Characteristics and predictors of social phobia course in a longitudinal study of primary-care patients

Abstract

Background Social Phobia (SP) is a prevalent disorder in primary care settings. To date, few researchers have examined the natural course of SP in primary care. We examined the natural course and predictors of recovery in a large sample of primary care patients. Methods Data are obtained from the Primary Care Anxiety Project (PCAP), a naturalistic, longitudinal study of anxiety disorders in primary care patients. The current report pertains to 182 patients with SP at intake. We examined intake demographic and clinical variables as predictors of recovery within the five years of follow-up. Results The probability of recovery from SP during the 5 year follow-up period was .40. At intake, a longer duration of SP episode, co-morbid Panic Disorder with Agoraphobia, lower psychosocial functioning, and the presence of a medical condition predicted lower rates of recovery. Conclusions These findings highlight the chronicity of SP, as well as factors that may affect its naturalistic course. It is imperative that primary care physicians and mental health specialists assess for and treat SP in their practices. Future research is warranted to further examine the effect of medical and psychiatric comorbidity on SP course.

A 2010 Evidence-Based Algorithm for the Pharmacotherapy of Social Anxiety Disorder

“…In patients with generalized SAD (rather than nongeneralized or discrete SAD), anxiety is evident in most social situations. Patients with SAD may not present to primary care practitioners complaining of SAD, or social anxiety may be erroneously viewed as normal shyness; thus, unfortunately, SAD continues to be underdiagnosed in primary care settings [4].…”

“…It is one of the most prevalent psychiatric disorders in the developed and the developing world [2] and is associated with substantial comorbidity (particularly of mood and substance use disorders), disability and distress (including social and occupational impairment), and economic costs [3]. SAD tends to have a relatively early onset and long duration, with chronicity of symptoms often seen in primary care practice [4]. Notably, patients with this disorder seek help for it relatively uncommonly [5].…”

Predictors of outcome in outpatients with anxiety disorders: The Leiden routine outcome monitoring study

“…Conversely, older age was associated with lower severity at one-year follow-up and a steeper decline in anxiety over time in subjects with PD/A and GAD but not in SP (Ramsawh et al, 2009). Others found no predictive value of age (Chavira et al, 2009;Van Ameringen et al, 2004;Beutel et al, 2011;Beard et al, 2010;Serretti et al, 2009). Additional socio-demographic factors that have been linked to poor outcome in anxiety disorders are: lower education-level (Ramsawh et al, 2009), and being unemployed and having low socioeconomic status in PD/A (Roy-Byrne et al, 2003).…”

Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology

“…Generalised anxiety disorder tends to run a waxing and waning course in non-clinical samples [I] (Angst et al, 2009), and a prolonged course in primary care [I] (Rodriguez et al, 2006): but may also 'switch' to other diagnoses particularly depression and somatoform disorders [II] (Rubio and Lopez-Ibor, 2007a). Social anxiety disorder tends to run a chronic course in primary [I] (Beard et al, 2010) Figure 1. Suggested scheme for exploring a suspected anxiety disorder.…”