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The aim of this study is to investigate the clinical features and frequency and importance of related co-morbid disorders of social phobia in a clinical sample. Eighty-seven patients meeting DSM-III-R diagnostic criteria for social phobia were studied. All patients were assessed by using a semi-structured socio-demographic form, the Structured Clinical Interview for DSM-III-R, Manual for the Structured Clinical Interview for DSM-III-R Personality Disorders, Liebowitz Social Anxiety Scale, Hamilton Rating Scale for Depression and Hamilton Rating Scale for Anxiety. Sixty-eight (78.2%) of the group were male, 19 (21.8%) were female. The ages varied between 16-58 years, with a mean of 26.2 years (SD = 8.5). Fifty-one point seven percent of the subjects were assessed as having a co-morbid axis I disorder, of which 12.6% consisted of panic disorder and 10.3% agoraphobia. An additional axis II disorder had been found in 67.8% of the subjects, and 54.0% of them had been diagnosed as having avoidant personality disorder. The frequency of co-morbid disorders in our social phobic sample is lower than most of the studies in the literature. The interface between social phobia and avoidant personality disorder needs to be studied and discussed further.
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PMID:Clinical features and co-morbidity of social phobics in Turkey. 1131 Nov 76

The Social Anxiety and Phobia Inventory for Children (SPAI-C), the Children's Depression Inventory (CDI), Harter's (1982) Perceived Competence Scale for Children (PCSC), as well as an inventory of cost and likelihood appraisal of negative social and non-social events, were filled in by 184 adolescents (14-15 years old). It was expected that social anxiety would be specifically related to low perceived competence in the social domain and threat appraisal in the same domain, whereas depression would be related to more general perceived competence deficits. The relationships of social anxiety and depression to perceived competence and appraisal were largely supported. Social anxiety was most strongly related to perceived social competence as well as to both social cost and likelihood appraisals, whereas depression was more generally related to perceived competence, and appraisal of negative events did not improve the prediction of depression any more than the prediction based on perceived competence.
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PMID:Social anxiety and depression in adolescents in relation to perceived competence and situational appraisal. 1143 80

Previous studies on social phobia (SP) have focused largely on comorbidity between SP and major depression. Less attention has been devoted to the comorbidity between SP and bipolar disorder. In this retrospective study, we investigated family history, lifetime comorbidity, and demographic and clinical characteristics among 153 outpatients who met DSM-III-R diagnostic criteria for SP. Information regarding axis I diagnoses was obtained using the Structured Clinical Interview for DSM III-R (SCID-UP-R). Social phobic symptoms and the severity of the illness were assessed by the Liebowitz Social Anxiety Scale (LSAS) and the Liebowitz Social Phobic Disorders Rating Scale, Severity (LSPDRS). Patients completed the Hopkins Symptom Checklist (HSCL 90). Fourteen patients (9.1%) satisfied DSM-III-R criteria for lifetime bipolar disorder not otherwise specified (NOS) (bipolar II), while 71 (46.4%) had unipolar major depression and 68 (44.4%) had no lifetime history of major mood disorders. Comorbid panic disorder/agoraphobia (PDA), obsessive-compulsive disorder (OCD), and alcohol abuse were reported more frequently in the bipolar group than in the other two subgroups. Unipolar patients showed higher rates of comordid PDA and OCD compared with SP patients without mood disorders. Severity and generalization of the SP symptoms, prevalent interactional anxiety, multiple comorbidity, and alcohol abuse appeared to be the most relevant consequences of SP-bipolar coexistence. In a significant minority of cases, protracted social anxiety may hypothetically have represented, along with inhibited depression, the dimensional opposite of gregarious hypomania.
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PMID:Bipolar II and unipolar comorbidity in 153 outpatients with social phobia. 1155 64

