Department of Psychiatry and Psychotherapy, Medical University of Vienna, Wien, Austria.
Psychiatr Danub. 2009 Dec;21(4):533-42.
Social anxiety disorder (SAD) is considered to be one of the most common anxiety disorders. Despite its high prevalence, the disorder is still considerably underdiagnosed and undertreated. SAD shows a typically early onset in childhood or early adolescence and generally becomes chronic. The disease places a massive burden on patients lives, affecting not only their social interactions but also their educational and professional activities, thereby constituting a severe disability. Although substantial progress in the study of the etiology of SAD has been made, no commonly accepted model has emerged yet. Data from genetic and neuroimaging studies point towards a contribution of several neurotransmitter systems (i.e. norepinephrine, dopamine and serotonin) to the pathophysiology of this disorder. Functional magnetic resonance imaging studies have repeatedly emphasized the central role of the amygdalae and insula in the neural circuitry of the disorder. Selective serotonin reuptake inhibitors (SSRI) are commonly accepted as first line therapy, however other substance classes like serotonin norepineprine reuptake inhibitors (SNRI), monoamine oxidase inhibitors (MAOI), benzodiazepines and several other agents have also proved effective. There is still a substantial lack of data on therapeutic options in cases of non-responsive SAD as well as on add-on therapy. A combined treatment-approach including psychotherapy (e.g. cognitive behavioural therapy) may prove useful.
社交焦虑障碍（SAD）被认为是最常见的焦虑障碍之一。尽管其患病率很高，但该疾病的诊断和治疗仍然严重不足。SAD 在儿童或青少年早期通常会出现典型的早期发病，并且通常会变成慢性疾病。该疾病给患者的生活带来了巨大的负担，不仅影响他们的社交互动，还影响他们的教育和职业活动，从而构成严重的残疾。尽管在 SAD 的病因研究方面已经取得了实质性进展，但尚未出现普遍接受的模型。遗传和神经影像学研究的数据表明，几种神经递质系统（即去甲肾上腺素、多巴胺和血清素）对该疾病的病理生理学有贡献。功能磁共振成像研究反复强调了杏仁核和脑岛在该疾病神经回路中的核心作用。选择性 5-羟色胺再摄取抑制剂（SSRI）通常被认为是一线治疗药物，然而其他物质类别，如 5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRI）、单胺氧化酶抑制剂（MAOI）、苯二氮䓬类药物和其他几种药物也已被证明有效。对于无反应性 SAD 以及附加治疗的治疗选择，仍然缺乏大量数据。包括心理治疗（例如认知行为疗法）在内的联合治疗方法可能会证明有用。
