Social anxiety disorder often untreated: third most common psychiatric disorder – Clinical Rounds
NEW ORLEANS — Only 57% of primary care patients with social anxiety disorder receive treatment, according to research presented at the annual meeting of the American Academy of Family Physicians.
Overall, 20% of patients with social anxiety disorder (SAD) in this setting were treated with medication only, 4% were treated with psychotherapy only, and 33% were treated with both, said Kristin M. Maki, Ph.D., of Brown University, Providence, R.I.
A total of 539 patients meeting the DSM-IV criteria for one or more intake anxiety disorders were recruited from 15 primary care, general internal medicine, and family medicine clinics in New England to take part in the Primary Care Anxiety Project. Follow-up interviews are performed every year.
SAD was the second most common anxiety disorder among these patients, accounting for 33% (179), following posttraumatic stress disorder (37%). “This was a group with a high degree of psychiatric comorbidity,” said Dr. Maki. Major depressive disorder was the most common comorbid condition (45%). In terms of the clinical course, only 33% were likely to recover after 4 years.
SAD is characterized by a marked fear of social and performance situations and the fear of humiliation and embarrassment. SAD has a lifetime prevalence of 13%, making it the third most common psychiatric disorder after depression and substance abuse. SAD has an earlier age of onset than the other anxiety disorders and has a chronic course.
“Combine these two facts and this means that SAD has the potential to have a pervasive and detrimental impact across all aspects of a person’s life,” said Dr. Maki.
Even without comorbidity, the risk of lifetime suicide attempts is almost four times greater among people with SAD than in the general population. In people with both SAD and major depressive disorder, the risk of lifetime suicide attempts is almost six times greater.
Primary care patients with SAD reported functioning worse than or comparable to patients with hypertension, recent MI, and diabetes, Dr. Maki said.
Patients with SAD were primarily women (73%), with an average age of 39 years.
Of patients receiving medication, 64% were receiving selective serotonin reuptake inhibitors (SSRIs). Benzodiazepines, tricylic antidepressants, and other anxiolytics were also prescribed.
The researchers also found that while primary care physicians and psychiatrists were equally likely to prescribe SSRIs, primary care doctors were less likely to prescribe benzodiazepines and tricylic antidepressants.
Those with SAD who did not seek treatment said that they did not believe in treatment with medications or psychotherapy, their physician did not recommend treatment, treatment was too inconvenient, or they did not think that they needed treatment.
The larger study of primary care patients revealed that 47% were likely to go to their primary physician for an emotional problem, compared with 86% for a medical problem.
Pfizer Inc. funds the Primary Care Anxiety Project.
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