Assessment
These are the approved guidelines published by the South African Society of Psychiatrists to provide an overview on treatment and management of commonly diagnosed psychiatric illnesses. The guidelines include consensus recommendations, based on peer contribution and using the international evidence based guidelines that are suitable for the local South African health service.
Please note that parts of this guideline may be out of date, an update will be published as soon as it is available.
There are several aspects of the clinical presentation of patients with SAD that may impact on treatment decisions.
First, it is important to assess the level of disability to help distinguish social phobia from shyness.[9]
Second, SAD may be complicated by comorbid major depression, which is usually responsive to first-line therapy options (e.g. selective serotonin reuptake inhibitors (SSRIs) and dual-acting serotonin-norepinephrine reuptake inhibitors (SNRIs)). Conversely, social anxiety symptoms should be excluded in patients presenting with depression, panic attacks restricted to social situations, or alcohol misuse.
Third, in patients with alcohol and substance use disorders it is generally advisable to detoxify first, prior to commencing pharmacotherapy for SAD.
Fourth, in women, pregnancy and lactation considerations may necessitate the use of a non-pharmacological intervention (e.g. cognitive-behavioural therapy) as first-line.
Fifth, the presence of comorbid medical disorders and the prescription of concurrent medications must be borne in mind when using an anti-anxiety agent, particularly in view of the potential for drug-drug interactions and the potential impact of pharmacotherapy for SAD on underlying medical conditions.