今日の臨床サポート

社交不安障害

著者: 松永寿人 兵庫医科大学 精神科

監修: 上島国利 昭和大学

著者校正/監修レビュー済:2019/03/22
患者向け説明資料

概要・推奨   

疾患のポイント:
  1. 社交不安障害(social anxiety disorder、SAD)の中核的臨床像とは、「恥ずかしい思いをするかもしれない社会的状況、または行為をする状況に対する顕著で持続的な恐怖」であり、恐怖や回避で日常や社会生活全般に重大な支障を来す。
  1. 人前で「話をする」、「字を書く」、「スポーツをする」、あるいは「パーティーに出席する」、「よく知らない人に会う」などの行為や状況を恐怖する。
  1. 一般人口中の生涯有病率は、わが国では1.4%程度とされるが、受診率は低い。
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要
閲覧にはご契
閲覧に
  1. 閲覧にはご契約が必要となります。閲覧にはご契約
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となりま
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契
閲覧にはご契
閲覧にはご契約
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となりま
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必
閲覧にはご契
閲覧に
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧に
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となりま
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧には

閲覧にはご契約が必要とな
  1. 閲覧にはご契約が必要となります。閲覧にはご
  1. 閲覧にはご契約が必要となります
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要と
  1. 閲覧にはご契約が必要となります。閲覧にはご契約
  1. 閲覧にはご契約が必要となります。閲覧にはご
閲覧にはご契
閲覧にはご契約が
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
松永寿人 : 企業などが提供する寄付講座((福)枚方療育園)[2021年]
監修:上島国利 : 原稿料(大日本住友製薬)[2021年]

改訂のポイント:

病態・疫学・診察

疾患情報  
  1. 社交不安障害(social anxiety disorder、 SAD)の中核的臨床像は、「恥ずかしい思いをするかもしれない社会的状況、または行為をする状況に対する顕著で持続的な恐怖」である。
  1. ICD-10では、「比較的少人数の集団内で、他の人々から注視される恐れ」が特徴とされる。
  1. 恐怖の対象は、人前で「話をする」、「字を書く」、「スポーツや楽器の演奏をする」など「行為をする状況」、あるいは「パーティーや結婚式に出席する」、「よく知らない人に会う」などの対人交流状況に大別される。
  1. このような状況への曝露により、ほとんどの場合は不安反応、例えば動悸、震戦、発汗、紅潮などが生じて、結果的にその状況を恐れ回避する。例えば手指の震戦などで恥をかくことを恐れ、人前での食事や書字などを避ける。
  1. 社交恐怖は、「あがり症」あるいは「内気」などの性格傾向とは異なり、恐怖や回避、またはその状況に直面する予期不安などによって、毎日の生活や職業的機能、社会生活などに著しい障害を来している、またはその恐怖による苦痛が顕著な場合においてのみ診断される。
  1. 成人においては、その恐怖の過剰性や不合理性を認識していることが必要である。
  1. このような恐怖が広範な社会的状況にみられ、通常は人前で行為をする状況、そして対人交流を持つ状況のいずれにも恐怖を感じている。
  1. パフォーマンス限局型の場合、恐怖する状況が、話したり演技をしたりなど、人前での行為状況に限定される。
  1. 回避性パーソナリティ障害との関連が強く、しばしば両者が併存する[1]
  1. パニック障害(広場恐怖を含む)、分離不安障害、広汎性発達障害などを鑑別する。
  1. 一般人口中における生涯有病率は、わが国では1.4%程度、欧米では2~12%とされている。
  1. 典型的な社交不安障害は、思春期、遅くても青年期までに発症する。
問診・診察のポイント  
  1. SADは、その有病率に比べ、受診率の低さが特徴である。

今なら12か月分の料金で14ヶ月利用できます(個人契約、期間限定キャンペーン)

