Both mindful discipline and being in the moment influenced adolescents' social anxiety level through self-esteem. Self-esteem completely mediated the association between mindful parenting and social anxiety level. Longitudinal research is needed to better understand the relationship between mindful parenting and social anxiety level in adolescents.

Developmental course of anxiety and depression from adolescence to young adulthood in a prospective Norwegian clinical cohort

Anxiety and depression are often co-occurring disorders, reflecting both homotypic and heterotypic continuity as possible developmental pathways. The present study aimed to examine homotypic and heterotypic continuities of anxiety and depression across 3 years in adolescence and young adulthood. Participants included patients presenting to psychiatric care with diagnoses of anxiety and/or depressive disorders aged 13-18 at T1 (N = 717, 44% initial participation rate) and aged 16-21 at T2 (N = 549, 80% follow-up participation rate). McNemar's mid-p test and ordinal proportional odds logistic regression analyses were used to assess changes in prevalence within and across diagnostic categories, respectively. More adolescents had an anxiety disorder (+ 11%), whereas fewer had a depressive disorder (- 11%), at T2 compared to T1. Of adolescents with anxiety and/or depression at T1, only 25% recovered or were non-symptomatic 3 years after referral to a psychiatric clinic. Homotypic continuity was observed for anxiety disorders in general (OR = 2.33), for phobic anxiety disorders (OR = 7.45), and for depressive disorders (OR = 2.15). For heterotypic continuity, depression predicted later anxiety (OR = 1.92), more specifically social anxiety (OR = 2.14) and phobic anxiety disorders (OR = 1.83). In addition, social anxiety predicted later generalized anxiety disorder (OR = 3.11). Heterotypic continuity was thus more common than homotypic continuity. For adolescents presenting with anxiety or depression, treatment should, therefore, target broad internalizing symptom clusters, rather than individual diagnoses. This may contribute to prevent future mental illness, particularly anxiety, in clinical samples.

Insular Volume Reduction in Patients with Social Anxiety Disorder

Despite the fact that social anxiety disorder (SAD) is highly prevalent, there have been only a few structural imaging studies. Moreover, most of them reported about a volume reduction in amygdale, which plays a key role in the neural function of SAD. Insula is another region of interest. Its hyperactivity in regard to processing negative emotional information or interoceptive awareness has been detected in patients with SAD. Referring to these studies, we hypothesized that insular volumes might reduce in patients with SAD and made a comparison of insular volumes between 13 patients with SAD and 18 healthy controls with matched age and gender using voxel-based morphometry. As a result, we found a significant volume reduction in insula in the SAD group. Our results suggest that the patients with SAD might have an insular volume reduction apart from amygdala. Since insula plays a critical role in the pathology of SAD, more attention should be paid not only to functional study but also morphometrical study of insula.

Internet-delivered cognitive-behavioral therapy for social anxiety disorder in Romania: a randomized controlled trial

Background and Aims

Internet-based cognitive-behavioral therapy (iCBT) for social anxiety disorder has been found effective, as attested by independently conducted randomized controlled trials in four languages. The study aim is to test the efficacy of an iCBT program in a culture where it was not tested before (i.e. Romania).

Methods

Participants (n = 76) were recruited, screened and randomized to either a nine-week guided iCBT or a wait-list control group in April and May 2012. Self-report measures were collected before (April 2012) and after the intervention (July 2012), as well as six months later (January 2013). Although social anxiety was assessed with multiple measures, the Liebowitz Social Anxiety Scale - Self Report version (LSAS-SR) and Social Phobia Inventory (SPIN) were used as the primary outcome measures.

Results

A significant difference with a large between-group effect size in favor of iCBT was found (Cohen´s d = 1.19 for LSAS-SR and d = 1.27 for SPIN). Recovery rates show that 36.8% (n = 14) in the treatment group score below the SPIN clinical cut-off compared to only 2.6% (n = 1) in the wait-list control group. Post-intervention clinical interviews also revealed that 34.2% (n = 13) of the treatment group was completely recovered (full remission) while additionally 36.8% (n = 14) retained some social anxiety symptoms (partial remission). However, an important study limitation is that post-intervention interviewers were not blinded to the study conditions. The program also effectively reduced depression and dysfunctional thinking (between-group Cohen´s d = 0.84 for depression and d = 0.63 for dysfunctional thinking). Moreover, the iCBT intervention appears to have a long-term impact for participants’ functioning, as the treatment gains were maintained six months later.

