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Murray B Stein - One of the best experts on this subject based on the ideXlab platform.
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self criticism and Social Phobia in the us national comorbidity survey
Journal of Affective Disorders, 2004Co-Authors: Brian J Cox, Claire Fleet, Murray B SteinAbstract:Abstract Background : This study sought to extend findings from a preliminary clinical investigation [J. Affect. Disord. 57 (2000) 223] by examining relations between the personality dimension of self-criticism and diagnostic prevalence of Social Phobia in a large nationally representative sample. Methods : Participants were from the national comorbidity survey Part II [ n =5877; Arch. Gen. Psychiatry 51 (1994) 8]. Psychiatric diagnoses were made using a modified version of the composite international psychiatric interview. Personality dimensions and distress were assessed using brief self-report measures with strong psychometric properties. Results : Self-criticism was elevated in NCS respondents with a diagnosis of Social Phobia, even in cases of only past history of Social Phobia (i.e. >1 year ago), compared to individuals with no psychiatric disorder. The highest levels of self-criticism were reported by people with the complex subtype of Social Phobia, both with and without comorbid major depression. These levels were significantly greater compared to those observed in another anxiety disorder (panic disorder), the pure speaking subtype of Social Phobia, and cases of major depression alone. In a regression analysis that controlled for current emotional distress, the broad personality trait of neuroticism, and lifetime histories of mood, anxiety, and substance use disorders, self-criticism remained significantly associated with lifetime prevalence of Social Phobia. Limitations : The cross-sectional design of the study does not permit causal inferences. Conclusions : Findings from this general population mental health survey demonstrated that self-criticism is robustly associated with Social Phobia. It may represent an important core psychological process in the complex subtype of this anxiety disorder.
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scrutinizing the relationship between shyness and Social Phobia
Journal of Anxiety Disorders, 2002Co-Authors: Denise A Chavira, Murray B Stein, Vanessa L MalcarneAbstract:Abstract The nature of the relationship between shyness and Social Phobia can be clarified by assessing rates of Social Phobia in highly shy and normative samples. In the present study, 2202 participants were screened and categorized on a shyness scale as highly shy (90th percentile) or “normatively” shy (40–60th percentile). The Composite International Diagnostic Interview and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II; Avoidant Personality Disorder module) were used to assign clinical diagnoses. Approximately 49% of individuals in the highly shy group had a Social Phobia diagnosis compared to 18% in the normatively shy group. Significantly more generalized Social Phobia (36% vs. 4%) and avoidant personality disorder (14% vs. 4%) diagnoses were present in the highly shy group compared to the normatively shy group. Equal rates of nongeneralized Social Phobia (i.e., 14% vs. 14%) were present in the highly shy and the normatively shy comparison group. Findings suggest that shyness and Social Phobia (especially the generalized type) are related constructs but not completely synonymous; an individual can be extremely shy yet not have a Social Phobia diagnosis.
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Social Phobia symptoms subtypes and severity findings from a community survey
Archives of General Psychiatry, 2000Co-Authors: Murray B Stein, Laine J Torgrud, John R WalkerAbstract:few persons (3.4%) had many (ie, $7). Among those with DSM-IV Social Phobia (7.2%), classification based on number (normally distributed with median of 3, mode of 5) or content (eg, speaking-only vs other fears; performanceonly vs interactional fears) of Social fears failed to yield a defensible subtyping solution. Impairment increased linearly as the number of Social fears was increased, with no clear threshold evident. Conclusions: Social Phobia is associated with substantial impairment in multiple functional domains. Support for subtyping based on the extent or pattern of Social fears was not provided. Rather, Social Phobia in the community seems to exist on a continuum of severity, with a greater number of feared situations associated with greater disability. Arch Gen Psychiatry. 2000;57:1046-1052
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disability and quality of life in Social Phobia epidemiologic findings
American Journal of Psychiatry, 2000Co-Authors: Murray B Stein, Yin M KeanAbstract:OBJECTIVE: Social Phobia in clinical studies is vividly associated with extensive disability and reduced quality of life. It is difficult to obtain a clear portrayal of the impairment associated with Social Phobia in community samples. Furthermore, it has been unclear in prior studies to what extent indices were attributable to Social Phobia as opposed to comorbid major depression. The authors examined relevant data from the Ontario Health Survey Mental Health Supplement. METHOD: The Ontario Health Survey Mental Health Supplement, a survey of more than 8,000 residents of Ontario, Canada, aged 15–64, used the University of Michigan Composite International Diagnostic Interview to assign DSM-III-R diagnoses. Several indicators of disability and quality of life were included. The authors compared these indices for persons with and without Social Phobia and adjusted where indicated for the effects of major depression and relevant sociodemographic factors. RESULTS: Persons with Social Phobia were impaired on a ...
