European Psychiatry - Volume 33 - March 2016

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24th European Congress of Psychiatry / European Psychiatry 33S (2016) S18–S55 S47
Pharmacological and psychological treatments The findings of
meta-analyses and randomized placebo-controlled treatment
studies indicate that a range of approaches are efficacious in acute
treatment. Pharmacological and psychological treatments, when
delivered singly, have broadly similar efficacy in acute treatment.
However, acute treatment with cognitive therapy (group or indi-
vidual) may be associated with a reduced risk of symptomatic
relapse at follow-up. Cognitive behaviour therapy is efficacious in
adults and children: cognitive therapy appears superior to exposure
therapy, but the evidence for the efficacy of social skills training is
less strong. It is unlikely that the combination of pharmacological
with psychological treatments is associated with greater overall
efficacy than with either treatment, when given alone, as only 1 of
4 studies of the relative efficacy of combination treatment found
evidence for superior efficacy.
Efficacy and length of acute pharmacological treatment Antide-
pressant drugs with proven efficacy include most SSRIs, the SNRI
venlafaxine, the MAOI phenelzine and the RIMA moclobemide: the
potential efficacy of tricyclic antidepressants is unknown. Some
benzodiazepines and anticonvulsants and the antipsychotic olan-
zapine also appear efficacious in acute treatment. Anumber of small
single-dose placebo-controlled crossover studies together suggest
that beta-blockers can be beneficial in reducing anxiety symp-
toms in individuals with ‘performance anxiety’ (for example, when
speaking in public), which overlaps with mild non-generalized
social anxiety disorder. Acute treatment studies indicate that the
proportion of responding patients increases steadily over time. A
post-hoc analysis of the clinical trial database with paroxetine indi-
cates that many non-responders to treatment at 8 weeks become
responders with a further 4 weeks of double-blind treatment:
however a post-hoc analysis of the clinical trial database for esci-
talopram indicates that response is unlikely if there is no onset of
clinical effect within the first 4 weeks of treatment.
Longer-term treatment and further treatment after non-response
The findings of randomized placebo-controlled relapse preven-
tion studies in patients who have responded to previous acute
treatment reveal a significant advantage for staying on active
medication (clonazepam, escitalopram, paroxetine, pregabalin,
sertraline) for up to six months. Fixed-dose randomized controlled
trials do not provide consistent evidence of a dose-response rela-
tionship with antidepressant drugs: but a fixed-dose study of
pregabalin found that only the higher daily dosage was efficacious.
Adouble-blind randomized controlleddosage escalation trial found
no advantage for increasing to a higher daily dosage (of duloxe-
tine), when compared to continuing treatment with a lower dosage.
Switching between treatments with proven efficacy may be help-
ful. An uncontrolled study of augmentation of SSRI treatment with
buspirone found some evidence of beneficial effects; but a placebo-
controlled crossover-study of the augmentation of paroxetine with
pindolol found no evidence of efficacy. A small placebo-controlled
study of the augmentation of paroxetine with clonazepam found
the combination was marginally short of superiority, when com-
pared to paroxetine alone.
Disclosure of interest The author has not supplied his declaration
of competing interest.
Further reading
Baldwin DS, et al. Benzodiazepines: risks and benefits. A reconsid-
eration. J Psychopharmacol 2013;11:967–71.
Baldwin DS, et al. Evidence-based pharmacological treatment of
anxiety disorders, posttraumatic stress disorder and obsessive-
compulsive disorder: a revision of the 2005 guidelines from the
British Association for Psychopharmacology. J Psychopharmacol
2014;28:403–39.
S92
Oxytocin in social anxiety: An
overview
I. Iancu
Tel Aviv University, Tel Aviv, Israel
Oxytocin is a neuropeptide that is synthesized in the hypothala-
mus. It acts as a central neurotransmitter, as well as a peripheral
hormone. It is called also trust hormone or love hormone. Because
of its anxiolytic, pro-social and social cognitive enhancing effects,
oxytocin has been suggested as a promising novel treatment for
patients with social anxiety disorder. However, controlled research
is small and the studies’ results are inconclusive. I will present the
results of several studies with several recommendations about the
role of oxytocin in social anxiety disorder. Whereas oxytocin shows
some promising effects in resistant cases, of course the preferred
agents are SSRIs, SNRIs and CBT.
Disclosure of interest The author has not supplied his declaration
of competing interest.
S93
The relationship between social
anxiety, shyness and blushing
A. Pelissolo∗, A. Moukheiber
AP–HP, Hôpitaux Universitaires Henri-Mondor, Department of
Psychiatry, UPEC, Créteil, France
∗ Corresponding author.
The diagnosis of social anxiety disorder (SAD) has seen substan-
tial changes in the last 35 years from its first appearance in the
DSM-III in 1980 up to the most recent ones in the DSM-5. Through-
out all these changes, this disorder, previously called social phobia,
is still considered one homogenous entity with only one specifier
(“performance only”) introduced in the DSM-5 revision with spe-
cific fears or associated personality profiles not being considered
relevant clinical markers to define SAD subtypes. However, our
therapeutic experience suggested substantial particularities asso-
ciated with the fear of blushing in patients with SAD. Some patients
presenting this profile, historically called “erythrophobia”, seem to
have a very specific type of social anxiety that does not include
shyness and other characteristics of classical SAD. In a study con-
ducted in a sample of 450 new consecutive outpatients seeking
treatment for SAD, we compared 142 subjects with fear of blushing
without other social fears, 97 subjects with fear of blushing with
other associated social fears and 190 SAD subjects without fear of
blushing. The group with pure fear of blushing presented a differ-
ent profile when compared with the two other groups: later age of
onset, less comorbidity, lower behavioral and temperamental inhi-
bition, i.e. less shyness, and higher self-esteem. Furthermore, froma
therapeutic point of view, some specific strategies such as the Task
Concentration Training have shown to be particularly effective in
fear of blushing. We will further argue the validity of a possible
“fear of blushing” subtype of SAD.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.