Conclusions

Internet-delivered interventions display a high potential to quickly and widely disseminate effective evidence-based programs around the world. This study provides support for guided iCBT as a promising treatment approach in Romania.

Trial Registration

ClinicalTrials.gov NCT01557894

Neurobiological correlates of social anxiety disorder: an update

Social anxiety disorder (SAD) is a condition characterized by pervasiveness and impairment in social functioning, with a prevalence in the general population between 1.9% and 12.1%. The most consistent findings on its neurobiological underpinnings involve a wide range of neurotransmitters (serotonin, norepinephrine, glutamate, and GABA) and neuropeptides (oxytocin), but no comprehensive hypothesis is yet available. In particular, oxytocin is becoming increasingly established as a "prosocial neuropeptide" and, as such, is a major focus of current research, with a great range of therapeutic applications including SAD treatment. Specifically, the amygdala plays a pivotal role in conditioning and processing of fear, and exaggerated amygdala responses in SAD patients have been observed during various social-emotional stimuli. In addition to the amygdala, other brain areas of interest in SAD-related circuitry are represented by the medial prefrontal cortex, dorsal raphe, striatum, locus coeruleus, prefrontal cortex, insular cortex, and anterior cingulate cortex. The aim of this review is to provide an update on neurobiological correlates of SAD, with a special focus on neurotransmitters and brain areas possibly involved, and suggestions for future research that could lead to more specific therapeutic interventions.

Social anxiety disorder in DSM-5

With the publication of DSM-5, the diagnostic criteria for social anxiety disorder (SAD, also known as social phobia) have undergone several changes, which have important conceptual and clinical implications. In this paper, we first provide a brief history of the diagnosis. We then review a number of these changes, including (1) the primary name of the disorder, (2) the increased emphasis on fear of negative evaluation, (3) the importance of sociocultural context in determining whether an anxious response to a social situation is out of proportion to the actual threat, (4) the diagnosis of SAD in the context of a medical condition, and (5) the way in which we think about variations in the presentation of SAD (the specifier issue). We then consider the clinical implications of changes in DSM-5 related to these issues.

Brand “you”: The emergence of social anxiety disorder in the age of enterprise

An historical ontology is conducted to identify conditions that led to the emergence of social anxiety disorder (SAD) in the late 20th century. Using Hacking’s (1998) ecological niche framework, SAD is analyzed in terms of four interrelated vectors (medical taxonomy, observability, cultural polarity, release) against the backdrop of neoliberal enterprise culture and its accompanying conception of the ideal self as confident, bold, and striving. The analysis suggests SAD has flourished as a consequence of a complex array of interrelated sociocultural and historical factors that have enabled social discomfort to be viewed as pathological while promoting its occurrence.

Evaluation of the proposed social anxiety disorder specifier change for DSM-5 in a treatment-seeking sample of anxious youth

BACKGROUND

The current proposal for the DSM-5 definition of social anxiety disorder (SAD) is to replace the DSM-IV generalized subtype specifier with one that specifies fears in performance situations only. Relevant evaluations to support this change in youth samples are sparse.

METHODS

The present study examined rates and correlates of the DSM-IV and proposed DSM-5 specifiers in a sample of treatment-seeking children and adolescents with SAD (N = 204).

RESULTS

When applying DSM-IV subtypes, 64.2% of the sample was classified as having a generalized subtype of SAD, with the remaining 35.2% classifying as having a nongeneralized subtype SAD. Youth with generalized SAD, relative to those with nongeneralized SAD, were older, had more clinically severe SAD, showed greater depressive symptoms, and were more likely to have a comorbid depressive disorder. No children in the current sample endorsed discrete fear in performance situations only in the absence of fear in other social situations.

CONCLUSIONS

The present findings call into question the meaningfulness of the proposed changes in treatment-seeking youth with SAD.

Group cognitive behavioral therapy for patients with generalized social anxiety disorder in Japan: outcomes at 1-year follow up and outcome predictors

BACKGROUND

Social anxiety disorder (SAD) is one of the most common psychiatric disorders worldwide. Cognitive behavioral therapy (CBT) is an effective treatment option for patients with SAD. In the present study, we examined the efficacy of group CBT for patients with generalized SAD in Japan at 1-year follow-up and investigated predictors with regard to outcomes.