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parental psychopathology parenting styles and the risk of Social Phobia in offspring a prospective longitudinal community study
Archives of General Psychiatry, 2000Co-Authors: Roselind Lieb, Hansulrich Wittchen, Murray B Stein, Martina Fuetsch, Michael Hofler, Kathleen R MerikangasAbstract:Background This article examines the associations between DSM-IV Social Phobia and parental psychopathology, parenting style, and characteristics of family functioning in a representative community sample of adolescents. Methods Findings are based on baseline and first follow-up data of 1047 adolescents aged 14 to 17 years at baseline (response rate, 74.3%), and independent diagnostic interviews with one of their parents. Diagnostic assessments in parents and adolescents were based on the DSM-IV algorithms of the Munich-Composite International Diagnostic Interview. Parenting style (rejection, emotional warmth, and overprotection) was assessed by the Questionnaire of Recalled Parental Rearing Behavior, and family functioning (problem solving, communication, roles, affective responsiveness, affective involvement, and behavioral control) was assessed by the McMaster Family Assessment Device. Results There was a strong association between parental Social Phobia and Social Phobia among offspring (odds ratio [OR], 4.7; 95% confidence interval [CI], 1.6-13.5). Other forms of parental psychopathology also were associated with Social Phobia in adolescents (depression: OR, 3.6; 95% CI, 1.4-9.1; any anxiety disorder other than Social Phobia: OR, 3.5; 95% CI, 1.4-8.8; and any alcohol use disorder: OR, 3.0; 95% CI, 1.1-7.8). Parenting style, specifically parental overprotection (OR, 1.4; 95% CI, 1.0-1.9) and rejection (OR, 1.4; 95% CI, 1.1-1.9), was found to be associated with Social Phobia in respondents. Family functioning was not associated with respondents' Social Phobia. Conclusions Data suggest that parental psychopathology, particularly Social Phobia and depression, and perceived parenting style (overprotection and rejection) are both associated with the development of Social Phobia in youth.
David M. Clark - One of the best experts on this subject based on the ideXlab platform.
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Imagery Rescripting of Early Traumatic Memories in Social Phobia.
Cognitive and behavioral practice, 2011Co-Authors: Jennifer Wild, David M. ClarkAbstract:Negative self-images appear to play a role in the maintenance of Social Phobia and research suggests they are often linked to earlier memories of Socially traumatic events. Imagery rescripting is a clinical intervention that aims to update such unpleasant or traumatic memories, and is increasingly being incorporated in cognitive behavioral therapy programs. In previous research, we have found that imagery rescripting was superior to a control condition in terms of its beneficial effects on negative beliefs, image and memory distress, fear of negative evaluation, and anxiety in Social situations. In this article, we describe our imagery rescripting procedure. We consider the importance of updating negative imagery in Social Phobia, the theoretical basis for imagery rescripting, directions for future research, and how to conduct imagery rescripting, including potential problems and their solutions.
