Instrumentos para diagnóstico e rastreamento do transtorno de ansiedade social adaptados para à realidade brasileira / Instrumentos de diagnóstico y cribado del trastorno de ansiedad social adaptados a la realidad brasileña / Social anxiety disorder diagnostic and screening tools adapted for the brazilian reality

Objetivo: descrever perante a literatura os instrumentos para diagnóstico e rastreamento do Transtorno de Ansiedade Social (TAS) que sejam adaptados à realidade brasileira. Método: revisão de literatura exploratória e descritiva, realizado através das bases de dados: PubMED, BVS e Scielo. No mês de agosto de 2022 com recorte temporal de 2017 a 2022. Sendo inclusos, documentos que versavam a respeito dos instrumentos para diagnóstico e rastreamento do TAS, adaptados à realidade brasileira. Resultado: ao revisar a literatura foram encontrados 14 documentos dentre as escalas de reconhecimento e rastreamento do TAS com validação e adaptação transcultural para realidade brasileira, foram encontrados quatro: Questionário de Ansiedade social para Adultos; Escala de Ansiedade em Interação Social Reduzida; Escala de Ansiedade Social Reduzida e a Escala de Ansiedade Social de Liebowitz versão auto aplicada.Conclusão:há uma minoria de estudos validados e adaptados aos brasileiros dificultando assim o diagnóstico, tratamento precoce e a avaliação multidisciplinar.(AU)

Objective: to describe in the literature the instruments for diagnosis and screening of Social Anxiety Disorder (SAD) that are adapted to the Brazilian reality. Method: exploratory and descriptive literature review, conducted through the databases: PubMED, BVS and Scielo. In August 2022, with a time frame of 2017 to 2022. Included were documents about the instruments for diagnosis and screening of SAD, adapted to the Brazilian reality. Result: After reviewing the literature, 14 documents were found among the SAD recognition and screening scales with validation and cross-cultural adaptation for the Brazilian reality, four were found: Adult Social Anxiety Questionnaire; Reduced Social Interaction Anxiety Scale; Reduced Social Anxiety Scale, and the Liebowitz Social Anxiety Scale, self-applied version. Conclusion: there is a minority of studies validated and adapted to Brazilians thus hindering diagnosis, early treatment and multidisciplinary assessment.(AU)

Objetivo:describir através de la literatura los instrumentos para el diagnóstico y rastreodelTrastorno de Ansiedad Social (TAS) que se adaptan a la realidade brasileña. Método:revisión bibliográfica exploratoria y descriptiva, realizada a través de las bases de datos: PubMED, BVS y Scielo. En agosto de 2022 conunplazo de 2017 a 2022. Se incluyeron documentos sobre los instrumentos de diagnóstico y cribadodelTAS, adaptados ala realidade brasileña. Resultados: al revisar la literatura se encontraron 14 documentos dentro de las escalas de reconocimiento y rastreo de laTASconvalidación y adaptación transcultural a la realidade brasileña, se encontraroncuatro: Questionário de Ansiedade social para Adultos; Escala de Ansiedade em Interação Social Reduzida; Escala de Ansiedade Social Reduzida y la Escala de Ansiedade Social de Liebowitzversión auto aplicada. Conclusión:hay una minoría de estudios validados y adaptados a losbrasileños, lo que dificulta el diagnóstico, el tratamento precoz y laevaluación multidisciplinar.(AU)

Instrumentos para diagnóstico e rastreamento do transtorno de ansiedade social adaptados para à realidade brasileira / Social anxiety disorder diagnostic and screening tools adapted for the brazilian reality

Objetivo: descrever perante a literatura os instrumentos para diagnóstico e rastreamento do Transtorno de Ansiedade Social (TAS) que sejam adaptados à realidade brasileira. Método: revisão de literatura exploratória e descritiva, realizado através das bases de dados: PubMED, BVS e Scielo. No mês de agosto de 2022 com recorte temporal de 2017 a 2022. Sendo inclusos, documentos que versavam a respeito dos instrumentos para diagnóstico e rastreamento do TAS, adaptados à realidade brasileira. Resultado: ao revisar a literatura foram encontrados 14 documentos dentre as escalas de reconhecimento e rastreamento do TAS com validação e adaptação transcultural para realidade brasileira, foram encontrados quatro: Questionário de Ansiedade social para Adultos; Escala de Ansiedade em Interação Social Reduzida; Escala de Ansiedade Social Reduzida e a Escala de Ansiedade Social de Liebowitz versão auto aplicada. Conclusão:há uma minoria de estudos validados e adaptados aos brasileiros dificultando assim o diagnóstico, tratamento precoce e a avaliação multidisciplinar.(AU)

