Professor Stuart Montgomery, internationally renowned speaker and psychiatrist was the guest speaker at a function hosted by Roche Pharmaceutical Company, manufacturers of Aurorix. Prof. Montgomery, recognised as a world expert on the anxiety disorder Social Phobia, has authored over twelve books on the subject and is in touch with the latest progress and research in the field. Originally born and schooled in Bulawayo, Prof. Montgomery chose to study medicine in Britain.
Prof. Montgomery began his talk with a brief history surrounding social phobia. The disorder was only ‘discovered’ thirty years ago by Isaac Marks, and it has been a relatively neglected disorder in the psychiatric field. Until recently, there has been little research on it. It is now rated as one of the most common mental disorders with a prevalence of up to 16% in the general population.
Prof. Montgomery stressed that the core of social phobia is a marked ‘fear of scrutiny’. He said that this is by far the most important feature of the disorder, and allows the doctor to distinguish between this disorder and other phobic disorders. It is important that the doctor ascertains exactly why the patient avoids certain social contact. For example, does the patient fear social contact because they fear being scrutinised (social phobia), because they fear panic attacks in crowds or small spaces (agoraphobia / claustrophobia), or because they fear being contaminated by other people (a form of Obsessive Compulsive Disorder). It is also important to distinguish between social phobia and shyness – shy patients will feel uncomfortable in social situations at the beginning, but this feeling will pass with time, whereas the social phobic will experience marked distress throughout the event.
Prof. Montgomery further distinguished between discrete social phobia and diffuse social phobia. Discrete social phobia occurs when a sufferer only avoids/fears certain situations, whereas a diffuse social phobic will be fearful of a range of situations.
The lack of awareness and ignorance about social phobia results in many health professionals not recognising the disorder when it is presented to them. Social phobics are experts at masking their symptoms. They have obvious difficulty disclosing to health professionals and develop alternative coping strategies. A further complication is the high comorbidity linked to social phobia – 19% of social phobics also suffer with agoraphobia, 19% with alcohol abuse, 17% with depression, 17% with drug-related problems and a high percentage with simple phobias. Research has shown that alcohol abuse can often begin 5 to 7 years after the onset of social phobia. Social phobics ‘self-medicate’ with alcohol in an attempt to decrease their anxiety. As a result of this misdiagnosis and lack of awareness for the disorder, social phobics receive bad target treatment from the medical sector. They consume high resources and funding for insufficient treatment.
Social phobia has an early age on onset – in most cases the disorder develops in the sufferers teenage years. New cases of social phobia are not usually seen in patients over the age of 35. This early onset has a number of serious reprecussions – most social phobics do not acquire important life skills nor do they mature adequately in their formative years. As a result, they often are single and socially isolated with low education levels, financial problems and bad coping skills. They often develop other anxiety disorders, abuse drugs and alcohol and are a high-risk group for suicide. Studies have shown that the more comorbidity disorders a social phobic has, the higher their risk is for committing suicide.
As in all anxiety disorders, research has shown that the most effective form of treatment for social phobia is a combination of psychotherapy and medication. Psychotherapy should focus on eliminating negative thoughts and beliefs. Psychotherapy is more effective for the patient if they are motivated. Group therapy has also been proven to be very beneficial for social phobics. On the medication side, betablockers can be prescribed to remove tremors but, according to Prof. Montgomery, two of the most effective drugs to combat social phobia are phenelzine and moclobemide. The recommended dosage of Aurorix goes up to between 600 – 900 mg.
Prof. Montgomery explained that research has proven that drug treatment can sometimes result in side effects such as headaches, dizziness, nausea and sleep problems. An interesting study showed that even those social phobic patients that were on the placebo treatment (sugarcoated pill) complained about these symptoms. Thus, as the condition itself gives rise to these kind of complaints, it is imperative that the health professional concerned warns the patient about possible side effects. After three months the patient should be having a good response to the drug. After 12 months, the patient can attempt to discontinue treatment. If the condition returns a second time, the patient should go back onto the drug treatment for another year. Prof. Montgomery stressed that if the condition should return a third time, it is strongly recommended that the patient stay on medication for life.
Prof. Montgomery said there was very little research in the field involving the use of drugs for children or adolescents displaying social phobic features, but felt that it would be inappropriate to use these drugs on children since their bodies are still in the process of developing and maturing. However, saw nothing wrong with this type of treatment for adolescents.