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when the present visits the past updating traumatic memories in Social Phobia
Journal of Behavior Therapy and Experimental Psychiatry, 2007Co-Authors: Jennifer Wild, Ann Hackmann, David M. ClarkAbstract:Research suggests that distorted images of the self are common in Social Phobia and play a role in maintaining the disorder. The images are often linked in thematic and sensory detail to distressing memories that are clustered around the onset or worsening of the disorder. This has led to speculation about the likely benefit of working directly with these memories to improve symptoms of Social Phobia. In this exploratory study, we describe a process of cognitive restructuring followed by imagery rescripting to update the meanings of distressing memories and images in Social Phobia. We first present illustrative clinical examples and then data of 14 patients with Social Phobia, on whom we developed this approach. Patients attended an imagery rescripting session in which a semi-structured interview was used to identify their recurrent images, the associated memories and their meanings. Next the identified memory was evoked and elaborated. We updated the meaning of the memory by first using cognitive restructuring to arrive at new perspectives and then linking these perspectives with the memory using imagery techniques. The procedure resulted in significant within session change in beliefs, and in image and memory distress and vividness. One week later significant change was seen in Social Phobia cognitions and a self-report measure of Social anxiety. Rescripting distressing memories in Social Phobia appears to be an effective way of modifying maladaptive beliefs linked to recurrent negative imagery. This paper presents our exploratory investigation of how to work with the memories and encourages more rigorous investigation in this area.
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Rescripting Early Memories Linked to Negative Images in Social Phobia: A Pilot Study
Behavior therapy, 2007Co-Authors: Jennifer Wild, Ann Hackmann, David M. ClarkAbstract:Negative self-images are a maintaining factor in Social Phobia. A retrospective study (Hackmann, A., Clark, D.M., McManus, F. (2000). Recurrent images and early memories in Social Phobia. Behaviour Research and Therapy, 38, 601–610) suggested that the images may be linked to early memories of unpleasant Social experiences. This preliminary study assessed the therapeutic impact of rescripting such memories. Patients with Social Phobia (N = 11) attended 2 sessions, 1 week apart. The first was a control session in which their images and memories were discussed but not modified. The second was an experimental session in which cognitive restructuring followed by an imagery with rescripting procedure was used to contextualize and update the memories. No change was observed after the control session. The experimental session led to significant improvement in negative beliefs, image and memory distress and vividness, fear of negative evaluation, and anxiety in feared Social situations. The results suggest that rescripting unpleasant memories linked to negative self-images may be a useful adjunct in the treatment of Social Phobia.
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cognitive therapy versus exposure and applied relaxation in Social Phobia a randomized controlled trial
Journal of Consulting and Clinical Psychology, 2006Co-Authors: David M. Clark, Freda Mcmanus, Ann Hackmann, Anke Ehlers, Melanie J V Fennell, Nick Grey, Louise Waddington, Jennifer WildAbstract:A new cognitive therapy (CT) program was compared with an established behavioral treatment. Sixty-two patients meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria for Social Phobia were randomly assigned to CT, exposure plus applied relaxation (EXP = AR), or wait-list (WAIT). CT and EXP = AR were superior to WAIT on all measures. On measures of Social Phobia, CT led to greater improvement than did EXP = AR. Percentages of patients who no longer met diagnostic criteria for Social Phobia at posttreatment-wait were as follows: 84% in CT, 42% in EXP = AR, and 0% in WAIT. At the 1-year follow-up, differences in outcome persisted. In addition, patients in EXP = AR were more likely to have sought additional treatment. Therapist effects were small and nonsignificant. CT appears to be superior to EXP = AR in the treatment of Social Phobia. (
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Information-processing bias in Social Phobia.
Clinical Psychology Review, 2004Co-Authors: Colette R. Hirsch, David M. ClarkAbstract:Social Phobia is a persistent disorder that is unlikely to be maintained by avoidance alone. One reason for the enduring nature of Social Phobia may be the way individuals with the disorder process Social information. It is important for those involved in Social Phobia to have an understanding of information-processing biases, because it has the potential to guide psychological interventions. In this review of Social Phobia, probability and cost estimates of Social situations are examined, interpretive biases are evaluated and findings relating to memory and negative imagery are also reviewed. The clinical implications of Social-Phobia-related information-processing biases are discussed and possible avenues for future research are outlined.
Deborah C. Beidel - One of the best experts on this subject based on the ideXlab platform.