11月30日(火)までにお申込みいただくと、
通常12ヵ月の使用期間が2ヶ月延長となり、14ヵ月ご利用いただけるようになります。

詳しくはクリック
本サイトの知的財産権は全てエルゼビアまたはコンテンツのライセンサーに帰属します。私的利用及び別途規定されている場合を除き、本サイトの利用はいかなる許諾を与えるものでもありません。 本サイト、そのコンテンツ、製品およびサービスのご利用は、お客様ご自身の責任において行ってください。本サイトの利用に基づくいかなる損害についても、エルゼビアは一切の責任及び賠償義務を負いません。 また、本サイトの利用を以て、本サイト利用者は、本サイトの利用に基づき第三者に生じるいかなる損害についても、エルゼビアを免責することに合意したことになります。  本サイトを利用される医学・医療提供者は、独自の臨床的判断を行使するべきです。本サイト利用者の判断においてリスクを正当なものとして受け入れる用意がない限り、コンテンツにおいて提案されている検査または処置がなされるべきではありません。 医学の急速な進歩に鑑み、エルゼビアは、本サイト利用者が診断方法および投与量について、独自に検証を行うことを推奨いたします。

文献 

著者: Ted Reichborn-Kjennerud, Nikolai Czajkowski, Svenn Torgersen, Michael C Neale, Ragnhild E Ørstavik, Kristian Tambs, Kenneth S Kendler
雑誌名: Am J Psychiatry. 2007 Nov;164(11):1722-8. doi: 10.1176/appi.ajp.2007.06101764.
Abstract/Text OBJECTIVE: The purpose of this study was to determine the sources of comorbidity for social phobia and dimensional representations of avoidant personality disorder by estimating to what extent the two disorders are influenced by common genetic and shared or unique environmental factors versus the extent to which these factors are specific to each disorder.
METHOD: Young adult female-female twin pairs (N=1,427) from the Norwegian Institute of Public Health Twin Panel were assessed at personal interview for avoidant personality disorder and social phobia using the Structured Interview for DSM-IV Personality and the Composite International Diagnostic Interview. Bivariate Cholesky models were fitted using the Mx statistical program.
RESULTS: The best-fitting model included additive genetic and unique environmental factors only. Avoidant personality disorder and social phobia were influenced by the same genetic factors, whereas the environmental factors influencing the two disorders were uncorrelated.
CONCLUSIONS: Within the limits of statistical power, these results suggest that there is a common genetic vulnerability to avoidant personality disorder and social phobia in women. An individual with high genetic liability will develop avoidant personality disorder versus social phobia entirely as a result of the environmental risk factors unique to each disorder. The results are in accordance with the hypothesis that psychobiological dimensions span the axis I and axis II disorders.

PMID 17974938  Am J Psychiatry. 2007 Nov;164(11):1722-8. doi: 10.1176/・・・
著者: Katja Beesdo, Antje Bittner, Daniel S Pine, Murray B Stein, Michael Höfler, Roselind Lieb, Hans-Ulrich Wittchen
雑誌名: Arch Gen Psychiatry. 2007 Aug;64(8):903-12. doi: 10.1001/archpsyc.64.8.903.
Abstract/Text CONTEXT: Epidemiological findings demonstrating an increased risk for individuals with social anxiety disorder (SAD) to develop depression have been challenged by discrepant findings from prospective longitudinal examinations in childhood and early adolescence.
OBJECTIVES: To examine patterns of SAD incidence, the consistency of associations of SAD with subsequent depression, and distal and proximal predictors for subsequent depression.
DESIGN: Face-to-face, 10-year prospective longitudinal and family study of up to 4 waves. The DSM-IV Munich-Composite International Diagnostic Interview was administered by clinically trained interviewers.
SETTING: Community sample in Munich.
PARTICIPANTS: Three thousand twenty-one individuals aged 14 to 24 years at baseline and 21 to 34 years at follow-up.
MAIN OUTCOME MEASURES: Cumulative incidence of SAD and depression (major depressive episode or dysthymia).
RESULTS: Cumulative incidence for SAD was 11.0%; for depression, 27.0%. Standardized person-years of incidence for SAD were highest for those aged 10 to 19 years (0.72%) and were low before (0.20%) and after (0.19%) that age range. Depression incidence was different, characterized by delayed and continued high rates. Social anxiety disorder was consistently associated with subsequent depression, independent of age at onset for SAD (relative risk range, 1.49-1.85, controlling for age and sex). Crude Cox regressions showed significant distal (eg, parental anxiety or depression, behavioral inhibition) and proximal SAD characteristics (eg, severity measures, persistence) as predictors. Most associations were attenuated in multiple models, leaving behavioral inhibition (hazard ratio, 1.30 [95% confidence interval, 1.04-1.62; P = .02]) and, less consistently, panic (hazard ratio, 1.85 [95% confidence interval, 1.08-3.18; P = .03]) as the remaining significant predictors.
CONCLUSIONS: Social anxiety disorder is an early, adolescent-onset disorder related to a substantially and consistently increased risk for subsequent depression. The demonstration of proximal and particularly distal predictors for increased depression risks requires further exploration to identify their moderator or mediator role. Along with previous evidence that comorbid SAD is associated with a more malignant course and character of depression, these results call for targeted prevention with the aim of reducing the burden of SAD and its consequences.