Objective: to describe in the literature the instruments for diagnosis and screening of Social Anxiety Disorder (SAD) that are adapted to the Brazilian reality. Method: exploratory and descriptive literature review, conducted through the databases: PubMED, BVS and Scielo. In August 2022, with a time frame of 2017 to 2022. Included were documents about the instruments for diagnosis and screening of SAD, adapted to the Brazilian reality. Result: After reviewing the literature, 14 documents were found among the SAD recognition and screening scales with validation and cross-cultural adaptation for the Brazilian reality, four were found: Adult Social Anxiety Questionnaire; Reduced Social Interaction Anxiety Scale; Reduced Social Anxiety Scale, and the Liebowitz Social Anxiety Scale, self-applied version. Conclusion: there is a minority of studies validated and adapted to Brazilians thus hindering diagnosis, early treatment and multidisciplinary assessment.(AU)

Objetivo:describir através de la literatura los instrumentos para el diagnóstico y rastreodelTrastorno de Ansiedad Social (TAS) que se adaptan a la realidade brasileña. Método:revisión bibliográfica exploratoria y descriptiva, realizada a través de las bases de datos: PubMED, BVS y Scielo. En agosto de 2022 conunplazo de 2017 a 2022. Se incluyeron documentos sobre los instrumentos de diagnóstico y cribadodelTAS, adaptados ala realidade brasileña. Resultados: al revisar la literatura se encontraron 14 documentos dentro de las escalas de reconocimiento y rastreo de laTASconvalidación y adaptación transcultural a la realidade brasileña, se encontraroncuatro: Questionário de Ansiedade social para Adultos; Escala de Ansiedade em Interação Social Reduzida; Escala de Ansiedade Social Reduzida y la Escala de Ansiedade Social de Liebowitzversión auto aplicada. Conclusión:hay una minoría de estudios validados y adaptados a losbrasileños, lo que dificulta el diagnóstico, el tratamento precoz y laevaluación multidisciplinar. (AU)

PREVALENCE AND SOCIODEMOGRAPHIC CORRELATES OF SOCIAL ANXIETY DISORDER AMONG MEDICAL UNDERGRADUATES

Background: Social anxiety disorder is a common mental health disorder characterized by persistent fear of being embarrassed, humiliated, rejected and looked down by others. It can cause impairment in education and in professional achievement, quality of life and social relationships. The objective of this study was to measure the prevalence and study associated factors of social anxiety disorder among students of a tertiary medical college and hospital. Methods: This cross-sectional study was conducted among 403 medical students of a medical college and Hospital. The questionnaire used in the study had questions related to socio-demographic details and had the social phobia inventory (SPIN) questionnaire which was used to assess social anxiety disorder. Results: Out of 403 medical students, 61.53% (n=248) students were not having any type of social anxiety disorder. Among 38.46% (n=155) of students who were having SAD, 21.33%(n=86) were having mild SAD and 17.11% (n=69) were having signi?cant SAD. Mild social anxiety is considered as normal. Factors such as age, year of study, self- perception of facial appearance, history of chronic illness, academic performance satisfaction and language barrier were found to be statistically associated with SAD. Conclusion: Social anxiety disorder was signi?cantly associated with age, year of study, self perception of facial appearance, history of chronic illness, academic performance satisfaction and language barrier.

Emotional face processing in patients with social anxiety disorder: an activation likelihood estimation meta-analysis / 中华行为医学与脑科学杂志

Objective:To explore the relevant brain regions of face/non-face processing, and face processing under different emotional valence in patients with social anxiety disorder(SAD).Methods:PubMed, Medline, ScienceDirect, CNKI and other databases were retrieved, and 31 peer-reviewed emotional face studies of SAD patients were obtained (facial and non-facial processing: 13 literatures, 481 subjects, 161 foci; face processing with different emotional titers: 18 literatures, 586 subjects, 331 foci). Cluster-level family-wise error (FWE, P<0.05) based coordinates of Talairach space was adopted. Results:Face processing in SAD patients activated the left amygdala (x=-18, y=-8, z=-12), the right amygdala (x=26, y=0, z=-20), the entorhinal cortex (Brodmann area 28, x=16, y=-8, z=-10) and the medial prefrontal cortex (Brodmann area 10, x=2, y=44, z=-8). In addition, when SAD patients processed negative faces, the left amygdala (x=-26, y=0, z=-16), the right amygdala (x=26, y=0, z=-12), the left medial globus pallidus (x=-20, y=-10, z=-6) and right medial globus pallidus (x=20, y=-10, z=-6) had strong activation, which fear faces activated bilateral amygdala (left: x=-28, y=0, z=-16, right: x=28, y=-2, z=-12) and angry faces activated the medial globus pallidus (x=20, y=-8, z=-6).Conclusion:There are specific neural mechanisms for face processing in patients with SAD.Bilateral amygdala, entorhinal cortex and medial prefrontal cortex are key brain regions for face processing.The amygdala and medial globus pallidus are important neural regions for face processing of negative emotions.