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differentiating Social Phobia from shyness
Journal of Anxiety Disorders, 2009Co-Authors: Nancy A Heiser, Samuel M Turner, Deborah C. Beidel, Roxann RobersonnayAbstract:To clarify the relationship between Social Phobia and shyness, this study examined the characteristics of highly shy persons with Social Phobia, highly shy persons without Social Phobia, and non-shy persons. Those with Social Phobia reported more symptomatology, more functional impairment, and a lower quality of life than those without Social Phobia. About one-third of the highly shy without Social Phobia reported no Social fears, highlighting heterogeneity of the shy. The Social Phobia group reported similar levels of anxiety as the shy without Social Phobia during analogue conversation tasks, but they reported more anxiety during a speech task. The Social Phobia group performed less effectively across tasks than those without Social Phobia. All groups’ perceptions of anxiety and effectiveness during behavioral tasks were consistent with ratings of independent observers. None of the groups differed on psychophysiological measures. Results are discussed in the context of theoretical models of Social Phobia.
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shyness relationship to Social Phobia and other psychiatric disorders
Behaviour Research and Therapy, 2003Co-Authors: Nancy A Heiser, Samuel M Turner, Deborah C. BeidelAbstract:The relationship between shyness, Social Phobia and other psychiatric disorders was examined. The prevalence of Social Phobia was significantly higher among shy persons (18%) compared with non-shy persons (3%). However, the majority of shy individuals (82%) were not Socially phobic. A significant and positive correlation was found between the severity of shyness and the presence of Social Phobia, but the data suggest that Social Phobia is not merely severe shyness. Social Phobia was also positively and moderately correlated with introversion and neuroticism. Thus, shy persons with Social Phobia were shyer, more introverted, and more neurotic than other shy people, but none of these factors was sufficient to distinguish shy persons with Social Phobia from those without Social Phobia. The proportion of the shy group with psychiatric diagnoses other than Social Phobia was significantly higher than among the non-shy group, indicating that various diagnostic categories are prominent among the shy. The results are discussed in terms of the overlap in shyness and Social Phobia and the relationship of shyness to other psychiatric diagnoses and personality dimensions.
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behavioral treatment of childhood Social Phobia
Journal of Consulting and Clinical Psychology, 2000Co-Authors: Deborah C. Beidel, Samuel M Turner, Tracy L MorrisAbstract:Sixty-seven children (ages 8 and 12) with Social Phobia were randomized to either a behavioral treatment program designed to enhance Social skills and decrease Social anxiety (Social Effectiveness Therapy for Children, SET-C) or an active, but nonspecific intervention (Testbusters). Children treated with SET-C were significantly more improved across multiple dimensions, including enhanced Social skill, reduced Social fear and anxiety, decreased associated psychopathology, and increased Social interaction. Furthermore, 67% of the SET-C group participants did not meet diagnostic criteria for Social Phobia at posttreatment compared with 5% of those in the Testbusters group. Treatment gains were maintained at 6-month follow-up. The results are discussed in terms of treatment of preadolescent children with Social Phobia and the durability of treatment effects.
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psychopathology of childhood Social Phobia
Journal of the American Academy of Child and Adolescent Psychiatry, 1999Co-Authors: Deborah C. Beidel, Samuel M Turner, Tracy L MorrisAbstract:ABSTRACT Objective To describe the clinical syndrome of Social Phobia in preadolescent children. Method Fifty children with DSM-IV Social Phobia were assessed with semistructured diagnostic interviews, self-report instruments, parental and teacher ratings, a behavioral assessment, and daily diary recordings. In addition, the behaviors of these children were compared with those of a sample of normal peers. Results Children with Social Phobia had a high level of general emotional over-responsiveness, Social fear and inhibition, dysphoria, loneliness, and general tearfulness. Sixty percent suffered from a second, concurrent disorder. Socially distressing events occurred quite frequently and were accompanied by maladaptive coping behaviors. In addition, children with Social Phobia had significantly poorer Social skills. There were few differences based on gender or race. Conclusions Children with Social Phobia suffer pervasive and serious functional impairment. In addition, the clinical presentation suggests specific avenues for psychoSocial interventions.
