Social anxiety disorder. A guide for primary care physicians.
Social anxiety disorder is prevalent, potentially disabling, but quite treatable. A thorough and directed history can distinguish social phobia from depression, panic disorder, and OCD. It can also screen for and identify possible substance abuse. Once the diagnosis is made, a combination of pharmacologic and psychotherapy is indicated. The SSRIs, MAOIs, benzodiazepines, and beta-blockers--as well as CBT--can effectively treat social anxiety symptoms. Primary care physicians may well want to begin by prescribing an SSRI like paroxetine, along with a high potency benzodiazepine to be taken on a regular or an as-needed basis, and a beta-blocker to take as needed in anticipation of stressful social situations. A referral for CBT should be considered. If the patient has marked side effects from drug treatment or a lack of adequate response to medication, psychiatric referral is definitely indicated.
Elliott
H W
HW
Wake Forest University Department of Psychiatry and Behavioral Medicine, USA. helliott@wfubmc.edu
Reifler
B
B
D000328:Adult; D006801:Humans; D008297:Male; D010698:Phobic Disorders / Q000188:drug therapy / Q000628:therapy; D011320:Primary Health Care; D012934:Social Isolation