Psychiatry

Answer 2 Evaluate for social phobia. By asking a few brief questions, the physician can determine whether a patient meets the DSM-IV criteria for social phobia. These criteria are: (1) persistent fear of social situations in which the person is exposed to unfamiliar people which includes a specific fear of humiliation or embarrassment; (2) exposure to the situation almost invariably provokes anxiety; (3) the fear is recognized as unreasonable; (4) the feared situations are avoided or endured with intense distress; and (5) the symptoms result in impairment and/or marked distress.1 Social phobia is common among those with substance abuse disorders. A recent study of patients receiving substance abuse treatment found that social phobia was the second most common comorbid psychiatric diagnosis, occurring in 31% of subjects.2 A psychiatric referral is not necessary to evaluate social phobia, and the remaining answers are not appropriate in this clinical scenario. REFERENCE 2. Adamson SJ, Todd FC, Sellman JD, et al. Coexisting psychiatric disorders in a New Zealand outpatient alcohol and other drug clinical population. Aust N Z J Psychiatry 2006;40:164-70. Click here to return to the questions

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