METHODS

This study was conducted as a single-arm, naturalistic, follow-up study in a routine Japanese clinical setting. A total of 113 outpatients with generalized SAD participated in group CBT from July 2003 to August 2010 and were assessed at follow-ups for up to 1 year. Primary outcome was the total score on the Social Phobia Scale/Social Interaction Anxiety Scale (SPS/SIAS) at 1 year. Possible baseline predictors were investigated using mixed-model analyses.

RESULTS

Among the 113 patients, 70 completed the assessment at the 1-year follow-up. The SPS/SIAS scores showed significant improvement throughout the follow-ups for up to 1 year. The effect sizes of SPS/SIAS at the 1-year follow-up were 0.68 (95% confidence interval 0.41-0.95)/0.76 (0.49-1.03) in the intention-to-treat group and 0.77 (0.42-1.10)/0.84 (0.49-1.18) in completers. Older age at baseline, late onset, and lower severity of SAD were significantly associated with good outcomes as a result of mixed-model analyses.

CONCLUSIONS

CBT for patients with generalized SAD in Japan is effective for up to 1 year after treatment. The effect sizes were as large as those in previous studies conducted in Western countries. Older age at baseline, late onset, and lower severity of SAD were predictors for a good outcome from group CBT.

Psychometric properties of the mini-social phobia inventory

OBJECTIVE

Although a potentially useful measure, to date, there has been only one published test of the psychometric properties of the Mini-Social Phobia Inventory (Mini-SPIN). Therefore, the psychometric properties of the Mini-SPIN, a brief 3-item screen for social anxiety disorder, were examined.

METHOD

Participants were 186 patients diagnosed with social anxiety disorder (DSM-IV criteria) attending a specialized anxiety disorders clinic for treatment, and 56 nonclinical participants were recruited to serve as comparisons. Participants were diagnosed using the Anxiety Disorders Interview Schedule for DSM-IV, and they also completed the Mini-SPIN, the Social Interaction Anxiety Scale (SIAS), and the Social Phobia Scale (SPS). Construct validity for the Mini-SPIN was assessed by its correlations with the SIAS and the SPS. Reliability, internal consistency, discriminant validity, and sensitivity to change were also examined, and receiver operating characteristic curve analysis was conducted to determine guidelines regarding cutoff scores for the Mini-SPIN. The study was conducted between April 1999 and December 2001.

RESULTS

Supporting findings from a previous study, strong support was found for the Mini-SPIN's ability to discriminate individuals with social anxiety disorder from those without the disorder. Receiver operating characteristic analysis revealed that using a cutoff score of 6 or greater (P < .001), the Mini-SPIN demonstrates excellent sensitivity, specificity, and positive and negative predictive values.

CONCLUSIONS

Findings suggest that the Mini-SPIN is a reliable and valid instrument for screening social anxiety disorder in adults. Importantly, the use of the Mini-SPIN in primary care may be one way to address the underrecognition of social anxiety disorder in such settings. Due to the ease and brevity of the measure, it also shows potential for use in epidemiology. Given that this study has revealed the ability of the Mini-SPIN to reflect treatment change, the Mini-SPIN may also be considered for use in treatment outcome studies that specifically require minimal assessment.

Cognitive-evaluative features of childhood social anxiety in a performance task

Using an experimental design, we analysed differences in the occurrence of cognitive-evaluative distortions and performance deficits across children with social anxiety disorder, with subclinical anxiety and without any anxiety symptoms. Twenty-one children with full syndrome social phobia, 18 children with partial syndrome social phobia and 20 children without any symptoms of social phobia were compared with respect to their degree of anxiety, negative thinking and task performance during two social-evaluative tasks. In addition, self-ratings of task performance, performance estimations for other children and objective behavioural ratings by two independent observers were obtained. Children with social anxiety disorder and subclinical social anxiety showed higher degrees of experienced anxiety and negative thinking than healthy control children. There was no group difference in respect to actual task performance. Findings are discussed with regard to the continuum assumption of childhood social anxiety disorder and the need of well-adapted early interventions.