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shy children phobic adults nature and treatment of Social Phobia
1998Co-Authors: Deborah C. Beidel, Samuel M TurnerAbstract:Clinical Presentation of Social Phobia in Adults Clinical Presentation of Social Phobia in Children and Adolescents Prevalence of Social Phobia Aetiology of Social Phobia Assessment Patient and Parent Management Pharmacological Treatment for Social Phobia Behavioural and Cognitive-Behavioural Treatment of Social Phobia in Adults Behavioural and Cognitive-Behavioural Treatment Strategies for Children and Adolescents Epilogue.
Samuel M Turner - One of the best experts on this subject based on the ideXlab platform.
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differentiating Social Phobia from shyness
Journal of Anxiety Disorders, 2009Co-Authors: Nancy A Heiser, Samuel M Turner, Deborah C. Beidel, Roxann RobersonnayAbstract:To clarify the relationship between Social Phobia and shyness, this study examined the characteristics of highly shy persons with Social Phobia, highly shy persons without Social Phobia, and non-shy persons. Those with Social Phobia reported more symptomatology, more functional impairment, and a lower quality of life than those without Social Phobia. About one-third of the highly shy without Social Phobia reported no Social fears, highlighting heterogeneity of the shy. The Social Phobia group reported similar levels of anxiety as the shy without Social Phobia during analogue conversation tasks, but they reported more anxiety during a speech task. The Social Phobia group performed less effectively across tasks than those without Social Phobia. All groups’ perceptions of anxiety and effectiveness during behavioral tasks were consistent with ratings of independent observers. None of the groups differed on psychophysiological measures. Results are discussed in the context of theoretical models of Social Phobia.
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shyness relationship to Social Phobia and other psychiatric disorders
Behaviour Research and Therapy, 2003Co-Authors: Nancy A Heiser, Samuel M Turner, Deborah C. BeidelAbstract:The relationship between shyness, Social Phobia and other psychiatric disorders was examined. The prevalence of Social Phobia was significantly higher among shy persons (18%) compared with non-shy persons (3%). However, the majority of shy individuals (82%) were not Socially phobic. A significant and positive correlation was found between the severity of shyness and the presence of Social Phobia, but the data suggest that Social Phobia is not merely severe shyness. Social Phobia was also positively and moderately correlated with introversion and neuroticism. Thus, shy persons with Social Phobia were shyer, more introverted, and more neurotic than other shy people, but none of these factors was sufficient to distinguish shy persons with Social Phobia from those without Social Phobia. The proportion of the shy group with psychiatric diagnoses other than Social Phobia was significantly higher than among the non-shy group, indicating that various diagnostic categories are prominent among the shy. The results are discussed in terms of the overlap in shyness and Social Phobia and the relationship of shyness to other psychiatric diagnoses and personality dimensions.
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behavioral treatment of childhood Social Phobia
Journal of Consulting and Clinical Psychology, 2000Co-Authors: Deborah C. Beidel, Samuel M Turner, Tracy L MorrisAbstract:Sixty-seven children (ages 8 and 12) with Social Phobia were randomized to either a behavioral treatment program designed to enhance Social skills and decrease Social anxiety (Social Effectiveness Therapy for Children, SET-C) or an active, but nonspecific intervention (Testbusters). Children treated with SET-C were significantly more improved across multiple dimensions, including enhanced Social skill, reduced Social fear and anxiety, decreased associated psychopathology, and increased Social interaction. Furthermore, 67% of the SET-C group participants did not meet diagnostic criteria for Social Phobia at posttreatment compared with 5% of those in the Testbusters group. Treatment gains were maintained at 6-month follow-up. The results are discussed in terms of treatment of preadolescent children with Social Phobia and the durability of treatment effects.
