Anxiety Disorders: Duke University

De Bellis MD, Van Dillen T. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3613, Durham, NC 27710, USA. · Child Adolesc Psychiatr Clin N Am. · Pubmed #16171701 No free full text.

Abstract: This article presents an overview of post-traumatic stress disorder (PTSD) as it relates to children and adolescents. The authors provide a critical review of the pediatric PTSD literature regarding the definition, epidemiology, clinical presentation, assessment, neurobiologic foundation, and treatment of PTSD. The importance of developmental and neurobiologic factors and the uniqueness of these factors to children are emphasized.

Costello EJ, Egger HL, Angold A. · Duke University Medical Center, Box 3454 DUMC, Durham, NC 27710, USA. · Child Adolesc Psychiatr Clin N Am. · Pubmed #16171696 No free full text.

Abstract: This article argues that the quality of diagnostic tools used to measure anxiety disorders in children and adolescents has improved enormously in the past few years. As a result, prevalence estimates are less erratic, understanding of comorbidity is increasing, and the role of impairment as a criterion for "caseness" is considered more carefully. Several of the instruments developed for epidemiologic research are now being used in clinical settings. Further integration of laboratory methods and clinical and epidemiologic ideas will benefit children with anxiety disorders and their families.

Krishnan KR. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center (3050A), 4584 Hospital South, Box 3950, Durham, NC 27710, USA. · Psychosom Med. · Pubmed #15673617 links to  free full text

Abstract: OBJECTIVES: This review summarizes the literature on psychiatric and medical comorbidities in bipolar disorder. The coexistence of other Axis I disorders with bipolar disorder complicates psychiatric diagnosis and treatment. Conversely, symptom overlap in DSM-IV diagnoses hinders definition and recognition of true comorbidity. Psychiatric comorbidity is often associated with earlier onset of bipolar symptoms, more severe course, poorer treatment compliance, and worse outcomes related to suicide and other complications. Medical comorbidity may be exacerbated or caused by pharmacotherapy of bipolar symptoms. METHODS: Articles were obtained by searching MEDLINE from 1970 to present with the following search words: bipolar disorder AND, comorbidity, anxiety disorders, eating disorder, alcohol abuse, substance abuse, ADHD, personality disorders, borderline personality disorder, medical disorders, hypothyroidism, obesity, diabetes mellitus, multiple sclerosis, lithium, valproate, lamotrigine, carbamazepine, atypical antipsychotics. Articles were prioritized for inclusion based on the following considerations: sample size, use of standardized diagnostic criteria and validated methods of assessment, sequencing of disorders, quality of presentation. RESULTS: Although the literature establishes a strong association between bipolar disorder and substance abuse, the direction of causality is uncertain. An association is also seen with anxiety disorders, attention-deficit/hyperactivity disorder, and eating disorders, as well as cyclothymia and other axis II personality disorders. Medical disorders accompany bipolar disorder at rates greater than predicted by chance. However, it is often unclear whether a medical disorder is truly comorbid, a consequence of treatment, or a combination of both. CONCLUSION: To ensure prompt, appropriate intervention while avoiding iatrogenic complications, the clinician must evaluate and monitor patients with bipolar disorder for the presence and the development of comorbid psychiatric and medical conditions. Conversely, physicians should have a high index of suspicion for underlying bipolar disorder when evaluating individuals with other psychiatric diagnoses (not just unipolar depression) that often coexist with bipolar disorder, such as alcohol and substance abuse or anxiety disorders. Anticonvulsants and other mood stabilizers may be especially helpful in treating bipolar disorder with significant comorbidity.

Compton SN, March JS, Brent D, Albano AM, Weersing R, Curry J. · Department of Psychiatry and Behavioral Psychology, Duke University Medical Center, Durham, NC 27710, USA. · J Am Acad Child Adolesc Psychiatry. · Pubmed #15266189 No free full text.