Evaluation of depressive symptoms in a sample with social anxiety disorder / Avaliação de sintomas depressivos em uma amostra com transtorno de ansiedade social / Evaluación de sintomas depresivos en una muestra con transtorno de ansiedad social

Individuals with Social Anxiety Disorder (SAD) often also experience depression. This study's objective was to verify the levels of depression present in a sample of individuals diagnosed with SAD and to characterize this sample according to sociodemographic variables. There were 104 participants diagnosed with SAD from a pre-existing database. The sociodemographic and clinical data were analyzed through descriptive statistics, as well as inferential statistics on levels of social anxiety and depressive symptoms, obtained through the Social Anxiety Inventory (SPIN) and Beck Depression Inventory (BDI-II). It was found that more than half of the people had Major Depressive Disorder as a secondary diagnosis and that higher levels of social anxiety correlated positively with higher levels of depressive symptoms. These data show the relationship between depression and social anxiety and corroborate the findings of the literature.

Os indivíduos com transtorno de ansiedade social (TAS) frequentemente apresentam também depressão. O objetivo deste trabalho foi verificar os níveis de depressão presentes em uma amostra de indivíduos diagnosticados com TAS, assim como ca racterizar essa amostra de acordo com as variáveis sociodemográficas. Contou-se com 104 participantes diagnosticados com TAS, provenientes de um banco de dados preexistente. Os dados sociodemográficos e clínicos foram analisados por meio de estatística descritiva, bem como se utilizou estatística inferencial nos níveis de ansiedade social e sintomas depressivos, obtidos por meio do Inventário de Fobia Social (SPIN) e do Inventário de Depressão de Beck (BDI-II). Constatou-se que mais da metade das pessoas possuía transtorno depressivo maior como diagnóstico secundário e que maiores níveis de ansiedade social se correlacionaram positivamente com maiores níveis de sintomas depressivos. Tais dados evidenciam a relação existente entre depressão e ansiedade social, e corroboram os achados da literatura.

Las personas con trastorno de ansiedad social (TAS) a menudo también experimentan depresión. El objetivo de este trabajo fue verificar los niveles de depresión presentes en una muestra de individuos diagnosticados con TAS, así caracterizar esta muestra de acuerdo con las variables sociodemográficas. Hubo 104 participantes diagnosticados con TAS provenientes de una base de datos preexistente. Los datos sociodemográficos y clínicos fueron analizados mediante estadística descriptiva, así como estadísticas inferenciales sobre los niveles de ansiedad social y síntomas depresivos, obtenidos a través del Inventario de Ansiedad Social (SPIN) y el Inventario de Depresión de Beck (BDI-II). Se encontró que más de la mitad de las personas tenían un trastorno depresivo mayor como diagnóstico secundario, y que los niveles más altos de ansiedad social se correlacionaron positivamente con niveles más altos de síntomas depresivos. Estos datos destacan la relación entre la depresión y la ansiedad social, y corroboran los hallazgos de la literatura.

The effectiveness of acceptance and commitment therapy for social anxiety disorder: a randomized clinical trial

Abstract Objective Acceptance and commitment therapy has been used to treat anxiety disorders recently. The purpose of this study was to investigate the effectiveness of acceptance and commitment therapy for psychological symptoms in students with social anxiety disorder, including difficulty in emotion regulation, psychological flexibility based on experiential avoidance, self-compassion, and external shame. Methods This study was a semi-experimental clinical trial. Twenty four students with social anxiety disorder were randomly divided into two groups after initial evaluations: an experimental group (12 subjects) and a control group (12 subjects). The experimental group received 12 treatment sessions based on a protocol of acceptance and commitment therapy for anxiety disorders, and the control group was put on a waiting list. Self-Compassion (SCS), Difficulty in Emotion Regulation (DERS), External Shame (ESS), Social Anxiety (SPIN), and Acceptance and Action (AAQ-II) questionnaires were used to assess participants. Data were analyzed using SPSS. Results Acceptance and commitment therapy was shown to be effective at the post-test and follow up stages for reducing external shame, social anxiety, and difficulty in emotion regulation and its components, and for increasing psychological flexibility and self-compassion (p < 0.05). The largest effect size of treatment was for increase of psychological flexibility and the lowest efficacy was for the components "difficulty in impulse control" and "limited access to emotional strategies" at the post-test and follow-up stages, respectively. Conclusion Acceptance and commitment therapy may be an appropriate psychological intervention for reducing the symptoms of students with social anxiety disorder and helping them to improve psychological flexibility. Emotion and related problems can be identified as one of the main targets of this treatment. Clinical trial registration: Iranian Registry of Clinical Trials, IRCT20180421039369N1.