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psychopathology of childhood Social Phobia
Journal of the American Academy of Child and Adolescent Psychiatry, 1999Co-Authors: Deborah C. Beidel, Samuel M Turner, Tracy L MorrisAbstract:ABSTRACT Objective To describe the clinical syndrome of Social Phobia in preadolescent children. Method Fifty children with DSM-IV Social Phobia were assessed with semistructured diagnostic interviews, self-report instruments, parental and teacher ratings, a behavioral assessment, and daily diary recordings. In addition, the behaviors of these children were compared with those of a sample of normal peers. Results Children with Social Phobia had a high level of general emotional over-responsiveness, Social fear and inhibition, dysphoria, loneliness, and general tearfulness. Sixty percent suffered from a second, concurrent disorder. Socially distressing events occurred quite frequently and were accompanied by maladaptive coping behaviors. In addition, children with Social Phobia had significantly poorer Social skills. There were few differences based on gender or race. Conclusions Children with Social Phobia suffer pervasive and serious functional impairment. In addition, the clinical presentation suggests specific avenues for psychoSocial interventions.
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shy children phobic adults nature and treatment of Social Phobia
1998Co-Authors: Deborah C. Beidel, Samuel M TurnerAbstract:Clinical Presentation of Social Phobia in Adults Clinical Presentation of Social Phobia in Children and Adolescents Prevalence of Social Phobia Aetiology of Social Phobia Assessment Patient and Parent Management Pharmacological Treatment for Social Phobia Behavioural and Cognitive-Behavioural Treatment of Social Phobia in Adults Behavioural and Cognitive-Behavioural Treatment Strategies for Children and Adolescents Epilogue.
Jonathan R. T. Davidson - One of the best experts on this subject based on the ideXlab platform.
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psychometric properties of the Social Phobia inventory spin new self rating scale
British Journal of Psychiatry, 2000Co-Authors: Kathryn M Connor, Jonathan R. T. Davidson, Edna B. Foa, L E Churchill, Andrew Sherwood, Richard H WeislerAbstract:Background Of available self-rated Social Phobia scales, none assesses the spectrum of fear, avoidance, and physiological symptoms, all of which are clinically important. Because of this limitation, we developed the Social Phobia Inventory (SPIN). Aims To establish psychometric validation of the SPIN. Method Subjects from three clinical trials and two control groups were given the 17-item, self-rated SPIN. Validity was assessed against several established measures of Social anxiety, global assessments of severity and improvement, and scales assessing physical health and disability. Results Good test—retest reliability, internal consistency, convergent and divergent validity were obtained. A SPIN score of 19 distinguished between Social Phobia subjects and controls. The SPIN was responsive to change in symptoms over time and reflected different responses to active drugs v. placebo. Factorial analysis identified five factors. Conclusions The SPIN demonstrates solid psychometric properties and shows promise as a measurement for the screening of, and treatment response to, Social Phobia.
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treatment of Social Phobia with gabapentin a placebo controlled study
Journal of Clinical Psychopharmacology, 1999Co-Authors: Atul C. Pande, Carol A Janney, Richard H Weisler, Jonathan R. T. Davidson, John H Greist, James W Jefferson, David J Katzelnick, Suzanne M SutherlandAbstract:A randomized, double-blind, placebo-controlled, parallel-group study was conducted to evaluate the efficacy and safety of gabapentin in relieving the symptoms of Social Phobia. Sixty-nine patients were randomly assigned to receive double-blind treatment with either gabapentin (dosed flexibly between 900 and 3,600 mg daily in three divided doses) or placebo for 14 weeks. A significant reduction (p < 0.05) in the symptoms of Social Phobia was observed among patients on gabapentin compared with those on placebo as evaluated by clinician- and patient-rated scales. Results were similar for the intent-to-treat and week-2 completer populations. Adverse events were consistent with the known side effect profile of gabapentin. Dizziness (p = 0.05), dry mouth (p = 0.05), somnolence, nausea, flatulence, and decreased libido occurred at a higher frequency among patients receiving gabapentin than among those receiving placebo. No serious adverse events or deaths were reported. On the basis of these limited data, it seems that gabapentin offers a favorable risk-benefit ratio for the treatment of patients with Social Phobia. Further studies are required to confirm this effect and to determine whether a dose-response relationship exists.
