LMCC/Social Phobia


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

Epidemiology

 * 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

 * 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

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

Management

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

Pharmacology

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