Social Phobia Screening

Screening is an important step in diagnosing social phobia. Patients with social phobia, by definition, are unlikely to raise the issue. Physicians should consider screening patients who

• appear shy or reticent
• present with psychologic symptoms: anxiety, fear, embarrassment, distress, avoidance
• present with physiologic symptoms: blushing, sweating, tremors, palpitations, GI discomfort
• may abuse alcohol or drugs
• have depressive symptoms

There are 2 screening questions recommended by the International Consensus Group on Depression and Anxiety:

• "Are you uncomfortable or embarrassed at being the center of attention?"
• "Do you find it hard to interact with people?"

A positive response to 1 or both of these questions should be followed by additional diagnostic inquiry to

1. determine if social phobia is present, and if so,
2. determine if the patient desires treatment.

A range of pharmacologic and non-pharmacologic options is currently used for treatment of SP. Selective serotonin reuptake inhibitors (SSRIs) have become the pharmacologic treatment of choice because of their favorable efficacy, safety, and tolerability profile, and lack of abuse potential.

The initial goal in treating patients with SP is attaining a response, which in social phobia means a clinically meaningful improvement, such that the patient no longer experiences the full range of symptoms. The International Consensus Group on

Depression and Anxiety recommends an 8-week initial treatment phase to establish efficacy and response, followed by a continuation phase of 1 year or more to achieve remission.