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fluvoxamine treatment of Social Phobia Social anxiety disorder a double blind placebo controlled study
American Journal of Psychiatry, 1999Co-Authors: Murray B Stein, Jonathan R. T. Davidson, Abby J. Fyer, Mark H Pollack, Brinda WiitaAbstract:OBJECTIVE: The purpose of this study was to determine the efficacy of fluvoxamine for the treatment of Social Phobia (Social anxiety disorder). METHOD: In a 12-week multicenter, double-blind, randomized, placebo-controlled trial, 92 patients with Social Phobia were treated with the selective serotonin reuptake inhibitor fluvoxamine; 91.3% of the patients had the generalized subtype of the disorder. The primary criterion for response was a rating of “much improved” or “very much improved” on the Clinical Global Impression of Improvement scale. Secondary response criteria were changes on three specialized rating scales for Social Phobia symptoms: the Brief Social Phobia Scale, the Social Phobia Inventory, and the Liebowitz Social Anxiety Scale. PsychoSocial impairment was assessed in three domains (disruption of work, Social life, and home/family life) by using the Sheehan Disability Scale. RESULTS: The mean daily dose of fluvoxamine was 202 mg (SD=86). At study end or with the last observation carried forw...
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moclobemide in Social Phobia a controlled dose response trial
Journal of Clinical Psychopharmacology, 1997Co-Authors: Jonathan R. T. Davidson, M R Liebowitz, Russell Noyes, Georges Moroz, Arnold B Davidson, Judith L Siegel, Jon Bell, John W Cain, Sharon M CurlikAbstract:Although the monoamine oxidase inhibitor phenelzine has proven efficacious in Social Phobia, the risk of hypertensive crises has reduced its acceptability. The reversible monoamine oxidase inhibitor moclobemide has less potential for such reactions, but its efficacy in this disorder remains unproven. A double-blind, placebo-controlled study was undertaken to assess the efficacy and safety of fixed doses of moclobemide. After a 1-week placebo run-in, subjects with Social Phobia were randomly assigned to placebo or one of five doses (75 mg, 150 mg, 300 mg, 600 mg, or 900 mg daily) of moclobemide for 12 weeks. Although a trend toward greater efficacy of higher doses of moclobemide was observed at 8 weeks, no differences in response to various doses of the drug and placebo were observed at 12 weeks. At 12 weeks, 35% of subjects on 900 mg of moclobemide and 33% of those on placebo were at least much improved. Moclobemide was well tolerated, insomnia being the only dose-related adverse event observed with the drug. In this dose-response trial, moclobemide did not demonstrate efficacy at 12 weeks. Some other controlled studies have found moclobemide and brofaromine, another reversible monoamine oxidase inhibitor, efficacious in Social Phobia. Possible reasons for inconsistent findings are discussed.
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the epidemiology of Social Phobia findings from the duke epidemiological catchment area study
Psychological Medicine, 1993Co-Authors: Jonathan R. T. Davidson, Diane Hughes, Linda K George, Dan G BlazerAbstract:Social Phobia was studied in a North Carolina community, using DSM-III criteria. Two kinds of comparison were made: Social Phobia v. non-Social Phobia, and comorbid Social Phobia v. non-comorbid Social Phobia. Six-month and lifetime prevalence rates were 2.7 and 3.8% respectively. Social Phobia had an early onset, lasted a long time and rarely recovered. Predictors of good outcome recovery in a logistic regression analysis were onset of Phobia after age 11, absence of psychiatric comorbidity and greater education. The disorder was often missed in medical consultation. Increased rates of psychiatric comorbidity existed, especially for other anxiety disorders and for schizophrenia/schizophreniform disorder. There was increased risk of neurological disorder. Social Phobia was also associated with an increased rate of suicide attempts, antiSocial behaviour and impaired school performance during adolescence, impaired medical health, increased health-seeking behaviour, poor employment performance, reduced Social interaction and impaired Social support. Comorbidity accounted for some, but not all observed differences.