Social anxiety disorder among medical students in a tertiary care hospital in Davangere, Karnataka

Background: Social anxiety disorder is a common psychiatric illness characterized by fear of being observed and scrutinized by others. It can impair academic performance and can lead to serious withdrawal from society and depression. The objective of the study was to measure the proportion and study the associated factors of Social Anxiety Disorder among students of a tertiary medical college and hospital.Methods: This hospital-based, cross-sectional study was conducted among the 272 medical students of a Tertiary care medical college and hospital at Davangere, Karnataka from October to December 2018. The social phobia inventory (SPIN) questionnaire was used to diagnose SAD among students.Results: Social anxiety disorder (SAD) was present among 30.5% (n=83) of the medical students. The female students (31.1%, n=45) documented a higher proportion of SAD compared to male students (29.9%, n=38). There was a higher incidence among above the 20 years age group and Muslims especially girl students.Conclusions: A higher proportion of medical students had social anxiety disorder which was influenced by increasing age, female gender, Muslim religion and higher academic years of exposure till final year.

Screening of social phobia symptoms in a sample of Egyptian university students

Abstract Background Public speaking is a main requisite for academic achievement amongst university students. Epidemiological data on social phobia among University students in the Arab World are scarce. Objectives To screen for social phobia symptoms in a representative sample of Egyptian university students, and to highlight some putative risk factors associated with them. Methods Two thousand nine hundred and nineteen Egyptian university students participated in the study. They were screened for social phobia using Brief Social Phobia Scale (BSPS). Students total and subdomain scores on the BSPS were correlated with their demographic and scholastic variables. Results Social phobia symptoms were estimated to be prevalent among (44%) of the study sample. A significant (p < 0.05) negative correlation was found between students' age and avoidance scores on BSPS and between students' educational year and their scores on fear, avoidance and physiologic subdomains on the BSPS. Regression analysis pointed out to a number of predictive factors for the higher total BSPS scores such as female gender and being a medical student. Discussion Our study demonstrated a high rate of social phobia symptoms in university students. It also demonstrated a number of significant predictive factors associated with the domains of social phobia such as gender, BMI, scholastic year and faculty type.

Psychometric properties of the Liebowitz Social Anxiety Scale in a large cross-cultural Spanish and Portuguese speaking sample

Objective: To examine the psychometric properties of the Liebowitz Social Anxiety Scale-Self Report (LSAS-SR) based on a large sample recruited from 16 Latin American countries, Spain, and Portugal. Methods: Two groups of participants were included: a non-clinical sample involving 31,243 community subjects and a clinical sample comprising 529 patients with a diagnosis of social anxiety disorder (SAD). Exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) were used in order to determine the psychometric properties of the LSAS-SR. Results: EFA identified five factors with eigenvalues greater than 1.00 explaining 50.78% of the cumulative variance. CFA and ESEM supported this 5-factor structure of the LSAS-SR. The factors included: 1) speaking in public; 2) eating/drinking in front of other people; 3) assertive behaviors; 4) working/writing while being observed; and 5) interactions with strangers. Other psychometric properties such as inter-factor correlations, invariance, reliability, and validity of the scale were also found. Conclusion: Psychometric data support the internal consistency and convergent validity of the LSAS-SR. It seems to be a valid and reliable measure of global social anxiety for Spanish and Portuguese-speaking countries, although when considering a multidimensional approach (factor-based assessment) it seems to be lacking some relevant social situations that are feared in those countries.

Prevalence of social anxiety disorder and its determinants among undergraduate medical students of East Delhi

Background: Social anxiety disorder (SAD) is a persistent fear of situations where a person is exposed to a possibility of being under scrutiny. This may lead to decreased academic performance which in turn can lead to depression and suicidal tendencies. Thus, medical students are more vulnerable since they are subjected to stress and academic pressure. The objective of the study was to find out the prevalence and determinants of SAD among medical undergraduate students.Methods: This was a cross-sectional descriptive study done among 404 undergraduate students of a Medical College in east Delhi. Data was collected using a questionnaire containing sociodemographic details and Social interaction anxiety scale (SIAS). Data analysis was done by MS Excel and SPSS 20.0 using frequencies, chi squared test and multiple logistic regression.Results: The mean age of the participants was 20.7 years with 75% males and two-third belonging to upper class. It was found that 12.62% of the study participants were having social phobia and 5.95% were having social anxiety. The determinants found to be significant by univariate analysis were language barrier, body image perception, facial appearance perception and academic performance satisfaction. However, after applying multiple logistic regression it was found out that language barrier (OR-4.36, 95% CI=1.567-12.165, p=0.005) and facial appearance perception (OR-2.98, 95% CI=1.206-7.375, p=0.018) were the main determinants of SAD.Conclusions: Early detection and appropriate intervention needs to be done among the students as they are the most vulnerable and most malleable.