Nosological status of social phobia: contrasting classical and recent literature

PURPOSE OF REVIEW

The aim of this review is to contrast classical and recent literature relating to social anxiety disorder in the context of its past, present and future position in classification systems.

RECENT FINDINGS

Social phobia is common; it starts early and is chronic and disabling. It runs in families. Social phobia is frequently comorbid with other anxiety, mood and substance use disorders and it often precedes axis I disorders. Concerning neurobiology of social anxiety disorder research is sparse and the results are inconclusive. The data from research on genetics, early environment, temperamental features, cognitive processing, phenomenology and treatment response indicate significant overlap between social phobia and a number of other axis I and axis II disorders (avoidant personality disorder).

SUMMARY

The review of the recent findings does not point to the existence of qualitative differences between social phobia and other anxiety and mood disorders. The results of recent research run against the current classification dividing anxiety and mood disorders into discrete categories and support the continuity among them. Taking into account conceptual issues of psychiatric classifications would promote subsequent research that could become a foundation for the development of psychiatric nosology.

Hierarchical Model of Generalized and Specific Vulnerabilities in Anxiety

This study evaluated a theoretical hierarchical relationship among the general anxiety vulnerability variable of neuroticism, the specific vulnerability variables of anxiety sensitivity and intolerance of uncertainty, and variables reflecting specific anxiety foci including panic symptoms, health anxiety, obsessive-compulsive symptoms and generalized anxiety/worry. Questionnaires assessing these variables were administered to a non-clinical sample of 91 first-year psychology students (64.8% women). Path analysis results were highly consistent with the hypothesized hierarchical model. Neuroticism was found to have a significant direct effect on both anxiety sensitivity and intolerance of uncertainty. Both neuroticism and anxiety sensitivity had direct significant effects on panic symptoms, neuroticism and intolerance of uncertainty both made significant direct contributions to the prediction of worry, and neuroticism made a significant direct contribution to the prediction of obsessive-compulsive symptoms. Contrary to the hypothesized model, anxiety sensitivity but not neuroticism uniquely predicted health anxiety. The results of this study provide initial empirical evidence for a hierarchical relationship among general and specific vulnerabilities, and specific anxiety manifestations.

Social phobia: an update on treatment

Social phobia is a prevalent anxiety disorder that may be treated with pharmacotherapy, psychotherapy, or both. This article reviews the empirical evidence for these interventions and discusses new treatment developments. Active ingredients and mechanisms involved in the effectiveness of treatment are discussed. In addition, the elements of social phobia and its treatment that are similar to other anxiety and non-anxiety disorders are considered. Finally, it discusses future efforts to improve diagnosis and treatment for social phobia, including possible revisions to the diagnostic criteria that might be considered in the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, as well as routine care and obstacles for dissemination.

Fear of death

Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH) founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient and support to caregivers and encourages the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. For many, cancer is synonymous with death. Fearing death is a rational response. For too long, medicine has ignored this primeval fear. Increasingly, clinicians recognize and address end-of-life issues, facing patients' and our own emotional vulnerabilities in order to connect and explore problems and fears. Listening and learning from the patient guides us as we acknowledge much of the mystery that still surrounds the dying process. Rarely is there a simple or right answer. An empathetic response to suffering patients is the best support. Support is vital in fostering the adjustment of patients. A silent presence may prove more helpful than well-meant counsel for many patients. Through an examination of eight caregiver narratives of their patients' experiences, the role of the health care provider in the dying process, particularly in regard to challenging fear, is reviewed.

Efficacy of the novel anxiolytic pregabalin in social anxiety disorder: a placebo-controlled, multicenter study

