Social anxiety disorder in review: two decades of progress.

Social anxiety disorder (SAD) is among the most common of all psychiatric disorders. It presents with a lifetime prevalence rate of up to 16% in the general population and, like other anxiety disorders, is more frequent in women. Patients with SAD suffer from considerable psychiatric comorbidity that is often preceded by social anxiety. Social anxiety affects people early in life and provokes a great deal of impairment and cost, much being related to the under-recognition and/or under-treatment of this disorder, which occurs frequently with GPs and others specialists. There is a clear need among GPs for training and awareness about the existence of this disorder, its assessment, differential diagnosis and available treatments. In this paper we review the development of the concept of SAD and its epidemiology, and discuss the available information regarding cost and how SAD presents in primary-care settings. Potential aetiologies and studies concerning possible neurobiological mechanisms are also reviewed. Pharmacological and psychosocial treatments for SAD are examined and effect sizes calculated for placebo-controlled pharmacological studies of five medication categories.

Generalized anxiety disorder. An important clinical concern.

GAD is common, often follows a chronic course, and usually is associated with extensive psychiatric and medical comorbidity. This disorder often presents in a primary care setting, commonly with somatic symptoms; it is important for primary care physicians to be aware of its existence, forms of presentation, and different treatments. GAD appears to be twice as common in women than men. There is some evidence that the neurobiologic basis of GAD may involve abnormalities in neurochemical, neuroendocrine, neurophysiologic, and neuroanatomic factors. Research on psychosocial treatment of GAD has favored the combination of cognitive therapy and relaxation techniques or anxiety management training. It also appears that relapse rates after termination of cognitive-behavioral therapy are low. Taking into consideration that GAD generally is chronic and associated frequently with depressive symptoms, the ideal pharmacotherapy may be a drug that can treat these comorbid disorders adequately. New antidepressants, especially those with action in the serotonin system and possibly noradrenergic, may be the appropriate option: They not only treat anxiety, but also treat or prevent the development of comorbid depression; they should be effective ideally during prolonged periods without risks related to addiction or withdrawal, such as may happen with benzodiazepines and some antidepressants. The role of newly emerging drugs, such as some anticonvulsants, in GAD needs to be defined more clearly. More research is warranted to address issues such as (1) whether pharmacotherapy is as effective, less effective, or more effective than cognitive-behavioral therapy; (2) whether antidepressants improve the rate of wellness or remission; and (3) whether prolonged antidepressant therapy for GAD protects against later emergent depression.

Predictors of treatment response in patients with posttraumatic stress disorder.

1. This study examines the relation between baseline clinical characteristics in patients with posttraumatic stress disorder (PTSD) and response to treatment with a reversible monoamine oxidase A inhibitor (RIMA), brofaromine. 2. Data from two comparable, double-blind, placebo-controlled studies of brofaromine in patients with PTSD were combined. Bivariate analyses of variables of interest and outcome were performed. 3. Treatment response was significantly associated with lower baseline scores on the full scale Clinician-Administered PTSD Scale (CAPS) and on CAPS subscales B (re-experiencing) and C (avoidance/numbing), as well as to drug treatment with brofaromine. Placebo response was related to a history of past sexual trauma. 4. Brofaromine may have therapeutic benefit in treating PTSD, with lower baseline levels of reexperiencing and avoidance/numbing and overall less severe PTSD most predictive of outcome.

Posttraumatic stress disorder: epidemiology and health-related considerations.

Epidemiologic studies show that prevalence of trauma and posttraumatic stress disorder (PTSD) is substantial in modern society. Most people will experience a traumatic event at some point in their life, and up to 25% of them will develop the disorder. Demographic and socioeconomic factors also play a role in the risk for exposure to traumatic experiences and subsequent PTSD. Psychiatric history, both personal or in family members, increases the likelihood of being exposed to trauma and of developing PTSD once exposed. Traumatic exposure and PTSD have an impact on the individual's health, health care service utilization, and general functioning. Such effects provoke a considerable economic burden not only for those persons experiencing trauma and PTSD, but also for the health care system and society as a whole.

Selective serotonin reuptake inhibitors in post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is a complex psychiatric condition, which can be triggered by a variety of traumatic events. Lifetime prevalence rates range from 1.3% to 10.4%, with women twice as likely as men to be affected. The clinical management of this condition is complex, since PTSD is associated with high rates of comorbid psychiatric disorders, particularly major depression, other anxiety and panic disorders, substance abuse and antisocial behaviour. Broadly, there are two main approaches to treatment: pharmacotherapy and cognitive or behavioural therapy. This paper reviews available pharmacological approaches for the treatment of PTSD and comorbid disorders. Although the optimal pharmacological approach has yet to be established, there is increasing evidence to support the use of antidepressants, and particularly selective serotonin reuptake inhibitors (SSRIs), as first-line therapy. In addition to alleviating the core symptoms of PTSD, some SSRIs are also effective for the treatment of common comorbidities, such as depression, panic disorder and social anxiety disorder; a fact which would appear to have important implications for patient management.