PMID 17679635  Arch Gen Psychiatry. 2007 Aug;64(8):903-12. doi: 10.100・・・
著者: F R Schneier, T E Foose, D S Hasin, R G Heimberg, S-M Liu, B F Grant, C Blanco
雑誌名: Psychol Med. 2010 Jun;40(6):977-88. doi: 10.1017/S0033291709991231.
Abstract/Text BACKGROUND: To assess the prevalence and clinical impact of co-morbid social anxiety disorder (SAD) and alcohol use disorders (AUD, i.e. alcohol abuse and alcohol dependence) in a nationally representative sample of adults in the United States.
METHOD: Data came from a large representative sample of the US population. Face-to-face interviews of 43093 adults residing in households were conducted during 2001-2002. Diagnoses of mood, anxiety, alcohol and drug use disorders and personality disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule - DSM-IV version.
RESULTS: Lifetime prevalence of co-morbid AUD and SAD in the general population was 2.4%. SAD was associated with significantly increased rates of alcohol dependence [odds ratio (OR) 2.8] and alcohol abuse (OR 1.2). Among respondents with alcohol dependence, SAD was associated with significantly more mood, anxiety, psychotic and personality disorders. Among respondents with SAD, alcohol dependence and abuse were most strongly associated with more substance use disorders, pathological gambling and antisocial personality disorders. SAD occurred before alcohol dependence in 79.7% of co-morbid cases, but co-morbidity status did not influence age of onset for either disorder. Co-morbid SAD was associated with increased severity of alcohol dependence and abuse. Respondents with co-morbid SAD and alcohol dependence or abuse reported low rates of treatment-seeking.
CONCLUSIONS: Co-morbid lifetime AUD and SAD is a prevalent dual diagnosis, associated with substantial rates of additional co-morbidity, but remaining largely untreated. Future research should clarify the etiology of this co-morbid presentation to better identify effective means of intervention.

PMID 20441690  Psychol Med. 2010 Jun;40(6):977-88. doi: 10.1017/S00332・・・
著者: M R Liebowitz
雑誌名: Mod Probl Pharmacopsychiatry. 1987;22:141-73.
Abstract/Text
PMID 2885745  Mod Probl Pharmacopsychiatry. 1987;22:141-73.
著者: Carlos Blanco, Muhammad S Raza, Franklin R Schneier, Michael R Liebowitz
雑誌名: Int J Neuropsychopharmacol. 2003 Dec;6(4):427-42. doi: 10.1017/S1461145703003791.
Abstract/Text Social anxiety disorder (SAD) is a highly prevalent and often disabling disorder. This paper reviews the pharmacological treatment of SAD based on published placebo-controlled studies and published meta-analyses. It addresses three specific questions: What is the first-line treatment of SAD? How long should treatment last? What should be the management of treatment-resistant cases? Based on their efficacy for SAD and common comorbid disorders, tolerability, and safety, SSRIs should be considered as the first-line treatment for most patients. Less information is available regarding the optimal length of treatment, although individuals who discontinue treatment after 12-20 wk appear more likely to relapse than those who continue on medication. Even less empirical evidence is available to support strategies for treatment-resistant cases. Clinical experience suggests that SSRI non-responders may benefit from augmentation with benzodiazepines or gabapentin, or from switching to MAOIs, RIMAs, benzodiazepines or gabapentin. Cognitive-behavioural therapy may also be a helpful adjunct or alternative.