Abstract: OBJECTIVE: To review the literature on the cognitive-behavioral treatment of children and adolescents with anxiety and depressive disorders within the conceptual framework of evidence-based medicine. METHOD: The psychiatric and psychological literature was systematically searched for controlled trials applying cognitive-behavioral treatment to pediatric anxiety and depressive disorders. RESULTS: For both anxiety and depression, substantial evidence supports the efficacy of problem-specific cognitive-behavioral interventions. Comparisons with wait-list, inactive control, and active control conditions suggest medium to large effects for symptom reduction in primary outcome domains. CONCLUSIONS: From an evidence-based perspective, cognitive-behavioral therapy is currently the treatment of choice for anxiety and depressive disorders in children and adolescents. Future research in this area will need to focus on comparing cognitive-behavioral psychotherapy with other treatments, component analyses, and the application of exportable protocol-driven treatments to divergent settings and patient populations.

Davidson JR, Stein DJ, Shalev AY, Yehuda R. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center Durham, NC 27710, USA. · J Neuropsychiatry Clin Neurosci. · Pubmed #15260364 links to  free full text

Abstract: Following exposure to trauma, a large number of survivors will develop acute symptoms of posttraumatic stress disorder (PTSD), which mostly dissipate within a short time. In a minority, however, these symptoms will evolve into chronic and persistent PTSD. A number of factors increase the likelihood of this occurring, including characteristic autonomic and hypothalamic-pituitary-adrenal axis responses. PTSD often presents with comorbid depression, or in the form of somatization, both of which significantly reduce the possibilities of a correct diagnosis and appropriate treatment. Mainstay treatments include exposure-based psychosocial therapy and selective serotonin reuptake inhibitors, such as paroxetine and sertraline, both of which have been found to be effective in PTSD. This paper looks at the course of PTSD, its disabling effect, its recognition and treatment, and considers possible new research directions.

Davidson JR. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center South, Durham, NC 27710, USA. · J Clin Psychiatry. · Pubmed #15078116 No free full text.

Abstract: Benzodiazepines are advantageous treatments for anxiety disorders because they work quickly. However, benzodiazepines can vary in terms of efficacy across anxiety disorders. Benzodiazepines have been found to be a superior treatment in social anxiety disorder. While benzodiazepines are effective in the treatment of generalized anxiety disorder, other treatments such as selective serotonin reuptake inhibitors may be more effective. Also, research indicates that benzodiazepines may not be effective in the treatment of posttraumatic stress disorder. Therefore, physicians need to consider the type of anxiety disorder before prescribing a benzodiazepine as a treatment.

Hybels CF, Blazer DG. · Department of Psychiatry and Behavioral Sciences, Center for the Study of Aging and Human Development, Duke University Medical Center, Box 3003, Durham, NC 27710, USA. · Clin Geriatr Med. · Pubmed #15024807 No free full text.

Abstract: This article reviews the prevalence and incidence of mental disorders in older adults. The authors outline the epidemiologic challenges in determining the frequency of mental disorders in late-life and discuss issues that are critical for understanding the prevalence of the disorders and for reviewing the evidence from epidemiologic studies of mental disorders in this population. The authors summarize the epidemiologic data for depression, anxiety, dementia, schizophrenia, and alcoholism. Also included is a discussion of risk factors and outcomes of these disorders and a discussion of the implications of these epidemiologic findings for geriatric medicine.

Ballenger JC, Davidson JR, Lecrubier Y, Nutt DJ, Marshall RD, Nemeroff CB, Shalev AY, Yehuda R. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA. · J Clin Psychiatry. · Pubmed #14728098 No free full text.

Abstract: OBJECTIVE: To provide an update to the "Consensus Statement on Posttraumatic Stress Disorder From the International Consensus Group on Depression and Anxiety" that was published in a supplement to The Journal of Clinical Psychiatry (2000) by presenting important developments in the field, the latest recommendations for patient care, and suggestions for future research. PARTICIPANTS: The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R. T. Davidson, Yves Lecrubier, and David J. Nutt. Other faculty who were invited by the chair were Randall D. Marshall, Charles B. Nemeroff, Arieh Y. Shalev, and Rachel Yehuda. EVIDENCE: The consensus statement is based on the 7 review articles in this supplement and the related scientific literature. CONSENSUS PROCESS: Group meetings were held over a 2-day period. On day 1, the group discussed topics to be represented by the 7 review articles in this supplement, and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chair and approved by all faculty. CONCLUSION: There have been advancements in the science and treatment of posttraumatic stress disorder. Attention to this disorder has increased with recent world events; however, continued efforts are needed to improve diagnosis, treatment, and prevention of posttraumatic stress disorder.

