LMCC/Social Phobia
< LMCC- a merked and persistent fear of social or performance situations where one is exposed to unfamiliar people or possible scrutiny
Epidemiology
- lifetime prevalence rate ~ 16%
- Female: Male = 1.5: 1
- Begins in early childhood and adolescence
- can lead to significant psychiatric comoribidy including depression, anxiety disorders, substance abuse and eating disorders
- often underrecognized by family practitioners
History
- fear of being humiliated or embarassed in social or performance situations
- include: public speaking, eating, drinking, writing, public restrooms, speaking on the telephone, social gatherings
- the fear is recognized as excessive/unreasonable
- the avoidance, anticipation and distress interfere significantly with social and occupational functioning
- often presents with somatic complaints of insomnia, fatigue, palpitations, chest pain, shortness of breath, dizziness, trembling of hands, sweating, blushing and GI complaints
Physical
- hyperhidrosis, tremor, blushing, stuttering, hypertension and tachycardia
- must do a thorough mental status examination
Management
- cognitive behavioural therapy
- exposure therapy (most firmly established therapeutic maneuver)
- cognitive restructuring
- social skills training
Pharmacology
- effective treatments include MAOI, anxiolytics and SSRIs (drug of choice due to effectiveness and lack of significant side effects)
References
Toronto Notes 2005
Family Medicine
Abdominal Pain - Acne Vulgaris - Adjustment Disorder - Alcohol - Allergic Rhinitis - Anxiety - Asthma/COPD - Acute Bronchitis - Chest Pain - Common Cold - Complementary and Alternative Medicine - Depression - Diabetes Mellitus - Dyslipidemia - Dysuria - Epistaxis - Exercise - Fatigue - Family Life Cycle - Headache - Hearing Impairment - Hypertension - Low Back Pain - Men's Health - Nutrition - Obesity - Osteoarthritis - Periodic Health Examination - Pharyngitis - Sexually Transmitted Diseases - Sinusitis - Sleep Disorders - Smoking Cessation - Social Phobia - Stress Management - Women's Health
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