Pregabalin is a novel compound in development for the treatment of anxiety disorders. The safety and efficacy of pregabalin for the treatment of social anxiety disorder was evaluated in a double-blind, multicenter clinical trial in which 135 patients were randomized to 10 weeks of double-blind treatment with either pregabalin 150 mg/d. pregabalin 600 mg/d, or placebo. The primary efficacy parameter was change from baseline to end point in the Liebowitz Social Anxiety Scale (LSAS) total score. Safety was assessed through clinical and laboratory monitoring, and recording spontaneously reported adverse events. Ninety-four patients (70%) completed the 11-week double-blind treatment phase. LSAS total score was significantly decreased by pregabalin 600 mg/d treatment compared with placebo (P = 0.024, analysis of covariance). Significant differences (P < or = 0.05) between pregabalin 600 mg/d and placebo were seen on several secondary measures including the LSAS subscales of total fear, total avoidance, social fear, and social avoidance, and the Brief Social Phobia Scale fear subscale. Pregabalin 150 mg/d was not significantly better than placebo on any measures. Somnolence and dizziness were the most frequently occurring adverse events among patients receiving pregabalin 600 mg/d. In conclusion, pregabalin 600 mg/d was an effective and well-tolerated treatment of social anxiety disorder.

Social anxiety disorder

Although social anxiety disorder (SAD) is a common and disabling disorder that may occur in different cultural settings, it is under-diagnosed by clinicians. In order to facilitate accurate diagnosis, the clinical features and differential diagnosis of SAD are described, together with useful assessment instruments for clinicians. Aetiological evidence suggests that the causal pathways for SAD include genetic, neurobiological, temperamental and cognitive factors. A range of effective treatments for SAD are available: current findings suggest that the selective serotonin reuptake inhibitors (SSRIs) are the first-line choice of pharmacotherapy for SAD, while several other agents show promise in treating refractory cases; furthermore, SAD responds well to psychotherapeutic interventions such as exposure therapy and cognitive restructuring.

Screening for social anxiety disorder in the clinical setting: using the Liebowitz Social Anxiety Scale

OBJECTIVE

We sought to determine optimal cutoff values for the Liebowitz Social Anxiety Scale (LSAS) total and subscale scores for the diagnosis of social anxiety disorder (SAD) and designation of the generalized subtype of SAD.

METHOD

Three hundred and sixty-four patients from a multi-site sample who met criteria for SAD according to structured diagnostic interview, 262 of whom met criteria for the generalized subtype, and 34 control participants free of current Axis I disorders participated in this study. All participants were given the Liebowitz Social Anxiety Scale by an independent assessor.

RESULTS

Receiver Operating Characteristics analysis revealed that the LSAS performed well in identifying individuals who met criteria for SAD and for the generalized subtype of SAD. Cutoffs of 30 for SAD and 60 for its generalized subtype on the LSAS total score represented the best balance of specificity and sensitivity.

CONCLUSIONS

These findings provide support for the use of the Liebowitz Social Anxiety Scale for the identification of individuals with SAD and its generalized subtype in clinical settings. Identification of patients with SAD should increase the percentage of these patients who receive appropriate treatment for this impairing disorder.

The psychometric properties of the Interpersonal Sensitivity Measure in social anxiety disorder

The Interpersonal Sensitivity Measure (IPSM) was developed to assess hypersensitivity to interpersonal rejection, a suggested trait of depression-prone personality (Aust NZ J Psychiatry 23 (1989) 341). Although studies of the IPSM and interpersonal rejection sensitivity have primarily been conducted in depressed populations, it is important to investigate interpersonal rejection sensitivity as a relevant construct in the assessment of social anxiety. This study examined the psychometric properties of the IPSM in treatment-seeking individuals with social anxiety disorder. The results of this investigation support the convergent and divergent validity and internal consistency of the IPSM in socially anxious individuals. An exploratory factor analysis of the scale was also conducted after the original factor and subscale structure was shown to be a poor fit for the present data. Three factors emerged (Interpersonal Worry and Dependency, Low Self-Esteem, and Unassertive Interpersonal Behavior), and 29 items were retained. Because they demonstrated negative factor loadings on Factor 2, it is suggested that the scoring for four items of the original IPSM be reversed. In summary, the revised IPSM assesses three aspects of interpersonal rejection sensitivity and appears to be a valid and reliable instrument for its assessment in social anxiety disorder.

