SOCIAL PHOBIA - LONG-TERM TREATMENT OUTCOME AND PREDICTION OF RESPONSE - A MOCLOBEMIDE STUDY

In this open, prospective, structured, naturalistic study of the effic acy of long-term treatment in social phobia 93 consecutive outpatients suffering from severe generalized or circumscribed social phobia (med ian Liebowitz Social Anxiety Scale score 83) and a high degree of conc omitant psychiatric disease were administered treatment with moclobemi de (712 +/- 75 mg/day at steady state). Fifty-nine patients who respon ded (Clinical Global Impression for Change: very much/much improved) c ompleted 2 years of treatment. Patients then entered a drug-free perio d of at least 1 month during which 88% of the patients deteriorated. I n a further 2-year treatment period with moclobemide those patients wh o had deteriorated became responders again. Symptoms recurred in a sub stantial number of the patients at the end of the study when the dose was reduced and then discontinued. Post-study follow up at 6-24 months after study completion found that 63.2% of patients were almost asymp tomatic or had only mild symptoms, 15.8% were off all treatment, 28.1% were back on moclobemide, 10.6% were taking another psychotropic drug and 8.8% were in psychotherapy. All previous non-responders to moclob emide and mostly alcohol abusers (36.9%), had moderate or severe socia l phobia and were off all treatment (13.3%), on psychotherapy (15.9%) or on another psychotropic drug (8.8%). Discriminant analysis correctl y predicted outcome in 93.5% of all patients. Alcohol abuse was by far the strongest predictor of negative outcome. Coexisting generalized a nxiety disorder and dysthymia were less potent in this regard, whereas high baseline Hamilton anxiety or depression scale scores, circumscri bed social phobia, or social phobia unassociated with avoidant persona lity disorder were predictors of a positive outcome. In conclusion, se vere social phobia can be successfully treated in the long-term but ma ny patients may need medication or psychotherapy for many years. Treat ment should start as early as possible because complications such as a lcohol abuse make treatment difficult.