Davidson JR. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. · J Clin Psychiatry. · Pubmed #14728096 No free full text.

Abstract: Posttraumatic stress disorder (PTSD) is a disabling condition almost universally associated with psychiatric comorbidity, reduced quality of life, and a chronic, often lifelong, course. Although acute treatment with selective serotonin reuptake inhibitors (SSRIs) has been shown to be effective, successful strategies for preventing PTSD have not been established. In addition, studies of the long-term treatment of chronic PTSD are just beginning to emerge. This review considers available evidence for the secondary prevention of PTSD in the acute aftermath of trauma and the long-term treatment of established PTSD. Unanswered questions pertaining to duration of treatment, candidates for long-term treatment, and potentially harmful treatments will also be considered.

Watson LC, Pignone MP. · Geriatric Psychiatry, Duke University Medical Center, Durham, NC 27710, USA. · J Fam Pract. · Pubmed #14653982 No free full text.

Abstract: OBJECTIVE: To determine the accuracy of depression screening instruments for older adults in primary care. STUDY DESIGN: Systematic review. DATA SOURCES: MEDLINE, PsycINFO (search dates 1966 to January 2002), and the Cochrane database on depression, anxiety and neurosis. We also searched the second Guide to Clinical Preventive Services, the 1993 Agency for Health Care Policy and Research Clinical Practice Guideline on Depression, and recent systematic reviews. Hand-checking of bibliographies and extensive peer review were also used to identify potential articles. OUTCOMES MEASURED: A predefined search strategy targeted only studies of adults aged 65 years or older in primary care or community settings, including long-term care. Articles were included in this review if they reported original data and tested depression screening instruments against a criterion standard, yielding sensitivity and specificity. RESULTS: Eighteen articles met criteria and are included in this review, representing 9 different screening instruments. The most commonly evaluated were the Geriatric Depression Scale (30- and 15-item versions), the Center for Epidemiologic Studies Depression Scale, and the SelfCARE(D). Differences in the performance of these 3 instruments were minimal; sensitivities ranged from 74% to 100% and specificities ranged from 53% to 98%. CONCLUSIONS: Accurate and feasible screening instruments are available for detecting late-life depression in primary care. More research is needed to determine the accuracy of depression screening instruments for demented individuals, and for those with subthreshold depressive disorders.

Krystal AD. · Sleep Research Laboratory, Duke University Medical Center, Durham, North Carolina, USA. · Clin Cornerstone. · Pubmed #14626540 No free full text.

Abstract: Insomnia is a highly prevalent disorder that can lead to substantial impairments in quality of life and functional capacity. This condition occurs significantly more frequently in women than men. An important contributing factor is that insomnia can occur in association with hormonal changes that are unique to women, such as those of menopause or the late-luteal phase of the menstrual cycle. Another consideration is that women are more likely to suffer from major depression and anxiety disorders, which are also associated with insomnia. The reasons are unclear as are the reasons why women are at increased risk of primary insomnia. These conditions are frequently encountered in clinical practice and present a challenge to the practitioner because there is a striking lack of research data to serve as a guide. For example, there are no published studies to indicate how to safely and effectively manage insomnia that often occurs late in pregnancy. This article reviews the available literature related to these conditions with a focus on the epidemiologic data and diagnosis and treatment of insomnia and highlights the need for further research.

Davidson JR. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. · Psychopharmacol Bull. · Pubmed #14566203 links to  free full text

Abstract: The past decade has seen remarkable advances in our ability to treat patients with posttraumatic stress disorder (PTSD). In addition, we are now much more aware of the prevalence of PTSD in civilian populations, and treatment studies now reflect the broad spectrum of patients with PTSD. Findings of studies conducted with the tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), mood stabilizers, and benzodiazepines suggest varying degrees of efficacy, with the MAOIs being particularly efficacious. However, the adverse-effect profiles of these agents, especially the TCAs and the MAOIs, limit their widespread use. The efficacy and tolerability of the selective serotonin reuptake inhibitors (SSRIs), paroxetine, sertraline, and fluoxetine, also have been demonstrated in clinical trials. Paroxetine is especially well studied in this regard, with demonstrated efficacy in men and women, in both short-term and long-term studies, and in combat veterans and civilians. Paroxetine also has been shown to improve quality of life, and to improve sleep disturbances, which can be remarkably disabling, in patients with PTSD. Emerging evidence also suggests that long-term treatment with paroxetine reverses the reductions in hippocampal volume and hypothalamic-pituitary-adrenal axis abnormalities associated with PTSD.