Moclobemide is effective and well tolerated in the long-term pharmacotherapy of social anxiety disorder with or without comorbid anxiety disorder

Social phobia (social anxiety disorder) is a highly prevalent and chronic disorder that is associated with significant comorbidity and disability. Despite recent advances in the pharmacotherapy of the disorder, there is a paucity of randomized controlled trials on patients with comorbid disorders and on maintenance treatment. A randomized placebo-controlled, double-blind multi-site trial of moclobemide, a reversible inhibitor of monoamine oxidase A, was undertaken with 390 subjects. After an initial 12 weeks, there was the option of continuing for an additional 6 months of treatment. The primary efficacy parameter chosen was responder status as defined by the Clinical Global Impression scale change item. From week 4 onwards, there was a significantly higher response rate on moclobemide than on placebo. Superiority of medication over placebo was similar in patients with comorbid anxiety disorders (33% of subjects) and without, as well as in patients with different subtypes of social anxiety disorder; indeed, treatment with moclobemide rather than placebo was the strongest predictor of response. Adverse events were similar across treatment groups, and were typically mild and transient. In the extension phase, response rates remained higher in the moclobemide group, and ratings of tolerability were equally high in both groups. Thus, in a large sample of social anxiety disorder patients with and without comorbid anxiety disorders, moclobemide was both effective and well-tolerated in the short as well as long-term. These data confirm and extend previous findings on the value of moclobemide in the treatment of social anxiety disorder, and strengthen the range of therapeutic options for managing this important disorder.

Paroxetine for social anxiety and alcohol use in dual-diagnosed patients

The objective of this study was to compare the efficacy and tolerability of paroxetine to matched placebo in adults with co-occurring social anxiety disorder and alcohol use disorder. Outcome measures included standardized indices of social anxiety and alcohol use. Fifteen individuals meeting DSM-IV criteria for both social anxiety disorder and alcohol use disorder were randomized to treatment. Paroxetine (n = 6) or placebo (n = 9) was given in a double-blind format for 8 weeks using a flexible dosing schedule. Dosing began at 20 mg/d and increased to a target dose of 60 mg/d. There was a significant effect of treatment group on social anxiety symptoms, where patients treated with paroxetine improved more than those treated with placebo on both the Clinical Global Index (CGI) and the Liebowitz Social Anxiety Scale (Ps < or = 0.05). On alcohol use, there was not a significant effect of treatment on quantity/frequency measures of drinking, but there was for the CGI ratings (50% paroxetine patients versus 11% placebo patients were improvers on drinking, P < or = 0.05). This pilot study suggests that paroxetine is an effective treatment for social anxiety disorder in individuals with comorbid alcohol problems, and positive treatment effects can be seen in as little as 8 weeks. Further study is warranted to investigate its utility in helping affected individuals reduce alcohol use.

The developmental psychopathology of social anxiety disorder

The role of developmental theory and developmental psychopathology in understanding the development, maintenance, and course of social anxiety disorder (SAD) is explored in this article. Following a brief examination of the phenomenology of SAD in youth, we provide an overview of the tenets of developmental psychology and developmental psychopathology, including the principles of equifinality (i.e., the same outcome can result from diverse developmental pathways) and multifinality (i.e., the same risk factor can lead to or result in different outcomes). We review various pathways for the acquisition and maintenance of SAD (e.g., genetic and temperamental influences, parental factors, conditioning or learning experiences, peer influences, and cognitive styles) and conclude, consistent with a developmental psychopathology perspective, that multiple pathways to SAD exist and that the various precursors to SAD do not invariably lead to SAD. We suggest that specificity in outcome is afforded by the combination, timing, and circumstances surrounding these various risk factors. Finally, we propose studies to test the viability of the developmental psychopathology model in understanding SAD.

Social anxiety disorder in childhood and adolescence: current status and future directions

This paper reviews the current status of research on the phenomenology, etiology, maintenance, assessment, and treatment of childhood and adolescent social anxiety disorder (SAD). Despite being one of the most prevalent disorders of childhood and adolescence, SAD paradoxically stands as one of the least recognized, researched, and treated pediatric disorders. The small treatment outcome literature provides preliminary support to the effectiveness of various forms of cognitive behavior therapy. The majority of studies to date, however, are limited by inadequate control conditions. Other findings include some support for the utility of parental involvement in treatment, significant advancements in outcome measures (e.g., normative comparisons, indices of naturalistic social functioning), and impressive durability of gains for the majority of treatments. Future directions are suggested, including experimental and naturalistic studies of developmental pathways and maintenance factors, the incorporation of "positive psychology" constructs (e.g., positive emotions, hope, self-control) in treatment and prevention, and the continued delineation of differences between child, adolescent, and adult manifestations of SAD.