LMCC/Social Phobia

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  • a marked and persistent fear of social or performance situations where one is exposed to unfamiliar people or possible scrutiny

Epidemiology[edit]

  • lifetime prevalence rate ~ 16%
  • Female: Male = 1.5: 1
  • Begins in early childhood and adolescence
  • can lead to significant psychiatric comoribidy including depression, anxiety disorders, substance abuse and eating disorders
  • often underrecognized by family practitioners

History[edit]

  • fear of being humiliated or embarassed in social or performance situations
    • include: public speaking, eating, drinking, writing, public restrooms, speaking on the telephone, social gatherings
  • the fear is recognized as excessive/unreasonable
  • the avoidance, anticipation and distress interfere significantly with social and occupational functioning
  • often presents with somatic complaints of insomnia, fatigue, palpitations, chest pain, shortness of breath, dizziness, trembling of hands, sweating, blushing and GI complaints

Physical[edit]

  • hyperhidrosis, tremor, blushing, stuttering, hypertension and tachycardia
  • must do a thorough mental status examination

Management[edit]

  • cognitive behavioural therapy
  • exposure therapy (most firmly established therapeutic maneuver)
  • cognitive restructuring
  • social skills training

Pharmacology[edit]

  • effective treatments include MAOI, anxiolytics and SSRIs (drug of choice due to effectiveness and lack of significant side effects)

References[edit]

Toronto Notes 2005