title: Pediatric social anxiety disorder: predictors of response to pharmacological treatment.
abstract: OBJECTIVE
  Pediatric social anxiety disorder (SAD) is associated with an increased risk of comorbid mental disorders, with implications for prognosis and treatment strategy. The aim of this study is to explore predictors of treatment response, and the role of comorbidity in affecting refractoriness.
  
  
  METHODS
  One hundred and forty consecutive youths (81 males, 57.9%), ages 7-18 years (mean age 13.7 ± 2.5 years, mean age at onset of SAD 10.6 ± 2.7 years) met American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for SAD as primary diagnosis, according to a structured clinical interview (Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Present and Lifetime Version [K-SADS-PL]). All received a pharmacological treatment with serotonin reuptake inhibitors (SSRIs) targeted to SAD, associated with additional medications for comorbidities (mood stabilizers in 27.1%, antipsychotics in 12.8%) and 57.9% received an additional psychotherapy.
  
  
  RESULTS
  Eighty-nine patients (63.6%) responded to treatments after 3 months, namely 72.8% with psychotherapy plus medication and 50.8% with medication only. Nonresponders had more severe symptoms at baseline in terms of both clinical severity and functional impairment, and had more comorbid disruptive behavior disorders. The backward logistic regression indicated that clinical severity and functional impairment at baseline, comorbid disruptive behavior disorders, and bipolar disorders were predictors of nonresponse.
  
  
  CONCLUSIONS
  Our data suggest that SSRIs can be effective in pediatric SAD, but that the more severe forms of the disorder and those with heavier comorbidity are associated with poorer prognosis.
authors.affiliation: IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone (Pisa), Italy. gabriele.masi@inpe.unipi.it
authors.forename: Gabriele
authors.initials: G
authors.lastname: Masi
authors.forename: Chiara
authors.initials: C
authors.lastname: Pfanner
authors.forename: Maria
authors.initials: M
authors.lastname: Mucci
authors.forename: Stefano
authors.initials: S
authors.lastname: Berloffa
authors.forename: Angela
authors.initials: A
authors.lastname: Magazù
authors.forename: Giulia
authors.initials: G
authors.lastname: Parolin
authors.forename: Giulio
authors.initials: G
authors.lastname: Perugi
mesh_terms: D000293:Adolescent; D018692:Antimanic Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000188:drug therapy / Q000453:epidemiology; D001714:Bipolar Disorder / Q000188:drug therapy / Q000453:epidemiology; D002648:Child; D003131:Combined Modality Therapy; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D010698:Phobic Disorders / Q000503:physiopathology / Q000628:therapy*; D011379:Prognosis; D011613:Psychotherapy / Q000379:methods*; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018692:Antimanic Agents; D014150:Antipsychotic Agents; D017367:Selective Serotonin Reuptake Inhibitors