The development, reliability and validity of a new measure of personality and affect, the Comprehensive Personality and Affect Scales (COPAS) was investigated in three studies of college students. In study 1, the factor structure of personality, negative affect, and positive affect was assessed, with five-factors found in each of the three analyses. Fifteen scales (Personality: Emotionality, Extroversion, Openness, Conscientiousness, and Agreeableness; Negative Affect: Depression, Hostility, Agitation, Anxiety, and Social Anxiety; Positive Affect: Contentment, Joy, Love, Vigor, and Excitement) were constructed based on results of the factor analysis. Confirmatory factor analyses confirmed the measurement model. In study 2, the reliability and construct validity of each of the 15 factor-derived scales was assessed in both referred and non-referred college students. Study 3 investigated the utility of the COPAS scales in differentiating referred and non-referred college students. Results indicated that reliability of the scales was good to excellent, while convergent and divergent validity was good for most scales. The COPAS scales were also shown to differentiate between referred and non-referred samples of college students. Overall, the COPAS was shown to be suitable for research with college student populations.
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PMID:Development of a measure that integrates positive and negative affect and personality: the Comprehensive Personality and Affect Scales. 1220 70

Paruresis is characterized by the fear of not being able to urinate in public bathrooms and has been classified by some to be a sub-type of social anxiety disorder (social phobia). Despite the existence of a consumer advocacy organization, the "Intentional Paruresis Association (www.paruresis.org)," there is sparse literature on this condition. A survey of people affiliated with the "International Paruresis Association" was undertaken using a self-report questionnaire with items that addressed demographic variables, the phenomenology of paruresis, comorbid disorders, and the impact of symptoms on quality of life. Sixty-three patients (59 M, 4 F) completed the questionnaire. The mean age of the subjects was 38.1+/-12 years, with the mean duration of symptoms being 24.5+/-13 years. Paruresis impacts significantly on sufferers' lives, with approximately one third limiting or avoiding parties, sports events, or dating and just over half of the sample limiting the job they choose to do. Social anxiety disorder (SAD) and depression are the most common comorbid disorders and the most common disorders in family members. Analysis of Liebowitz Social Anxiety Scale (LSAS) scores showed higher performance than social interaction subscale scores across the whole sample (whether suffering from SAD or not.) However, compared to subjects without co-morbid SAD, those with comorbidity had higher total, performance, and social interaction scores. Thus, paruresis can be a chronic and disabling symptom, and there seems to be an association between paruresis and other performance anxieties. Further research to characterize paruresis and to determine effective treatments is needed.
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PMID:Is "shy bladder syndrome" a subtype of social anxiety disorder? A survey of people with paruresis. 1221 40

This article describes the development of a questionnaire that assesses problems in adapting to chronic skin disorders, the Adjustment to Chronic Skin Diseases Questionnaire. Patients (N = 442) with different skin disorders completed the original item pool. Principal-components analysis suggested a 6-factor solution that was largely replicated with 2 additional samples of 192 patients with psoriasis or atopic dermatitis and 165 patients with atopic dermatitis. Four of the subscales showed very good internal consistencies, retest reliabilities, and sufficient correlations with expert ratings: Social Anxiety/Avoidance, Itch-Scratch Cycle, Helplessness, and Anxious-Depressive Mood. Two short additional subscales, Impact on Quality of Life and Deficit in Active Coping, showed moderate internal consistencies, but good retest reliabilities. Correlations of the subscales with measures of depression, anxiety, and coping, and meaningful differences between dermatological subgroups support their construct validity. A treatment study showed that changes in some of the subscales correlated with changes in the severity of the skin condition.
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PMID:Measuring adjustment to chronic skin disorders: validation of a self-report measure. 1469 48

This study investigated the frequency and psychosocial correlates of peer victimization in a sample of youths with diabetes. The Social Experience Questionnaire, Children's Depression Inventory, Social Anxiety Scale for Children-Revised, and Asher Loneliness Scale were administered to 32 children diagnosed with type 1 diabetes and 32 control children without a medical diagnosis who were matched for age and gender. Results indicated that children with diabetes reported higher rates of relational victimization and lower levels of prosocial peer support than youths without diabetes. In addition, relational victimization was positively associated with depression, social anxiety, and loneliness for diabetic children. Implications of these findings for clinicians working with this population are discussed.
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PMID:Peer victimization and psychosocial adjustment in children with type 1 diabetes. 1520 52

