Recent developments in the psychopharmacology of social phobia

Semax, an ACTH(4-10) analogue with nootropic properties, activates dopaminergic and serotoninergic brain systems in rodents

Corticotrophin (ACTH) and its analogues, particularly Semax (Met-Glu-His-Phe-Pro-Gly-Pro), demonstrate nootropic activity. Close functional and anatomical links have been established between melanocortinergic and monoaminergic brain systems. The aim of present work was to investigate the effects of Semax on neurochemical parameters of dopaminergic- and serotonergic systems in rodents. The tissue content of 5-hydroxyindoleacetic acid (5-HIAA) in the striatum was significantly increased (+25%) 2 h after Semax administration. The extracellular striatal level of 5-HIAA gradually increased up to 180% within 1-4 h after Semax (0.15 mg/kg, ip) administration. This peptide alone failed to alter the tissue and extracellular concentrations of dopamine and its metabolites. Semax injected 20 min prior D: -amphetamine dramatically enhanced the effects of the latter on the extracellular level of dopamine and on the locomotor activity of animals. Our results reveal the positive modulatory effect of Semax on the striatal serotonergic system and the ability of Semax to enhance both the striatal release of dopamine and locomotor behavior elicited by D-amphetamine.

Anxiety and depressive disorders in college youth

Fear and anxiety are common experiences throughout childhood and adolescence. Anxiety disorders, along with depression and dysthymia, are characterized as internalizing disorders; they stand in distinction from the externalizing disorders representing such conditions as oppositional-defiant disorder and conduct disorder. Clinicians evaluating anxiety disorders in college youth face the task of differentiating normal, transient, developmentally appropriate expression of anxiety from pathologic states of anxiety. The developmental course of anxiety and depression, its appropriateness, and its boundaries are areas of research and interest. A wide clinical perspective is necessary to effectively engage the assessment process. The treatment of anxiety and depression in youth is ideally multi-modal, involving medication, psychotherapy, and psychosocial interventions. This article focuses on assessment and treatment of anxiety and depression. These are presented separately, although areas of overlap often are encountered in practice.

Pharmacological treatment of social anxiety disorder: a meta-analysis

Placebo-controlled trials have evaluated the efficacy of several medications in the treatment of social anxiety disorder but information regarding their relative efficacy is lacking. We compared the efficacy of medications systematically studied for the treatment of social anxiety disorder using meta-analytic techniques. The methodology included a database search of articles published between January 1980 and June 2001 and manual searches of bibliographies in published manuscripts. Trials were included if they reported outcome data on the Liebowitz Social Anxiety Scale (LSAS) or a categorical measure of responder status. Data were extracted independently by two authors. The Q statistic was used to assess homogeneity across trials. All analyses were conducted using intent-to-treat data. There was substantial heterogeneity across trials. The medications with largest effect sizes were phenelzine [effect size, 1.02; 95% Confidence Interval (CI), 0.52-1.52], clonazepam (effect size, 0.97; 95% CI, 0.49-1.45), gabapentin (effect size, 0.78; 95% CI, 0.29-1.27), brofaromine (effect size, 0.66; 95% CI, 0.38-0.94), and the selective serotonin reuptake inhibitors (SSRIs; effect size, 0.65; 95% CI, 0.50-0.81). There were no statistically significant differences between medications or medication groups. However, formal methods of interim monitoring adapted for meta-analyses suggested strongest evidence of efficacy for SSRIs and brofaromine. Several medications are efficacious for the treatment of social anxiety disorder. The stability of the SSRI effect size estimate in conjunction with other evidence for safety and tolerability and their ability to treat comorbid conditions supports the use of SSRIs as the first-line treatment. Direct comparisons of SSRIs vs. other promising medications deserve consideration.

Therapeutic strategies for patients with social phobia

Social phobia is a serious condition in the range of anxiety disorders which, until quite recently, has not been given due attention in research. In this paper we compare existing studies and follow-up results of behaviour therapy and pharmacotherapy. We have endeavoured to work out an effective therapy for this serious condition. Apart from psychological education as a basic therapeutic element, the use of effective drugs promises to yield good results, especially in conjunction with behaviour therapy, including training in social skills, cognitive therapy and exposure therapy. Whichever form of treatment is chosen depends on the patient's preference and the availability of services. If the patient does not respond, the possible causes should be examined thoroughly and new types of treatment considered. A combination of behaviour and drug treatments might be provided for special groups.