Social phobia is a mental disorder characterized in the presence of anxiety when faced with a social situation or performance in public. This is one type of phobia disorder. For example, anxiety arises when someone becomes center of attention of others or there is fear to be assessed or behave embarrassing. Anxiety can also cause autonomic symptoms or cognitive symptoms that are similar to panic attacks. Individuals always try to avoid social situations that evoke anxiety or if they survived the situation can be a great tension or panic attacks

Social Phobia quite often found in society. One-year prevalence ranged between 1.7% -7.4percent while the lifetime prevalence of about 13.3%. Onset usually starts in early adolescence and is usually chronic. In the course of their illness, social phobia often related to anxiety and other mood disorder. The first episode of depression is often preceded by a social phobia. In addition, the risk of suffering from other mental disorders is three times more frequently in patients with social phobia compared with control.

There are two subtypes of social phobia that is specific and general (generalized social phobia). Common social phobia is associated with impaired functioning (work and social) and the low quality of life such as education, income and lack of support poor social and marital relationships. Although the psychosocial impact is quite large, the amount of social phobia sufferers who seek treatment is very less when compared with other anxiety disorder or mood disorder (<20%). Quite a few people with social phobia are not recognized and did not receive treatment. Enterprises get the case in the community are often hampered by a psychiatric interview that often only covers a very narrow social situations. Both of the above factors led to the low prevalence of social phobia in the community.

Social Phobia Symptoms

Social phobia symptoms may be a fear of speaking in public or in small groups even though the people are well known, fear of eating in restaurants, writing in public, talking to strangers or new, join social groups, or dealing with someone who has the authority. Social phobia is usually accompanied by low self-esteem and fear of criticism. Complaints can be a shame (red face), hands trembling, nausea, or want to urinate, when dealing with social groups. Patients tend to shy away and in extreme circumstances which may occur total social isolation.

DIAGNOSTIC CRITERIA
The existence of a clear and persistent fear of one or more social situations such as fear appears when one is dealing with strangers or be the center of attention of others or perform in public performance. Individuals are afraid to act or be embarrassing.

social phobia

Exposure to social situations can arouse anxiety or even provoke panic attacks. The individual is aware that their anxiety is excessive and unreasonable. The individual avoid the social situations or when they survived a situation which can cause intense anxiety or suffering (distress).

Avoidance, anxious anticipation, or suffering caused by social or performance situations in public can affect the function of work, academic, social activities, or relationships with others, or there is clearly suffering because of these phobias. When occur in individuals under 18 years, duration of phobia should at least six months. Fear or avoidance is not due to the effects of a substance or general medical condition or not caused by another mental disorder

There are several instruments that can be used to assess social phobia. Most of these instruments used for research while the day-to-day, especially in health centers could be used Social Phobia Inventory (SPIN)

Cause of Social Phobia
There are some factors that cause of social phobia. Some factor involved the process in the body.

ASPECTS OF BIOCHEMISTRY
In normal subjects, usually the concentration of norepinephrine and heart rate increased first few minutes of speaking in public and then returned to normal (maximum 15 minutes). Whereas in patients with social phobia, increased heart rate is much higher and the return to normalcy is also longer. The increased of thyrotrophic releasing hormone (TRH) is also found in patients with social phobia. Giving yohimbine (stimulant) can increase anxiety and also associated with increased plasma MHPG concentration – a metabolite of norepinephrine. Panic attacks on lactate infusion or inhalation of CO2 to the social phobia patients less frequently when compared with patients with panic disorder. Caffeine does not provoke anxiety in patients with social phobia. Pentagastrin can induce panic attacks in social phobia and its incidence is almost equal to that found in patients with panic disorder. From the research data, we can see the similarity between the basic neurobiology of social phobia with panic disorder. There is no difference between social phobia with normal controls regarding urinary cortisol levels and dexamethasone suppression test

SYSTEM dopaminergic
Prefrontal dopamine levels thought to be the main cause of anxiety expression. The enzyme catechol-o-methyltranferase (COMT) accelerated

degradation of dopamine function. COMT gene polymorphism causes the substitution of methionine to valine. Increased activity of the valine allele may increase the metabolism of dopamine and increase the risk anxiety phobia. Therefore, COMT polymorphism is associated with the occurrence of phobia anxiety. Clinical improvement after administration of drugs known as monoamine oxidizes inhibitors (MAOIs) indicates that there is deficiency of dopamine in social phobia. In addition, the provision of an MAOI is also more effective when compared with tricyclics. This suggests that dopamine plays in social phobia. With single photon emission computed tomography (SPECT) visible decrease in the density of dopamine in the striatum. Examination by magnetic resonance spectroscopy showed a decrease in cellular energy activity, neuronal, and membrane function in the basal ganglia. There is also a reduction in the size of the putamen in patients with social phobia (as seen by magnetic resonance imaging). Both of these regions are rich with dopamine.

Serotonin system
The release of serotonin can affect anxiogenic or anxiolytic. It really depends on the region and receptor subtype activated. Most of the anxiogenic effects are mediated by serotonin whereas anxiolytic by stimulation of 5HT. Mice that marred their 5HT receptors show similar behavior anxiety (anxiety-like behaviors). No visible difference in prolactin response to fenfluramin among patients with social phobia with the control.

Treatment of Social Phobia
Medication combined with psychotherapy is better when compared with medication or psychotherapy only. Currently there are three types medication which can be used on the social phobia, RIMA, SSRIs, and benzodiazepines. Moclobemide, drug class of RIMA, is the drug of choice. However, many studies stating that SSRIs (such as citalopram, fluoxetine, paroxetine, fluvoxamine, and sertraline) are also effective.

Benzodiazepines such as alprazolam and clonazepam can also be used for social phobias. Long-term use must be careful because it can lead to tolerance. Relaxation therapy, psychotherapy, and other therapies that could eliminate the causes of social phobia, is much more important. According to research, patient can get better treatment results if drug therapy combined with psychotherapy. One of psychotherapy which is effective for social phobia is Cognitive-Behavioral Therapy (CBT).

 

 

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