Van Ameringen Michael, Allgulander Christer, Bandelow Borwin, Greist John H, Hollander Eric, Montgomery Stuart A, Nutt David J, Okasha Ahmed, Pollack Mark H, Stein Dan J, Swinson Richard P
Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada.
CNS Spectr. 2003 Aug;8(8 Suppl 1):40-52. doi: 10.1017/s1092852900006933.
What is the best approach for treating patients with social phobia (social anxiety disorder) over the long term? Social phobia is the most common anxiety disorder, with reported prevalence rates of up to 18.7%. Social phobia is characterized by a marked and persistent fear of being observed or evaluated by others in social performance or interaction situations and is associated with physical, cognitive, and behavioral (ie, avoidance) symptoms. The onset of social phobia typically occurs in childhood or adolescence and the clinical course, if left untreated, is usually chronic, unremitting, and associated with significant functional impairment. Social phobia exhibits a high degree of comorbidity with other psychiatric disorders, including mood disorders, anxiety disorders, and substance abuse/dependence. Few people with social phobia seek professional help despite the existence of beneficial treatment approaches. The efficacy, tolerability, and safety of the selective serotonin reuptake inhibitors (SSRIs), evidenced in randomized clinical trials, support these agents as first-line treatment. The benzodiazepine clonazepam and certain monoamine oxidase inhibitors (representing both reversible and nonreversible inhibitors) may also be of benefit. Treatment of social phobia may need to be continued for several months to consolidate response and achieve full remission. The SSRIs have shown benefit in long-term treatment trials, while long-term treatment data from clinical studies of clonazepam are limited but support the drug's efficacy. There is also evidence for the effectiveness of exposure-based strategies of cognitive-behavioral therapy, and controlled studies suggest that the effects of treatment are generally maintained at long-term follow-up. In light of the chronicity and disability associated with social phobia, as well as the high relapse rate after short-term therapy, it is recommended that effective treatment be continued for at least 12 months.
长期治疗社交恐惧症（社交焦虑障碍）患者的最佳方法是什么？社交恐惧症是最常见的焦虑症，报告的患病率高达18.7%。社交恐惧症的特征是在社交表现或互动情境中明显且持续地害怕被他人观察或评价，并伴有身体、认知和行为（即回避）症状。社交恐惧症通常在儿童期或青少年期发病，如果不治疗，临床病程通常是慢性的、不间断的，并伴有明显的功能损害。社交恐惧症与其他精神障碍高度共病，包括情绪障碍、焦虑症和物质滥用/依赖。尽管存在有效的治疗方法，但很少有社交恐惧症患者寻求专业帮助。随机临床试验证明，选择性5-羟色胺再摄取抑制剂（SSRI）的疗效、耐受性和安全性支持将这些药物作为一线治疗。苯二氮䓬类药物氯硝西泮和某些单胺氧化酶抑制剂（包括可逆和不可逆抑制剂）也可能有益。社交恐惧症的治疗可能需要持续数月以巩固疗效并实现完全缓解。SSRI在长期治疗试验中已显示出益处，而氯硝西泮临床研究的长期治疗数据有限，但支持该药物的疗效。也有证据表明基于暴露的认知行为疗法有效，对照研究表明治疗效果在长期随访中通常得以维持。鉴于社交恐惧症的慢性病程和功能障碍，以及短期治疗后的高复发率，建议持续有效的治疗至少12个月。