PMID 14609440  Int J Neuropsychopharmacol. 2003 Dec;6(4):427-42. doi: ・・・
著者: Carlos Blanco, Yang Xu, Franklin R Schneier, Mayumi Okuda, Shang-Min Liu, Richard G Heimberg
雑誌名: J Psychiatr Res. 2011 Dec;45(12):1557-63. doi: 10.1016/j.jpsychires.2011.08.004. Epub 2011 Aug 27.
Abstract/Text Social anxiety disorder (SAD) is highly prevalent and impairing. Little is known about rates and predictors of persistence of SAD in the community. The current study derived data from the National Epidemiologic Survey on Alcohol and Related Conditions, Wave 1 (2001-2002, n = 43,093) and Wave 2 (2004-2005, n = 34,653), a large survey of a representative sample of the United States adult population. Individuals with current DSM-IV SAD at Wave 1 were re-interviewed 3 years later at Wave 2 using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM IV Version (AUDADIS-IV). We found that in the community, 22.3% of respondents with SAD at the Wave 1 evaluation met DSM-IV criteria for SAD three years later, and endorsement of social interaction fears and a higher number of avoided social situations, treatment-seeking during past year, and comorbidity with mood disorders independently predicted persistence of SAD. These results suggest that persistence of SAD in the community is common and associated with symptom severity and comorbid mood disorders.

Copyright © 2011. Published by Elsevier Ltd.
PMID 21875720  J Psychiatr Res. 2011 Dec;45(12):1557-63. doi: 10.1016/・・・
著者: Dan J Stein, David S Baldwin, Borwin Bandelow, Carlos Blanco, Leonardo F Fontenelle, Sing Lee, Hisato Matsunaga, David Osser, Murray B Stein, Michael van Ameringen
雑誌名: Curr Psychiatry Rep. 2010 Oct;12(5):471-7. doi: 10.1007/s11920-010-0140-8.
Abstract/Text A growing evidence base on the management of social anxiety disorder has yielded many meta-analyses and guidelines on the pharmacotherapy of this clinically important condition. We aimed to update a pharmacotherapy algorithm for the treatment of social anxiety disorder that was developed to be concise and user friendly and that was addressed to the primary care practitioner in particular. The updated algorithm attempts to summarize succinctly the recent literature in this area, as well as to include the views of an international panel of experts with diverse experience. The algorithm comprises eight sequential steps, beginning with those focused on diagnosis and initiating treatment and ending with the management of the treatment-refractory patient.

PMID 20686872  Curr Psychiatry Rep. 2010 Oct;12(5):471-7. doi: 10.1007・・・
著者: Noortje Vriends, Eni S Becker, Andrea Meyer, S Lloyd Williams, Rainer Lutz, Jürgen Margraf
雑誌名: J Anxiety Disord. 2007;21(3):320-37. doi: 10.1016/j.janxdis.2006.06.005. Epub 2006 Aug 17.
Abstract/Text The present longitudinal study aimed to determine rate of natural recovery from DSM-IV social phobia in the community and to examine predictors of recovery. Data were derived from the Dresden Predictor Study of a representative sample of 1396 young German women. The participants completed a diagnostic interview and self-report questionnaires at two survey points approximately 1.5 years apart. Of the 91 women with social phobia at baseline 64% were at least partially recovered and 36% showed full recovery from social phobia at follow-up, defined as absence of any of the DSM-IV criteria of social phobia. Predictors of recovery from social phobia were: being employed, no lifetime depression, fewer than three lifetime psychiatric disorders, less psychopathology, less anxiety sensitivity, fewer daily hassles, and better mental health. These results show that rates of recovery from social phobia are relatively high in community and that less stress and internal psychological problems play an important role in recovery from social phobia.

