title: Alcohol abuse in social phobic patients: is there a bipolar connection?
abstract: BACKGROUND
  Epidemiological and clinical studies have reported the frequent co-occurrence of social phobia (SP) and alcohol use disorders. Patients with SP often use alcohol to cope with the social situations they fear, and to lessen anticipatory anxiety, behavioral inhibition, and phobic avoidance. We investigated whether the presence of lifetime comorbidity with alcohol abuse was associated with significant differences as regards demographic and clinical features, family history and pattern of comorbidity in a large clinical sample of SP outpatients.
  
  
  METHODS
  The sample comprised 153 outpatients who met DSM-III-R diagnostic criteria for SP. Demographic, family history and course characteristics were investigated by a semi-structured interview. Social phobic symptoms and the severity of the illness have been assessed by the Liebowitz Social Anxiety Scale (LSAS) and the Liebowitz Social Phobic Disorders Rating Scale, Severity (LSPDRS). Patients completed the Hopkins Symptom Checklist (HSCL 90).
  
  
  RESULTS
  Thirty-four patients (22.2%) had a past or current history of alcohol abuse for at least 1 year. There were no significant differences between these patients and those without a history of alcohol abuse, as regards demographic features and lifetime comorbidity with major depression and other anxiety disorders. Bipolar disorder type II was found almost exclusively among patients with alcohol abuse, as well as family history for bipolar disorders.
  
  
  CONCLUSIONS
  Retrospective study.
  
  
  CONCLUSIONS
  Our data indicate a strong relationship between bipolar II disorder and alcohol abuse comorbidity in patients with SP. The socializing and disinhibiting effect that many social phobics report might be mediated by mood elation induced by alcohol. The presence of bipolar diathesis in patients presenting with social anxiety might explain their increased susceptibility to alcohol, as they might undertake alcohol abuse as an attempt to overcome social difficulties.
authors.affiliation: Department of Psychiatry, University of Pisa, Via Roma 67, 56100 Pisa, Italy. g.perugi@psico.med.unipi.it
authors.forename: Giulio
authors.initials: G
authors.lastname: Perugi
authors.forename: Franco
authors.initials: F
authors.lastname: Frare
authors.forename: Donato
authors.initials: D
authors.lastname: Madaro
authors.forename: Icro
authors.initials: I
authors.lastname: Maremmani
authors.forename: Hagop S
authors.initials: HS
authors.lastname: Akiskal
mesh_terms: D000328:Adult; D000339:Affect; D000437:Alcoholism / Q000150:complications / Q000523:psychology*; D001714:Bipolar Disorder / Q000523:psychology*; D015897:Comorbidity; D003710:Demography; D005192:Family Health; D005260:Female; D006801:Humans; D008297:Male; D010698:Phobic Disorders / Q000150:complications / Q000523:psychology*; D012189:Retrospective Studies; D012307:Risk Factors; D012919:Social Behavior