Analysis on components of attentional bias on anger and disgust emotional faces in college students with social anxiety disorders / 中华行为医学与脑科学杂志

Objective To analyze the components of attentional bias on anger and disgust emotional faces in college students with social anxiety disorder.Methods DSM-V was used for clinical diagnosis after the initial screening with Interaction Anxiousness Scale.The subjects meet the inclusion criteria were divided into social anxiety disorder group (SAD group) and healthy control group (HC group).Koster's improved dot-probe paradigm was used in a 2 (group:SAD group,HC group) ×2 (emotion categories:anger,disgust)mixed-design experiment,and the different characteristics of attentional bias between the two groups on different emotional faces were compared.Results In SAD group,under the condition of angry faces,the response times to the probe targets with the same or different positions from the negative faces were (369.7±53.0)ms and (447.2±54.3) ms,while the response times were (429.6±70.2) ms and (444.2±55.8) ms under the condition of disgust faces,and the SAD group showed attentional bias towards both anger and disgust faces (t =24.15 and 2.45,P＜0.05).Under the condition of anger faces,the response time of HC group to the consistent and inconsistent position of probe target were (466.9±40.0) ms and (483.8±43.8) ms,and the HC group had an attentional bias towards anger faces(t=6.58,P＜0.05).The response time under disgust faces was (493.8±43.6)ms and (498.0±46.7)ms in HC group,and did not show an attentional bias towards disgust(t=1.65,P=0.108).The scores of attentional orientation to anger faces in SAD group were significantly higher than those in the HC group(F=19.26,P＜0.001),but there was no significant difference between the two groups towards disgust faces (F=0.02,P=0.897).Compared with disgust faces,the attentional orientation to anger faces was faster in both HC and SAD groups (F=101.66 and 8.00,P＜0.05).Compared with the HC group,the SAD group had an impaired attentional disengagement from anger faces(F=8.66,P=0.004).Conclusion The students with social anxiety disorder have attentional bias towards both anger and disgust facial expressions,which manifested as facilitated attentional orientation and impaired attentional disengagement to anger faces.

Validación del Inventario de Fobia y Ansiedad Social- Forma Breve para universitarios argentinos / Validação do Inventário de Fobia e Ansiedade Social- Forma Breve para universitários argentinos / Validation of the Social Phobia and Anxiety Inventory- Brief Form for Argentinean college

Las problemáticas que afectan la capacidad de las personas para desempeñarse adecuadamente en las interacciones sociales, tales como el trastorno de ansiedad social (Social Anxiety Disorder, SAD), constituyen un ámbito de estudio que ha cobrado gran interés, debido a la importancia que las relaciones sociales tienen en todas las áreas de desempeño de los seres humanos. Sin embargo, se observa una escasez generalizada de estudios sobre ansiedad social en países latinoamericanos, en parte, debido a la ausencia de instrumentos construidos o adaptados a la población general o a conjuntos específicos. En función de ello, el objetivo del presente trabajo fue analizar las propiedades psicométricas del Inventario de Fobia y Ansiedad Social- Forma Breve (SPAI- B) para su utilización en estudiantes universitarios argentinos. Los resultados evidenciaron propiedades psicométricas adecuadas de validez y confiabilidad y se aportó evidencia de validez de grupos contrastados y convergente. Se discuten las limitaciones del estudio y nuevas líneas de investigación. (AU)

As problemáticas que afetam a capacidade das pessoas para terem um desempenho adequado nas interações sociais, como o transtorno de ansiedade social (Social Anxiet Disorder, SAD), constituem um âmbito de estudo que ganhou grande interesse devido à importância que as relações sociais têm em todas as áreas de desempenho dos seres humanos. No entanto, há um déficit generalizado de estudos sobre ansiedade social em países latino-americanos, devido a uma ausência de instrumentos construídos ou adaptados à população geral ou grupos específicos. Com base nisso, o objetivo do presente trabalho foi analisar as propriedades psicométricas do Inventario de Fobia e Ansiedade Social - Forma Breve (SPAI- B) para sua utilização com estudantes universitários argentinos. Os resultados mostraram propriedades psicométricas adequadas de validade e fidedignidade e gerou evidência de validade de grupos contrastados e validade convergente. As limitações do estudo e novas linhas de pesquisa são discutidas. (AU)

The problems that affect people's ability to perform adequately in social interactions, such as Social Anxiety Disorder (SAD), constitute an area of study that has gained great interest, due to the importance that social relations have in all areas of performance of human beings. However, there is a general scarcity of studies on social anxiety in Latin American countries, partly because of the absence of instruments built or adapted to the general population or specific groups. Due to this, the objective of the present investigation was to analyze the psychometric properties of the Spanish version of the Social Phobia and Anxiety Inventory-Short form (SPAI - B) to be used in Argentine college students. The results showed appropriate validity and reliability psychometric properties and it also has been provided evidence of contrasting groups and convergent validity. The limitations of the study and new lines of research are discussed. (AU)

Anxiety Disorders - Assessment and Management in General Practice

@#The objective of this article is to provide an update on the diagnosis, assessment, and management of anxiety disorders in adults. This article covers the following disorders: panic disorder, panic attacks, specific phobia, social anxiety disorder and generalized anxiety disorder. Selective mutism and separation anxiety disorder, being childhood anxiety disorders, will not be covered. Obsessive compulsive disorder and post-traumatic stress disorder, which are not categorized as anxiety disorders in DSM-5, will not be covered. Anxiety and related disorders are common mental health disorders but are under-diagnosed and undertreated. Most cases of anxiety disorders present first to the primary care physician and can be managed in primary care.It is important to take a detailed history of the patient’s symptoms and their severity and duration, enquire about psychosocial stressors, as well as symptoms that may be suggestive of a medical condition and also to assess suicidality. A combined approach of psycho-education, relaxation training, and medications give the best results. SSRIs are first line pharmacologic treatment for most anxiety disorders. There is a need to stress that benzodiazepines have no role in the long-term treatment of anxiety disorders. They should not be given for more than 2 to 4 weeks. Treatment for generalized anxiety disorder should be for at least 32 weeks as high relapse rates are reported after discontinuing medications.