PMID 16919416  J Anxiety Disord. 2007;21(3):320-37. doi: 10.1016/j.jan・・・
著者: Jonathan R T Davidson
雑誌名: J Clin Psychiatry. 2006;67 Suppl 12:20-6.
Abstract/Text The treatment goals for social anxiety disorder (SAD) are to reduce fear, avoidance, physical distress, disability, and comorbidity. This review illustrates some of the primary studies used to evaluate efficacy of treatments for SAD. The selective serotonin reuptake inhibitors (SSRIs) paroxetine, sertraline, fluoxetine, fluvoxamine, and escitalopram and the serotonin-norepinephrine reuptake inhibitor venlafaxine are effective treatments. They have the additional benefit of being able to treat comorbid conditions. For people who do not respond to serotonin reuptake inhibitors, treatment options include benzodiazepines (clonazepam, alprazolam, and bromazepam), alpha2delta calcium-channel blockers (gabapentin and pregabalin), reversible inhibitors of monoamine oxidase A (moclobemide, although agents in this class are not available in the United States), antiepileptics (levetiracetam), and atypical antipsychotics (olanzapine). The irreversible monoamine oxidase inhibitor phenelzine can be considered an effective third-line therapy. Combination treatments may be beneficial, but more research is needed. Benefits of beta-blockers (propranolol and atenolol) are limited to performance anxiety. Botulinum toxin A may be an effective augmentation treatment option for severe axillary hyperhidrosis in patients with SAD. Studies show that patients with SAD who are maintained on paroxetine, sertraline, or clonazepam have a low relapse rate.

PMID 17092192  J Clin Psychiatry. 2006;67 Suppl 12:20-6.
著者: Richard A Hansen, Bradley N Gaynes, Gerald Gartlehner, Charity G Moore, Ruchi Tiwari, Kathleen N Lohr
雑誌名: Int Clin Psychopharmacol. 2008 May;23(3):170-9. doi: 10.1097/YIC.0b013e3282f4224a.
Abstract/Text A systematic review and meta-analysis were conducted to evaluate the comparative efficacy and tolerability of second-generation antidepressants in social anxiety disorder. Studies were identified by searching MEDLINE, Embase, The Cochrane Library, PsychLit, and the International Pharmaceutical Abstracts from January 1980 through October 2006. Comparative evidence was summarized and indirect comparisons were made using network meta-analysis. Only three head-to-head trials were identified; comparative trials found only minimal differences in efficacy between escitalopram and paroxetine, and no statistically significant differences in efficacy between extended-release venlafaxine and paroxetine. Pooled evidence from 15 placebo-controlled trials suggests that escitalopram [relative benefit (RB) 1.3; 95% confidence interval (CI) 1.2-1.5], paroxetine (RB 1.9; 95% CI 1.5-2.3), sertraline (RB 1.8; 95% CI 1.5-2.2), and venlafaxine (RB 1.7; 95% CI 1.5-1.9) all produce significantly more responders than placebo; evidence favored fluvoxamine over placebo but was not significant (RB 1.5; 95% CI 0.9-2.4). Network meta-analysis did not reveal differences in efficacy among drugs. Overall, a fair amount of evidence supports the efficacy of escitalopram, fluvoxamine, paroxetine, sertraline, and venlafaxine in social anxiety disorder. The drugs do not differ in efficacy, although their adverse event profiles do.

PMID 18408531  Int Clin Psychopharmacol. 2008 May;23(3):170-9. doi: 10・・・
著者: Dan J Stein, Marcio Versiani, Tanya Hair, Rajinder Kumar
雑誌名: Arch Gen Psychiatry. 2002 Dec;59(12):1111-8.
Abstract/Text BACKGROUND: The efficacy of selective serotonin reuptake inhibitors in the acute treatment of social anxiety disorder (social phobia) is well established.
OBJECTIVE: To evaluate whether the efficacy of paroxetine hydrochloride in this disorder is maintained in the long term.
METHODS: This was a placebo-controlled multicenter study comprising a single-blind acute treatment phase (12 weeks) and a randomized, double-blind maintenance treatment phase (24 weeks) for patients who had responded to paroxetine during the acute phase. Four hundred thirty-seven adult patients with social anxiety disorder (according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria, code 300.23) entered the acute phase, and 323 continued into the maintenance phase (162 paroxetine and 161 placebo). The principal outcome measure was the proportion of patients relapsing during the maintenance phase.
RESULTS: Two hundred fifty-seven patients completed the study (136 paroxetine-treated and 121 placebo-treated patients). Significantly fewer patients relapsed in the paroxetine group than in the placebo group (14% vs 39%; odds ratio, 0.24; 95% confidence interval, 0.14-0.43; P<.001). At the end of the study, a significantly greater proportion of patients in the paroxetine group showed improvement as shown on the Clinical Global Impression global improvement rating compared with the placebo group (78% vs 51%; odds ratio, 3.66; 95% confidence interval, 2.22-6.04; P<.001). Compared with placebo, paroxetine treatment significantly (P<.001) improved the symptoms of social anxiety as shown on the Liebowitz Social Anxiety Scale, Social Phobia Inventory, Sheehan Disability Scale, Symptom Checklist-90 score, and EuroQol visual analogue scale, indicating decreased disability and increased well-being. Paroxetine was well tolerated.
CONCLUSION: Paroxetine is an effective long-term treatment for social anxiety disorder.

