PHARMACOTHERAPY OF SOCIAL PHOBIA

社交恐惧症是一种高度普遍、致残的慢性焦虑症，与成人和儿童的职业、社交和学业障碍有关。它增加了抑郁、药物滥用和经济依赖的风险。然而，与其他焦虑症相比，社交恐惧症受到的关注较少，而且这种疾病也有普遍接受的治疗方法。然而，特定的社会心理和精神药理学治疗已证明有效。由海姆伯格开发的认知行为团体疗法（CBGT）已被证明优于对照疗法，而由利博维茨首先研究的MAOI苯肼已被证明在几项对照试验中优于安慰剂。海姆伯格和利博维茨共同比较了苯肼、CBGT、药丸安慰剂和一种可靠的心理社会控制治疗，发现苯肼和CBGT在各种措施上都更优越，并且具有明显的临床效益，这一新颖而非常成功的合作已成为该领域的典范。苯肼在某些方面比CBGT更有效，而CBGT在停药后更持久。虽然苯乙胺和CBGT产生了积极的效果，但许多患者，特别是广泛性社交恐惧症患者，没有充分的反应。停药后也有明显的复发。因此，仍然需要一种比这两种治疗方法更有效、更持久的治疗方法来治疗社交恐惧症。重要的是，MAOI和CBGT的组合从未被评估过。由于许多原因，联合治疗可能比单独治疗更有效，比单独用药更持久，对广泛性社交恐惧症患者尤其有效。如果是这样，苯乙嗪/CBGT联合治疗将对许多目前临床需求未得到很好满足的患者有明显的益处。为了解决严重的疗效问题，Liebowitz和Heimberg得到资助，在为期12周的社交恐惧症试验中比较CBGT， phenelzine，这两种治疗方法的组合，以及安慰剂。该试验正在进行中。通过独立的盲评人访谈、自我报告问卷和标准化行为测试来评估结果。亚型和治疗地点对结果的影响也正在研究中。迄今为止，已有相当数量的患者入组，联合治疗似乎比单独给药苯乙嗪或CBGT更有效。然而，需要两年的额外研究结果才能完成研究登记。这项研究完成后，将大大提高我们对社交恐惧症有效治疗方法的认识。

Social Phobia is a highly prevalent, disabling, and chronic anxiety disorder associated with substantial vocational, social, and academic impairment in adults as well as children. It increases the risk of depression, substance abuse and financial dependence. Nevertheless, social phobia has received less attention than other anxiety disorders, and there are universally accepted treatments for this condition. However, specific psychosocial and psychopharmacological treatments have demonstrated efficacy. Cognitive Behavioral Group Therapy (CBGT), developed by Heimberg, has proven superior to control therapies, while the MAOI phenelzine, first studied by Liebowitz, has proven superior to placebo in several controlled trials. In a novel and highly successful collaboration that has become a model in the field, Heimberg and Liebowitz together compared phenelzine, CBGT, pill placebo, and a credible psychosocial control treatment, and found phenelzine and CBGT, superior on a variety of measures and of distinct clinical benefit. Phenelzine was faster active and more effective than CBGT on some measures, while CBGT was more durable following treatment discontinuation. While phenelzine and CBGT produced positive effects, a number of patients, especially among generalized social phobics, did not respond sufficiently. There was also significant relapse following phenelzine discontinuation. Therefore, there is still a need for treatments for social phobia that are more effective and more durable than these two treatments as typically administered. Importantly, the combination of an MAOI and CBGT has never been evaluated. For many reasons, the combination treatment may be more effective than either individual therapy, more durable than medication alone, and especially effective for patients with generalized social phobia. If so, combined phenelzine/CBGT treatment would be of distinct benefit to many patients whose clinical needs are currently not well met. To address the acute efficacy issues, Liebowitz and Heimberg were funded to compare CBGT, phenelzine, the combination of these two treatments, and pill placebo in a 12-week trial of social phobia, and this trial is now underway. Outcome is evaluated by blind independent assessor interviews, self-report questionnaires, and standardized behavioral tests. The contributions of subtype and treatment site to outcome are also being examined. To date, a substantial number of patients have been enrolled, and combined treatment does appear to be more efficacious than either phenelzine or CBGT administered individually. However, two years of additional findings are being requested to complete study enrollment. When completed, this study should substantially enhance our knowledge of effective treatments for social phobia.