Mutismo Selectivo: Revisión de la literatura / Selective Mutism: a review

El mutismo selectivo es un cuadro clínico caracterizado por una falta constante del habla en situaciones sociales específicas en las que hay una expectativa de hablar, a pesar de hacerlo en otras situaciones. El objetivo del presente trabajo es realizar una revisión narrativa de la evidencia en relación a este trastorno, con un énfasis en la evolución que presentan estos pacientes. La evidencia muestra que, si bien los síntomas generalmente mejoran con el tiempo, las personas a menudo continúan exhibiendo problemas de comunicación, un peor desempeño académico y laboral, además de presentar un mayor riesgo de otros trastornos psiquiátricos, principalmente Trastorno de Ansiedad Social. Es necesaria mayor investigación respecto al seguimiento de estos pacientes considerando la escasa evidencia disponible y el gran impacto que genera en el paciente y su familia. Palabras clave: Mutismo Selectivo, Revisión, Pronóstico, Niños, Trastorno de Ansiedad Social.

Abstract. Selective mutism is a disorder in which an individual fails to speak in certain social situations, in spite of being able to speak normally in other settings. The aim of the present work is to perform a narrative review of the evidence in relation to this disorder, with an emphasis on the progression presented by these patients. Evidence shows that, although symptoms generally improve over time, people often continue to exhibit communication problems, have a worse academic and work performance than expected, and present a higher risk of other psychiatric disorders, mainly Social Anxiety Disorder. Further research is necessary regarding the follow-up of these patients, considering the limited available evidence and the great impact it has on the patient and his family. Keywords: Selective Mutism, Review, Prognosis, Child, Social Anxiety Disorder

Um Programa de Intervenção para Transtorno de Ansiedade Social com o Uso da Realidade Virtual / Un Programa de Intervención para la Trastorno de Ansiedad Social con el Uso de la Realidad Virtual / A Treatment Program for Social Anxiety Disorder by Using Virtual Reality

Resumo A Realidade Virtual (RV) foi utilizada nesse estudo como recurso terapêutico em uma intervenção analítico-comportamental para dois participantes com transtorno de ansiedade social. Os objetivos foram avaliar os efeitos terapêuticos do programa de intervenção e o simulador quanto à capacidade de gerar senso de presença e respostas de ansiedade. O programa consistiu em: (a) sessão inicial, (b) linha de base, (c) intervenção com exposição à RV, (d) encerramento e (e) follow up (1 e 3 meses após a intervenção). O senso de presença, ansiedade e respostas galvânicas da pele foram registrados em cada sessão com exposição e inventários de ansiedade, depressão e fobia social ao término de cada fase. Foram formuladas análises funcionais baseadas na ocorrência de comportamentos apresentados em contexto social no intervalo entre as sessões. O simulador produziu ansiedade e níveis elevados de presença ao longo das exposições; e ambos participantes apresentaram redução dos níveis de ansiedade ao fim do programa e generalização para o contexto natural. Conclui-se que a intervenção com exposição à RV apresentou efeito terapêutico e promoveu repertório de enfrentamento frente a situações de interação social.

Resumen La realidad virtual (RV) fue empleada en este estudio como herramienta terapéutica en un programa de intervención analítico-conductual para dos participantes con trastorno de ansiedad social. Los objetivos fueron evaluar los efectos terapéuticos del programa de intervención y el simulador en cuanto a la capacidad de generar presencia y respuestas de ansiedades. El programa consistió en: (a) sesión inicial, (b) línea base, (c) intervención con exposición a la RV, (d) finalización y (e) seguimiento (1 y 3 meses después de la intervención). La sensación de presencia, ansiedad y la respuesta galvánica de la pele fueron registrados en cada sesión con exposición y inventario de la ansiedad, depresión y fobia social al final de cada fase. Análisis funcionales fueron formulados en base a la ocurrencia de las conductas de interacción social en el intervalo entre las sesiones. El simulador produce ansiedad y niveles elevados de presencia a lo largo de las exposiciones y ambos participantes presentaron reducción de los niveles de ansiedad al final de lo programa, con generalización de los resultados para un contexto natural. Se concluye que la intervención analítico-conductual con la exposición a la RV tuvo efecto terapéutico y aprendieron un repertorio de afrontamiento de esas situaciones.

