Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Neuropsychiatr Dis Treat. 2012;8:203-15. doi: 10.2147/NDT.S23317. Epub 2012 May 3.
This article proposes a number of recommendations for the treatment of generalized social phobia, based on a systematic literature review and meta-analysis. An optimal treatment regimen would include a combination of medication and psychotherapy, along with an assertive clinical management program. For medications, selective serotonin reuptake inhibitors and dual serotonin-norepinephrine reuptake inhibitors are first-line choices based on their efficacy and tolerability profiles. The nonselective monoamine oxidase inhibitor, phenelzine, may be more potent than these two drug classes, but because of its food and drug interaction liabilities, its use should be restricted to patients not responding to selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors. There are other medication classes with demonstrated efficacy in social phobia (benzodiazepines, antipsychotics, alpha-2-delta ligands), but due to limited published clinical trial data and the potential for dependence and withdrawal issues with benzodiazepines, it is unclear how best to incorporate these drugs into treatment regimens. There are very few clinical trials on the use of combined medications. Cognitive behavior therapy appears to be more effective than other evidence-based psychological techniques, and its effects appear to be more enduring than those of pharmacotherapy. There is some evidence, albeit limited to certain drug classes, that the combination of medication and cognitive behavior therapy may be more effective than either strategy used alone. Generalized social phobia is a chronic disorder, and many patients will require long-term support and treatment.
本文基于系统文献回顾和荟萃分析，提出了一些广泛性社交恐惧症的治疗建议。最佳治疗方案包括药物治疗和心理治疗的联合应用，并辅以积极的临床管理计划。对于药物治疗，基于疗效和耐受性，选择性 5-羟色胺再摄取抑制剂和双重 5-羟色胺-去甲肾上腺素再摄取抑制剂是首选。非选择性单胺氧化酶抑制剂苯乙肼可能比这两类药物更有效，但由于其与食物和药物的相互作用，其使用应仅限于对选择性 5-羟色胺再摄取抑制剂或 5-羟色胺-去甲肾上腺素再摄取抑制剂无反应的患者。还有其他一些药物类别在社交恐惧症中显示出疗效（苯二氮䓬类药物、抗精神病药、α2-δ 配体），但由于有限的已发表临床试验数据以及苯二氮䓬类药物可能导致依赖和戒断问题，因此尚不清楚如何将这些药物最佳地纳入治疗方案。关于联合用药的临床试验非常少。认知行为疗法似乎比其他基于证据的心理技术更有效，其效果似乎比药物治疗更持久。虽然证据有限，仅限于某些药物类别，但药物治疗和认知行为疗法的联合应用可能比单独使用任何一种策略更有效。广泛性社交恐惧症是一种慢性疾病，许多患者需要长期支持和治疗。