Davidson JR. · Duke University Medical Center, Department of Psychiatry, Durham, NC 27710, USA. · Acta Psychiatr Scand Suppl. · Pubmed #12950437 No free full text.

Abstract: OBJECTIVE: To review placebo-controlled medication trials in social phobia (SP). METHOD: Published and/or presented placebo-controlled trials of medication were reviewed and summarized. RESULTS: Phenelzine is effective in 60-70% of patients with SP and always superior to placebo. Although reversible inhibitors of monoamine oxidase type A (RIMAs) are safer, their benefits are unpredictable. SSRIs, fluvoxamine, paroxetine and sertraline are superior to placebo in generalized SP. Gabergic drugs are useful, e.g. clonazepam, gabapentin and pregabalin. Promising effects have been found with venlafaxine, a serotonin-norepinephrine reuptake inhibitor, and the results of larger studies should be forthcoming in the next 2 years. Drugs such as buspirone, tricyclics and beta-blockers are either ineffective or have limited use. SP is a chronic disorder, and early termination of successful pharmacotherapy is associated with a greater likelihood of relapse. Studies with paroxetine, clonazepam, sertraline and brofaromine show that continued treatment is associated with better maintenance of response. Special populations that require further study include children, those with comorbid Axis I disorders and the population with discrete (non-generalized) SP. CONCLUSION: MAOI and SSRI are most uniformly effective in treating SP. Clonazepam and gabapentin may also be useful. Other drugs are of more limited value. Long-term treatment is recommended to reduce rates of relapse.

Masand PS, Gupta S. · Program for Continuing Medical Education, Department of Psychiatry, Box 3391, Duke University Medical Center, Durham, NC 27710, USA. · Expert Opin Drug Saf. · Pubmed #12946249 No free full text.

Abstract: Generalised anxiety disorder (GAD) significantly impacts upon quality of life and has a chronic and persistent nature. GAD requires pharmacological therapies that are well-tolerated, lessen the mitigating effects of common comorbidities and do not pose a high risk for dependency or abuse. Selective serotonin and serotonin-noradrenaline re-uptake inhibitors have become more viable treatments for GAD than the traditionally used benzodiazepines due to greater efficacy and a more tolerable adverse event profile. Among these newer-generation antidepressants, only paroxetine and venlafaxine are currently FDA-approved for the treatment of GAD. Paroxetine was approved after three double-blind, placebo-controlled studies demonstrated its superior efficacy compared to placebo for short-term treatment of GAD. Venlafaxine was approved for both short- and long-term treatment of GAD after demonstrating efficacy in 8-week and 6-month double-blind, placebo-controlled trials. For both paroxetine and venlafaxine, the safety and tolerability profiles during treatment of GAD are consistent with those demonstrated during the short- and long-term treatment of patients with major depressive disorder.

Franks RP. · Yale Child Study Center, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT 06510, USA. · Child Adolesc Psychiatr Clin N Am. · Pubmed #12910822 No free full text.

Abstract: Children who suffer from childhood seizure disorders, especially epilepsy, have various potential psychiatric issues and concerns that the treating physician and psychiatric consultant should consider. These children are at increased risk of adjustment reactions, anxiety and mood disorders, ADHD, learning difficulties, and familial and social stress. Because of potential risks and vulnerabilities for the development of comorbid psychiatric conditions and the increased risk for individual, familial, and social impairment, a psychiatric consultation to children and families dealing with epilepsy may play an important role in the successful management of this complex disorder.

March JS. · Child and Family Study Center, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA. · Biol Psychiatry. · Pubmed #12725973 No free full text.

Abstract: There is little empirical support for the diagnosis of acute stress disorder (ASD) in children and adolescents. Most reports treat ASD as "provisional posttraumatic stress disorder (PTSD)" (meaning that children evidence ASD on the way to a formal diagnosis of PTSD), while speculating on factors that might moderate or mediate the transformation of ASD into PTSD. This report briefly reviews the literature on ASD in the context of presenting a testable, multivariate model for understanding acute stress responses in youth.