Abstract Virtual Reality (VR) was used in this study as a therapeutic tool in a behavior-analytic intervention with two subjects who had social anxiety disorder. The goals were to assess the therapeutic effects of the intervention program and the VR simulator with regard to the ability to generate sense of presence and anxiety responses. The program consisted of: (a) initial session, (b) baseline, (c) intervention sessions with exposure to VR, (d) closing session, (e) follow up (up to one and three months after treatment). Sense of presence, anxiety and galvanic skin response were reported in each exposure therapy session and anxiety, depression and social phobia inventories were reported at the end of each stage. Functional analyses were formulated based on behaviors occurring in social contexts between sessions. The simulator produced anxiety and high levels of presence during exposure; and both participants had reduced levels of anxiety at the end of intervention and generalization to the natural context. In conclusion, behavior-analytic intervention with exposure to VR was effective and fostered a repertoire for coping with situations of social interaction.

Social anxiety symptoms and body image dissatisfaction in medical students: prevalence and correlates / Sintomas de ansiedade social e insatisfação com a imagem corporal em estudantes de Medicina: prevalência e correlatos

ABSTRACT Objective Social anxiety disorder (SAD) and body image dissatisfaction (BID) are common problems among college students, but few studies focused on medical students. We aimed to estimate the prevalence, severity and correlates of SAD symptoms and BID among medical students of a Brazilian public university. Methods A cross-sectional study with 479 students, using structured instruments: Social Phobia Inventory (SPIN), Body Shape Questionnaire (BSQ), and Beck Depression Inventory (BDI). Bivariate analyses were followed by logistic regression models to obtain independent predictors of SAD symptoms, BID and both outcomes combined. Results Most students were single (99%) and female (58.7%). The prevalence rates of SAD symptoms (SPIN ≥ 19) and BID (BSQ ≥ 81) were 36.3% and 34.7%, respectively. Depressive symptoms (BDI ≥ 19) occurred in 8.8% of the sample. SAD symptoms were independently associated with: BID, thoughts of abandoning the course, difficulty making friends, depressive symptoms, and mental health treatment prior to university. Besides SAD symptoms, BID was associated with female sex, difficulty making friends, depressive symptoms, and body mass index (BMI). Seventy-eight students (16.3%) presented SAD symptoms and BID, which was associated with female sex, difficulty making friends, dissatisfaction with the course, depressive symptoms and BMI. Conclusion SAD symptoms and BID are common and related problems that should be screened for among medical students. The identification of specific correlates could contribute to the elaboration of preventive measures, minimizing the distress and negative impact of these mental health problems on relationships and academic performance.

RESUMO Objetivo O transtorno de ansiedade social (TAS) e a insatisfação com a imagem corporal (IIC) são problemas comuns em estudantes universitários, mas poucos estudos avaliaram estudantes de Medicina. O objetivo do estudo foi estimar a prevalência, a gravidade e os correlatos de sintomas de TAS e IIC em estudantes de Medicina de uma universidade pública brasileira. Métodos Estudo transversal com 479 estudantes utilizando os seguintes instrumentos de avaliação estruturados: Social Phobia Inventory (SPIN), Body Shape Questionnaire (BSQ) e Beck Depression Inventory (BDI). Análises bivariadas foram seguidas de modelos de regressão logística para identificar preditores independentes de sintomas de TAS, IIC e ambos os desfechos combinados. Resultados A maioria dos estudantes era solteira (99%) e do sexo feminino (58,7%). As prevalências de sintomas de TAS (SPIN ≥ 19) e de ICC (BSQ ≥ 81) foram de 36,3% e 34,7%, respectivamente. Sintomas depressivos (BDI ≥ 19) ocorreram em 8,8% da amostra. Sintomas de TAS associaram-se de modo independente com: IIC, pensamentos de abandonar o curso, dificuldade de fazer amigos, sintomas depressivos e tratamento de saúde mental antes de ingressar na universidade. Além de sintomas de TAS, IIC associou-se com sexo feminino, dificuldade de fazer amigos, sintomas depressivos e índice de massa corporal (IMC). Setenta e oito estudantes (16,3%) apresentaram sintomas de TAS e IIC, o que se associou com sexo feminino, dificuldade de fazer amigos, insatisfação com o curso, sintomas depressivos e IMC. Conclusão Sintomas de TAS e IIC são problemas comuns e inter-relacionados que devem ser rastreados em estudantes de Medicina. A identificação de correlatos específicos pode contribuir para a elaboração de medidas preventivas minimizando o sofrimento e o impacto negativo desses problemas de saúde mental nos relacionamentos e no desempenho acadêmico desses estudantes.

