Social anxiety disorder

This is among the most common and disabling mental disorders. It can be chronic, and access to treatment is often delayed or avoided. About 70% to 80% of cases have a lifetime history of concurrent anxiety, depression, and/or substance-use disorders. Effective management requires early detection, education, and delivery of evidence-based pharmacotherapy and/or cognitive behavioral therapy (CBT). Long-term treatment is often recommended due to relapse potential. Relapse may occur in 30% to 50% of patients following medication discontinuation.[108]Kimmel RJ, Roy-Byrne PP, Cowley DS. Pharmacological treatments for panic disorder, generalized anxiety disorder, specific phobia, and social anxiety disorder. In: Nathan PE, Gorman JM, eds. A guide to treatments that work. 4th ed. New York, NY: Oxford University Press; 2015:463-506. https://academic.oup.com/book/1049/chapter-abstract/137972796?redirectedFrom=fulltext ​[166]Blanco C, Schneier FR, Schmidt A, et al. Pharmacological treatment of social anxiety disorder: a meta-analysis. Depress Anxiety. 2003;18(1):29-40. http://www.ncbi.nlm.nih.gov/pubmed/12900950?tool=bestpractice.com ​​​[167]Ipser JC, Kariuki CM, Stein DJ. Pharmacotherapy for social anxiety disorder: a systematic review. Expert Rev Neurother. 2008 Feb;8(2):235-57. http://www.ncbi.nlm.nih.gov/pubmed/18271710?tool=bestpractice.com ​​​​ Relapse rates may be attenuated in those who have received elements of CBT.[137]Haug T, Blomhoff S, Hellstrom K, et al. Exposure therapy and sertraline in social phobia: 1-year follow-up of a randomised controlled trial. Br J Psychiatry. 2003 Apr;182:312-8. https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/exposure-therapy-and-sertraline-in-social-phobia-1year-followup-of-a-randomised-controlled-trial/747376F717429C0723CE8B995B658F2F http://www.ncbi.nlm.nih.gov/pubmed/12668406?tool=bestpractice.com In addition, it appears that the probability of relapse may be reduced following periodic "booster" CBT sessions.

Failure to respond to initial treatment should prompt reconsideration of diagnosis and evaluation of other medical conditions that may be contributing to the clinical presentation. Treatment-resistant patients should be referred to a mental health professional with expertise in the management of anxiety disorders. Ambivalence in accepting a psychiatric referral should be discussed with the patient, and they should be provided with corrective information and motivational enhancements where indicated.