Krishnan KR. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA. · Biol Psychiatry. · Pubmed #12706956 No free full text.

Abstract: Comorbidity is common among patients with major depression, but in most instances it may be of little relevance. Nonetheless, it is a complex issue because of its relation to treatment response, and few studies have attempted to address this. Most have examined comorbidity after the fact in secondary analyses. In this article, I focus on whether comorbidity influences depression treatment response among patients who are primarily diagnosed as suffering from major depression. At least three comorbidities are believed to influence treatment response: medical, anxiety, and personality disorders. Whether studies find that these factors predict worse outcomes in patients with major depression appears to depend on the nature and severity of the medical illness, the study setting, and the study design. The best designed studies reported the least effects of these factors on treatment outcome. Clinically, this suggests that these factors should not be seen as impediments to treatment.

De Bellis MD, Thomas LA. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3613, Durham, NC 27710, USA. · Curr Psychiatry Rep. · Pubmed #12685990 No free full text.

Abstract: Child maltreatment is a serious problem in US society, affecting approximately three million children. Children and adolescents exposed to child abuse and neglect experience high rates of post-traumatic stress disorder (PTSD). In addition, they are at risk for comorbid mental illness. Biologic stress systems affected in trauma and in PTSD are complex. Findings in cognitive testing, neuroimaging, and affected pathways shed light on the consequences of child maltreatment. What is known about treatment and outcomes for children with history of maltreatment and maltreatment-related PTSD indicates the need for prevention, intervention, and treatment of children exposed to abuse and neglect. The following is a brief review of the most recent neurobiologic findings in child maltreatment and related PTSD.

Compton SN, Burns BJ, Helen LE, Robertson E. · Department of Psychiatry and Behavioral Sciences, Durham, North Carolina 27705, USA. · J Consult Clin Psychol. · Pubmed #12472300 No free full text.

Abstract: This article reviews the empirical literature on psychosocial, psychopharmacological, and adjunctive treatments for children between the ages of 6 and 12 with internalizing disorders. The aim of this review was to identify interventions that have potential to prevent substance use disorders in adolescence by treating internalizing disorders in childhood. Results suggest that a variety of behavioral, cognitive-behavioral, and pharmacological interventions are effective in reducing symptoms of childhood depression, phobias, and anxiety disorders. None of the studies reviewed included substance abuse outcomes. Thus, little can be said about the relationship between early treatment and the prevention of later substance use. The importance of evaluating the generalizability of research-supported interventions to community settings is highlighted and recommendations for future research are offered.

Schmader KE. · Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA. · Clin J Pain. · Pubmed #12441828 No free full text.

Abstract: OBJECTIVE: This article reviews the prevalence, risk factors, natural history, and impact on quality of life of painful diabetic neuropathy (PDN) and postherpetic neuralgia (PHN). DISCUSSION: Diabetes mellitus afflicts more than 14 million persons in the U.S. An estimated 20% to 24% of these persons experience PDN. Data on risk factors for PDN are limited, but duration of diabetes mellitus and poor glycemic control are probably important factors. Painful diabetic neuropathy may interfere with general activity, mood, mobility, work, social relations, sleep, leisure activities, and enjoyment of life. Herpes zoster strikes an estimated 800,000 persons each year in the U.S., most of whom are elderly or immunosuppressed. Using pain at 3 months after rash onset as a definition of PHN, between 25% and 50% of adults older than 50 years develop PHN, depending on early antiviral therapy for herpes zoster. Increasing age, greater pain and rash severity, greater degree of sensory impairment, and psychological distress are risk factors for PHN. Postherpetic neuralgia may cause fatigue, insomnia, depression, anxiety, interference with social roles and leisure activity, and impaired basic and instrumental activities of daily living. CONCLUSIONS: Both conditions are common complications of their underlying disorders and can profoundly diminish the quality of life of affected persons.

Butterfield MI, Becker M, Marx CE. · Department of Psychiatry, Duke University and the Department of Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC 27705, USA. · Curr Psychiatry Rep. · Pubmed #12441028 No free full text.