Given the importance of romantic and dating relationships during adolescence, the purpose of the study was to develop and evaluate the psychometric properties of the Dating Anxiety Scale for Adolescents (DAS-A). Participants were 757 high school students (56% girls, ages 15 to 18 years). Adolescents completed the DAS-A, the Social Anxiety Scale for Adolescents (SAS-A), a Dating Questionnaire, and the Revised Beck Depression Inventory-II (BDI-II). Factor analysis of the DAS-A yielded a 3-factor solution with acceptable internal consistencies: fear of negative evaluation in dating situations (FNE-Dating); social distress when interacting with real or potential dating partners (SD-Date); and social distress when in a group of mixed-sex peers (SD-Group). Confirmatory factor analysis confirmed the 3-factor solution. Results indicated that younger adolescents reported more dating anxiety than older adolescents, and boys reported more SD-Group than girls. Dating anxiety was associated with peer-related anxiety and depressive symptoms and was a significant predictor of adolescents' current and usual dating status, even when controlling for adolescents' peer-related social anxiety. The findings provide support for the reliability and validity of the DAS-A. Clinical and research implications are discussed.
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PMID:The Dating Anxiety Scale for Adolescents: scale development and associations with adolescent functioning. 1527 14

Venlafaxine extended release (ER) is a dual serotonin-norepinephrine reuptake inhibitor previously shown to be effective in the treatment of major depressive disorder and generalized anxiety disorder. This placebo-controlled, multicenter, randomized, double-blind trial examined the efficacy and safety of venlafaxine ER in outpatients with generalized social anxiety disorder. Two hundred seventy-two outpatients were randomly assigned to receive either a flexible dose of venlafaxine ER (75 to 225 mg/d) or placebo for 12 weeks. Venlafaxine ER was statistically significantly more effective than placebo as demonstrated by the Liebowitz Social Anxiety Scale total scores at weeks 4 to 12. Scores of both the Clinical Global Impression-Severity and Clinical Global Impression-Improvement scales showed that venlafaxine ER was significantly more effective than placebo at weeks 4 to 12. In addition, more venlafaxine ER-treated patients achieved CGI-Improvement scores of 1 or 2 than placebo-treated patients at weeks 4 to 12, demonstrating a greater percentage of responders to venlafaxine ER treatment. Assessment using the fear/anxiety and avoidance subscales of the Liebowitz Social Anxiety Scale and the Social Phobia Inventory Scale also showed venlafaxine ER to be more effective than placebo at weeks 4 to 12 and 6 to 12, respectively. The Sheehan Disability Inventory showed that patients in the venlafaxine ER-treated group had significantly better outcomes in social life at weeks 4 and 12, and in work at week 12. Adverse events were similar to those reported in studies of venlafaxine ER in depression and generalized anxiety disorder. Venlafaxine ER was safe, well tolerated, and efficacious in the short-term treatment of generalized social anxiety disorder.
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PMID:A double-blind, placebo-controlled study of a flexible dose of venlafaxine ER in adult outpatients with generalized social anxiety disorder. 1534 4

Recognition of social anxiety disorder (social phobia) as a common and disabling condition has led to new advances in its pharmacotherapy. Limitations with selective seroton reuptake inhibitors (side effects) and behavior therapy (scarcity of trained therapists), coupled with the tendency for patients with the disorder to self-medicate with alternative treatments, have led to the interest in Saint John's wort (SJW) (Hypericum perforatum) for this disorder. Although the literature is mixed, SJW has demonstrated efficacy in several double-blind depression trials, and some open-label studies with anxiety disorders. There is pharmacokinetic evidence for the serotonergic, domaminergic, and GABAminergic activity of hypericum, all of which are implicated in social anxiety disorder. This study was designed to generate pilot data to examine the potential efficacy of SJW in generalized social anxiety disorder. Forty subjects were randomized to 12 weeks of treatment with a flexible dose (600-1800 mg) of SJW (n = 20) or placebo (n = 20). Subjects with comorbid depression (clinician HAMD > 16) were excluded. Results found no significant difference between mean change on the Liebowitz Social Anxiety Scale with SJW (11.4) and placebo (13.2), P = 0.27, effect size = -0.09. Post-hoc analyses found larger effects sizes associated with increased baseline severity, omitting patients with variable scores (+/-30%) during the first week, and use of self-report HAMD scores for exclusion. Results of the study fail to provide evidence for the efficacy of SJW in social phobia. The impact of methodologic improvements on signal detection, while suggestive of improvement, remains to be established.
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PMID:St. John's wort versus placebo in social phobia: results from a placebo-controlled pilot study. 1564


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