Both obsessive-compulsive disorder (OCD) and social phobia are common in community and clinical settings, and it should be expected that a proportion of patients with one of these conditions will also fulfill either current or lifetime criteria for the other condition. However, comorbid social phobia is more common among patients with a primary diagnosis of OCD than is comorbid OCD in patients with a primary diagnosis of social phobia. This article explores the extent of the association of OCD and social phobia in epidemiological studies, and examines the possible role of underlying depression and other disorders in mediating the appearance of the comorbid condition. Although there have been no published randomized controlled trials in patients with this particular pattern of co-morbidity, it seems sensible to adopt pharmacologic and psychologic treatment approaches which have been found efficacious in both OCD and social phobia. Pharmacologic management therefore centers on first-line treatment with a selective serotonin reuptake inhibitor. Psychologic intervention should draw on the range of cognitive and behavioral approaches required for optimal outcomes in OCD and social phobia, as discrete conditions.
Anxiety symptoms and disorders are common in community settings, and in primary and secondary care. Symptoms can be mild and transient, but many people are troubled by severe symptoms that cause great personal distress, and which impair social and occupational function. The societal burden associated with anxiety disorders is considerable, but many who might benefit from treatment are not recognized or treated by healthcare professionals. By contrast, some patients receive unnecessary or inappropriate treatment. Recognition relies on keen awareness of the psychological and physical symptoms seen in all anxiety disorders, and accurate diagnosis rests on the identification of the specific features of particular disorders. The need for treatment is determined by the severity and persistence of symptoms, the level of associated disability and impact on everyday life, the presence of co-existing depressive symptoms, and other features such as a good response to or poor tolerability of previous treatment approaches. Choice of treatment is influenced by patient characteristics, patient and doctor preferences, and the local availability of potential interventions. There is much overlap between the different anxiety disorders for evidence-based and effective therapies (such as the prescription of a selective serotonin reuptake inhibitor or a course of individual cognitiveebehavioural therapy) but there are also important differences, so it helps to become familiar with the characteristic features and evidence base for each disorder.
Intoxication and withdrawal syndromes are common presentations in acute medicine. A comprehensive history, including a collateral one, and thorough examination looking for patterns of signs and symptoms, backed by appropriate investigations, forms the basis of good management. A collaborative, empathic and non-judgemental approach that recognizes the patient's distress, explains the goals of management and sets clear boundaries significantly reduces potential complications and improves outcomes. An understanding of the pharmacology and clinical effects of alcohol, benzodiazepines, opioids and stimulants is essential to accurately diagnose and manage patients who may not be able to give an accurate history.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.