Systematic assessment of social phobia in clinical practice

The purpose of this review is to propose a systematic approach to the assessment of social phobia for monitoring treatment outcome in clinical settings. A selection of measures is available, including questionnaires and structured interviews varying in length, complexity, and content. To design an assessment protocol for a particular patient or patient population, the clinician needs to be familiar with the characteristics of these available measures. The measures selected for detailed description and discussion here: (a) are specifically designed to assess social anxiety and social phobia, (b) have been demonstrated to have acceptable psychometric characteristics, and (c) have been utilized in treatment outcome research. Five questionnaire measures will be reviewed: (1) the Social Phobia and Anxiety Inventory (SPAI) (Turner et al., 1989a: Psychol Assessment 1:35-40), (2) the Social Interaction and Anxiety Scale (SIAS) (Mattick and Clarke, 1989 in Heimberg et al., 1992), (3) the Social Phobia Scale (SPS) (Mattick and Clarke, 1989 in Heimberg et al., 1992: Behav Therapy 23:53-73), (4) the Fear of Negative Evaluation Scale (FNES) (Watson and Friend, 1969: J Consult Clin Psychol 33:448-457), and (5) The Social Anxiety and Distress Scale (SADS) (Watson and Friend, 1969: J Consult Clin Psychol 33:448-457). Two interview measures will be reviewed, the Liebowitz Social Anxiety Scale (LSAS) (Liebowitz, 1987: Modern Problems Pharmacopsych 22:141-173) and Brief Social Phobia Scale (BSPS) (Davidson et al., 1991: J Clin Psychiatry 52:48-51). Measures developed for specific subgroups, including patients with speech anxiety and musical performance anxiety, as well as the application of other evaluation methods, such as the Behavioral Assessment Test, will also be discussed. Guidelines for selecting appropriate social phobia measures for varying clinical and research situations will be proposed that take into consideration the strengths and weaknesses of these methods.

Case study: ego-dystonic anger attacks in mothers of young children

Parental anger can have detrimental effects on children and can contribute to physical abuse. Ego-dystonic anger attacks are an underrecognized psychiatric symptom that occurs in associated with depression, with other psychiatric disorders, and in the absence of comorbid disorders. They are characterized by overwhelming anger and autonomic arousal occurring upon provocation viewed as trivial by the individual, and they respond well to treatment with serotonergic antidepressants. Consequently, they represent a readily treatable problem. Four cases of anger attacks in mothers of young children are described to illustrate the importance of recognizing and treating anger attacks.

Anxiety disorders in primary care: a life-span perspective

From a family-oriented life-span perspective, the authors highlight issues involved in recognition, assessment, and treatment of anxiety disorders. After reviewing prevalence rates for these disorders in child, adult, and geriatric groups, they discuss cross-generational transmission of illness and identify cross-cutting themes, such as comorbidity of anxiety and depression, relationship between anxiety disorders and quality of life, and links among disability, adversity, and anxiety. They also discuss issues specific to childbearing, motherhood, and bereavement, and conclude with a brief summary of treatment approaches.

Anger attacks and treatment nonadherence in a perinatal psychiatry clinic

Anger attacks are common in depressive disorders. High levels of anger have been associated with treatment nonadherence in medical and psychiatric patients. In this study we examined the relationship between anger attacks and treatment nonadherence in a perinatal psychiatry clinic that treats pregnant and postpartum women. Treatment adherence was examined by chart review. Patients with anger attacks at initial assessment were more likely to drop out of treatment than were patients without anger attacks at initial assessment (11/34 vs. 2/21; one-tailed Fisher's exact test p < .05). Treatment nonadherence among pregnant and postpartum women with anger attacks may be an important problem because of its impact on treatment outcome and because anger in depressed mothers is frequently directed at their children.