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(PSYCHIATRIC TIMES) - A total of 3021 individuals aged 14 to 24 years from a community sample in Munich, participated in the baseline evaluations. The patients had 3 follow-up diagnostic assessments over a 10-year period. It was found that the cumulative incidence of social anxiety disorder was 11%, with the greatest incidence in those aged 10 to 19 years. The cumulative incidence of depression was 27%. There was a strong association between social anxiety disorder and depression (odds ratio, 3.2). The risk of depression was independent of the age at onset of social anxiety disorder. In most cases, social anxiety disorder preceded the development of a depressive disorder.

Risk factors for subsequent depression in patients with social anxiety disorder were having a parent with an anxiety disorder or episodes of major depression, female sex, behavioral inhibition in childhood, and having at least 3 preceding anxiety disorders. This study demonstrated that during the first 3 decades of life, social anxiety disorder is associated with a substantial increase in risk of depression. This calls attention to the morbidity associated with social anxiety disorder and the importance of early treatment of the disorder.

Venlafaxine extended-release (Effexor XR) was recently shown to be effective in the treatment of children and adolescents with social anxiety disorder.2 A total of 293 outpatients aged 8 to 17 years participated in a randomized, double-blind, placebo-controlled trial. The starting venlafaxine dosage was 37.5 mg/d, which could be increased to a maximum dosage of 225 mg/d over the course of the 16-week trial. The mean daily dose of venlafaxine was 142 mg.

There was statistically significant superiority of venlafaxine over placebo in reduction of symptoms of social anxiety disorder. Response rates (defined as much or very much improved) were 56% in the venlafaxine-treated subjects and 37% in the placebo group. Treatment-emergent ad- verse events that occurred in at least 2% of participants and were at least twice the rate seen in the placebo group with a statistically significant difference between venlafaxine and placebo were asthenia (20%), anorexia (22%), nausea (23%), weight loss (11%), abnormal behavior (4%), pharyngitis (19%), and mydriasis (4%).

There were no suicides or suicide attempts during the trial. There were 3 cases of suicidal ideation in the venlafaxine group and none in the placebo group. The investigators concluded that venlafaxine is an effective and reasonably well-tolerated treatment for children and adolescents with social anxiety disorder.
Posttraumatic stress

Two recent studies have addressed the timely issue of treatment for posttraumatic stress disorder (PTSD) in children and adolescents. In one, the efficacy of individual trauma-focused cognitive-behavioral therapy (CBT) for PTSD in children and adolescents was evaluated.3 All participants with PTSD were to complete 4 weeks of symptom monitoring, with minimal telephone contact by the therapist, before being randomized to a treatment group. Participants met criteria for PTSD and had experienced a single-incident traumatic event (eg, witnessing violence or experiencinginterpersonal violence or a motor vehicle accident). The initial sample consisted of 38 participants. At the end of the 4-week monitoring period, 24% of the participants no longer met criteria for PTSD.

Twenty-four youths were then randomized to either CBT or a waiting list control. The CBT was manual-based and administered individually to participants in 10 weekly sessions. Some of the treatment components included psychoeducation, imaginal reliving, activities for scheduling and reclaiming life, cognitive restructuring, revisiting the site of the trauma, stimulus discrimination regarding traumatic reminders, work with nightmares, and work with parents.

It was found that the youths who received CBT had significantly greater improvement than the waiting list group in symptoms of PTSD, depression, and anxiety. Following CBT, 92% of the youths no longer met criteria for PTSD, compared with 42% of the youths in the waiting list group. At 6-month follow-up, treatment gains made during CBT were maintained. The authors reported that the effect of CBT was to change maladaptive appraisals about the trauma and its sequelae. It is noteworthy that although this CBT treatment is trauma-focused and discusses very traumatic events, no patients had worsening of PTSD symptoms.

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