Korean Guidelines for the Pharmacological Treatment of Social Anxiety Disorder: Initial Treatment Strategies

OBJECTIVE: The aim of the present study was to provide clinical consensus and evidence regarding initial treatment strategies for the pharmacological treatment of social anxiety disorder (SAD) in Korea. METHODS: We prepared a questionnaire to derive a consensus from clinicians regarding their preference for the pharmacological treatment of SAD in Korea. Data regarding medication regimens and psychotropic drugs used during initial treatment, the doses used, and the pharmacological treatment duration were obtained. Responses were obtained from 66 SAD experts, and their opinions were classified into three categories (first-line, second-line, third-line) using a chi-square analysis. RESULTS: Clinicians agreed upon first-line regimens for SAD involving monotherapy with selective serotonin reuptake inhibitors (SSRIs) or the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine, or combined therapy using antidepressants with betablockers or benzodiazepines on a standing or as-needed basis. First-line psychotropic drug choices for initial treatment included the following: escitalopram, paroxetine, sertraline, venlafaxine, and propranolol. The medication dosage used by domestic clinicians was found to be comparable with foreign guidelines. Domestic clinicians tended to make treatment decisions in a shorter amount of time and preferred a similar duration of maintenance treatment for SAD when compared with foreign clinicians. CONCLUSION: This study may provide significant information for developing SAD pharmacotherapy guidelines in Korea, especially in the early stage of treatment.

The Relationship between Plasma Oxytocin Levels and Social Anxiety Symptoms

OBJECTIVE: The pathophysiology of social anxiety disorder (SAD) is not yet well understood, but previous research has suggested that oxytocin is associated with social behavior and may play a role in human anxiety states and anxiety-related traits. The aim of this study was to investigate the possible relationship between social anxiety symptoms and plasma oxytocin levels. METHODS: Twenty-three male patients with SAD and 28 healthy male controls participated in this study. All participants were assessed using the Mini International Neuropsychiatric Interview (MINI) and the Liebowitz Social Anxiety Scale (LSAS). Multivariate regression analysis was performed to identify associations between plasma oxytocin levels and SAD. RESULTS: In multiple regression models, after controlling for age and years of education, we found that higher oxytocin levels were significantly associated with higher total LSAS scores (R²=0.157, coefficient=0.145, 95% CI=-0.0005–0.291, p=0.051) and fear subscale scores (R²=0.134, coefficient=0.083, 95% CI=0.007–0.159, p=0.034) in the SAD group. CONCLUSION: In this study, increased plasma oxytocin levels were associated with higher social anxiety symptoms among SAD patients, but not among controls. This might be because among SAD patients, higher oxytocin (OT) secretion is an insufficient compensatory attempt to reduce social anxiety symptoms.

Cognitive behavioral therapy for social anxiety disorder: A case report based on conceptualization / 中国心理卫生杂志

To introduce the cognitive behavioral therapy-orientated case conceptualization and process for social anxiety disorder. Based on the detailed and integrated case conceptualization, 15 sessions of the systematic and standardized CBT treatments were conducted for maladaptive cognitive and behavioral problems. The results showed that the Liebowit Social Anxiety Scale (LSAS) score was reduced from 49 to 26, and the initial treatment goal was achieved. This case report suggests that "cognitive reconstruction combined with exposure" therapy strategy could be used to treat social anxiety disorder.

Evidencias de validez de la versión en español del Inventario de Fobia Social (SPIN) / Evidence of validity of the spanish version of the Social Phobia Inventory (SPIN)

Resumen El objetivo del presente estudio fue analizar en muestras mexicanas las propiedades psicométricas del Inventario de Fobia Social (Social Phobia Inventory, SPIN). Los participantes consistieron en estudiantes universitarios, pacientes diagnosticados con trastorno de ansiedad social y pacientes con trastorno de ansiedad generalizada. El SPIN mostró una alta consistencia interna, una buena confiabilidad test-retest y una adecuada validez convergente y discriminante. Al analizar la estructura interna, el modelo que manifestó mejores indicadores de ajuste fue el de tres factores correlacionados. El análisis de curvas ROC indicó que el SPIN es capaz de discriminar entre los trastornos de ansiedad social y de ansiedad generalizada; un punto de corte de 25 representó el mejor balance entre sensibilidad y especificidad. Se concluye que la versión en español del SPIN demuestra propiedades psicométricas sólidas, por lo que puede ser potencialmente utilizado como instrumento de cribado para detectar el trastorno de ansiedad social en población mexicana.

Abstract The aim of this study was to analyze the psychometric properties of the Social Phobia Inventory (SPIN), in Mexican samples. The participants comprised university students, patients diagnosed with social anxiety and patients with generalized anxiety disorder. The SPIN demonstrated high internal consistency, good test-retest reliability, and adequate convergent and discriminate validity. Different models of the internal structure were tested, result showed better adjustment for the three correlated factor model. Analysis of ROC curves indicated that the SPIN is able to discriminate between social anxiety and generalized anxiety disorders; a cutoff of 25 represented the best balance between sensitivity and specificity. It is possible to conclude that the Spanish version of the SPIN demonstrated solid psychometric properties, and thus it could potentially be used as a screening tool for detecting social anxiety disorder in the Mexican population.