Abstract: In the US, 13% of women develop post-traumatic stress disorder (PTSD) during their lifetime. An accurate diagnosis of PTSD requires screening for trauma and symptoms of PTSD. Current research in the neurobiologic and psychologic responses to traumatic stress supports the use of pharmacologic and psychosocial interventions. Selective serotonin reuptake inhibitors are the current first-line pharmacotherapy. Efficacious psychosocial interventions include exposure therapy and cognitive processing therapy.

Beckham JC, Calhoun PS, Glenn DM, Barefoot JC. · Department of Psychiatry, Duke University Medical Center, Durham, NC, USA. · Ann Behav Med. · Pubmed #12173679 No free full text.

Abstract: A large body of evidence indicates that hostility is related to increased morbidity and mortality and evidence is growing that posttraumatic stress disorder (PTSD) is associated with poorer health outcomes. The majority of this research, however, has been conducted in male samples. As a result, the connections between PTSD and hostility and the ramifications of these variables on health in women are less clear. We review the current literature examining PTSD, hostility, and health in women and discuss possible mechanisms underlying the relationship between PTSD and hostility on health outcomes in the context of a proposed theoretical model. Although the current literature suggests that hostility and PTSD are related to health in women, more rigorous, focused research is lacking. A number of suggestions for future research are provided.

Butterfield MI, Becker ME. · Department of Veterans Affairs, Health Services Research, Duke University Medical Center, Durham, North Carolina 27705, USA. · Prim Care. · Pubmed #11856664 No free full text.

Abstract: The focus of this article is to provide primary care clinicians with a better understanding of women who have undergone sexual trauma and have related post-traumatic stress disorder. Victimization has adverse physical and mental health effects and affects a woman's clinical presentation, her coping skills, and the primary care intervention strategies needed to treat her. The article reviews issues of victimization and related PTSD among women, including the prevalence and sequel of victimization, and provides a theoretical framework for primary care intervention, treatment, and referral.

Tharwani HM, Davidson JR. · Anxiety and Traumatic Stress Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA. · Psychiatr Clin North Am. · Pubmed #11723625 No free full text.

Abstract: There are several old and new tools for assessment of generalized SAD but few for nongeneralized SAD. Scales are available in both self-rated and interviewer-rated formats. Self-rated scales vary in appearance in length and specificity for SAD and psychometric properties. The best-studied self-rated scales are the FQ, FNE, SAAD, SPAI, and SPIN. The FQ is an early scale, with a subscale of social phobia with reasonable psychometric properties and has withstood the test of time. The FNE and SAAD are based on cognitive models of SAD but lack assessment of physiologic arousal symptoms--an important symptom cluster of SAD. The SPIN is a relatively new scale and shows potential especially with its three-item screener for generalized SAD. The two interviewer-rated scales, the LSAS and BSPS, are both widely used and demonstrate sound psychometric properties. Either one can be regarded as a satisfactory scale in the assessment of symptom severity and treatment response. The BSPS also measures several physical symptoms common in SAD. There are fewer validated tools available for nongeneralized SAD. It is a prevalent condition that may account for 25% or more of patients with SAD. More research is required on the epidemiology, recognition, assessment, and treatment of nongeneralized SAD. Education of patients and clinicians, and the use of improved and briefer tools in these settings, may help SAD patients to obtain appropriate help and improve their functioning and productivity. Few tools are available that can reliably assess disability due to SAD, and more research in this area is important and required.

Hidalgo RB, Barnett SD, Davidson JR. · Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. · Int J Neuropsychopharmacol. · Pubmed #11602035 No free full text.

Abstract: Social anxiety disorder (SAD) is among the most common of all psychiatric disorders. It presents with a lifetime prevalence rate of up to 16% in the general population and, like other anxiety disorders, is more frequent in women. Patients with SAD suffer from considerable psychiatric comorbidity that is often preceded by social anxiety. Social anxiety affects people early in life and provokes a great deal of impairment and cost, much being related to the under-recognition and/or under-treatment of this disorder, which occurs frequently with GPs and others specialists. There is a clear need among GPs for training and awareness about the existence of this disorder, its assessment, differential diagnosis and available treatments. In this paper we review the development of the concept of SAD and its epidemiology, and discuss the available information regarding cost and how SAD presents in primary-care settings. Potential aetiologies and studies concerning possible neurobiological mechanisms are also reviewed. Pharmacological and psychosocial treatments for SAD are examined and effect sizes calculated for placebo-controlled pharmacological studies of five medication categories.