An open trial of paroxetine for the “offensive subtype” oftaijin kyofusho and social anxiety disorder

Abstract

The taijin kyofusho (TKS) offensive subtype is thought to be a culture-bound syndrome similar to social anxiety disorder (SAD). In Western countries, such patients would be diagnosed as having delusional disorder, somatic subtype, or body dysmorphic disorder. Recently, open trials for the TKS offensive subtype and a randomized controlled trial for body dysmorphic disorder demonstrated that selective serotonin reuptake inhibitors (SSRIs) might be as effective in TKS as in SAD. This study investigated the efficacy of the SSRI paroxetine in patients with the TKS offensive subtype, both on anxiety and fears, as well as insight. This study was a 12-week open trial using paroxetine in 22 patients with TKS. Subjects were diagnosed based on the original diagnostic criteria for the TKS offensive subtype. Insight regarding TKS symptoms was assessed by the 11th supplement subscale "Insight into obsessions and compulsions" of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). The Liebowitz Social Anxiety Scale (LSAS), the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), Rosenberg's Self-Esteem Scale, and the Interpersonal Distrust subscale of the Eating Disorder Inventory were also administered. Offensive anxiety was assessed by the original TKS offensive anxiety subscale (0-3 points). The primary efficacy variable was the Clinical Global Impression scale (CGI) global improvement item. Nineteen patients completed the study. Forty-seven percent (9/19) were responders to the drug treatment (scoring 2 or less on the CGI). Last observation carried forward (LOCF) analysis (N=22) demonstrated a statistically significant reduction in LSAS total score and offensive anxiety in TKS, and the insight scale score of the Y-BOCS also significantly improved. Interpersonal distrust showed a trend toward improvement.

Culture and the Anxiety Disorders: Recommendations for DSM-V

“…[84,86] Similar to most clinical studies of SAD, [80] more males than females-about 3:2 ratio-present with TKS in Japanese clinical settings. [84] In addition, TKS appears to respond well to an SSRI [85,87] or an SNRI. [88] The relationship between SAD and the offensive subtype of TKS has been examined in several studies.…”

Social Anxiety/Taijin-Kyofu Scale (SATS): Development and Psychometric Evaluation of a New Instrument

“…A chart review of 48 patients with c-TK reported a 48% response rate to treatment with clomipramine or fluvoxamine [26]; an open-label trial reported that 6 of 11 patients diagnosed with c-TK responded to milnacipran [27], and a recent open-label trial reported that 41% of 19 patients diagnosed with c-TK responded to paroxetine [28]. These preliminary SSRIs and SNRI studies only used the CGI-Global Improvement Scale and/or the Taijin-Kyofu-Sho offensive anxiety scale (0-3 points), the validity of which was not examined systematically for the evaluation of c-TK symptoms.…”

“…There are reports on the efficacy of SSRIs and SNRI for BDD and the delusional variant of BDD (delusional disorder, somatic type) [22,23,24,25]. In addition, preliminary studies [12,26,27,28] suggest that SSRIs and SNRI may be effective for the treatment of c-TK. Given the suggestion of consistent pharmacologic responsiveness for SAD, BDD, and c-TK, it may be worth expanding the current DSM diagnostic criteria for SAD to incorporate symptoms of c-TK.…”

Cross-Cultural Study of Conviction Subtype Taijin Kyofu

“…Alternatively, the diagnostic criteria for psychotic disorders and/or body dysmorphic disorder in the DSM-IV could be modified to diagnose such patients with high reliability. Nevertheless, there are some case reports and case series reports that suggest that selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are more effective for conviction subtype TK than antipsychotics (Clarvit et al, 1996;Matsunaga et al, 2001;Nagata et al, 2003;Nagata et al, 2006;Nagata et al, 2005). Our own experiences with six cases of offensive subtype SAD also suggest that they respond to the CBT program as well as those without offensive fears (Chen et al, submitted, Group cognitive-behavior therapy for Japanese patients with social anxiety disorder: Outcomes and their predictors).…”

“…It is possible that many clinicians in the West are diagnosing patients with conviction subtype TK as conditions other than SAD, including delusional disorder, body dysmorphic disorder or paranoid disorder, since the diagnostic criteria for SAD in DSM-IV and ICD-10 do not fully cover conviction subtype TK (Kasahara, 2005;Lochner et al, 2003;TanakaMatsumi, 1979). Importantly, there are some single case reports and case series reports that suggest that selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are more effective for conviction subtype TK than antipsychotics (Clarvit et al, 1996;Matsunaga et al, 2001;Nagata et al, 2003;Nagata et al, 2006;Nagata et al, 2005).…”