PMID 12470127  Arch Gen Psychiatry. 2002 Dec;59(12):1111-8.
著者: Carlos Blanco, Richard G Heimberg, Franklin R Schneier, David M Fresco, Henian Chen, Cynthia L Turk, Donna Vermes, Brigette A Erwin, Andrew B Schmidt, Harlan R Juster, Raphael Campeas, Michael R Liebowitz
雑誌名: Arch Gen Psychiatry. 2010 Mar;67(3):286-95. doi: 10.1001/archgenpsychiatry.2010.11.
Abstract/Text CONTEXT: Medication and cognitive behavioral treatment are the best-established treatments for social anxiety disorder, yet many individuals remain symptomatic after treatment.
OBJECTIVE: To determine whether combined medication and cognitive behavioral treatment is superior to either monotherapy or pill placebo.
DESIGN: Randomized, double-blind, placebo-controlled trial.
SETTING: Research clinics at Columbia University and Temple University.
PARTICIPANTS: One hundred twenty-eight individuals with a primary DSM-IV diagnosis of social anxiety disorder.
INTERVENTIONS: Cognitive behavioral group therapy (CBGT), phenelzine sulfate, pill placebo, and combined CBGT plus phenelzine.
MAIN OUTCOME MEASURES: Liebowitz Social Anxiety Scale and Clinical Global Impression (CGI) scale scores at weeks 12 and 24.
RESULTS: Linear mixed-effects models showed a specific order of effects, with steepest reductions in Liebowitz Social Anxiety Scale scores for the combined group, followed by the monotherapies, and the least reduction in the placebo group (Williams test = 4.97, P < .01). The CGI response rates in the intention-to-treat sample at week 12 were 9 of 27 (33.3%) (placebo), 16 of 34 (47.1%) (CBGT), 19 of 35 (54.3%) (phenelzine), and 23 of 32 (71.9%) (combined treatment) (chi(2)(1) = 8.76, P < .01). Corresponding remission rates (CGI = 1) were 2 of 27 (7.4%), 3 of 34 (8.8%), 8 of 35 (22.9%), and 15 of 32 (46.9%) (chi(2)(1) = 15.92, P < .01). At week 24, response rates were 9 of 27 (33.3%), 18 of 34 (52.9%), 17 of 35 (48.6%), and 25 of 32 (78.1%) (chi(2)(1) = 12.02, P = .001). Remission rates were 4 of 27 (14.8%), 8 of 34 (23.5%), 9 of 35 (25.7%), and 17 of 32 (53.1%) (chi(2)(1) = 10.72, P = .001).
CONCLUSION: Combined phenelzine and CBGT treatment is superior to either treatment alone and to placebo on dimensional measures and on rates of response and remission.

PMID 20194829  Arch Gen Psychiatry. 2010 Mar;67(3):286-95. doi: 10.100・・・

ページ上部に戻る

戻る

さらなるご利用にはご登録が必要です。

こちらよりご契約または優待日間無料トライアルお申込みをお願いします。

(※トライアルご登録は1名様につき、一度となります)


ご契約の場合はご招待された方だけのご優待特典があります。

以下の優待コードを入力いただくと、

契約期間が通常12ヵ月のところ、14ヵ月ご利用いただけます。

優待コード: (利用期限:まで)

ご契約はこちらから