Social phobia: diagnosis and treatment of social phobia - NICE project

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Social phobia: diagnosis and treatment of social phobia - NICE projectApril 16 2011 at 10:34 PM

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http://guidance.nice.org.uk/CG/Wave24/1

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Shy at parties? NHS considers treatment to save your blushes

April 16 2011, 10:35 PM

Shy at parties? NHS considers treatment to save your blushes

The NHS is considering whether shy people should be offered drugs or even surgery to stop their blushes.

Photo: ALAMY

By Donnelly, Health Correspondent 9:00PM BST 16 Apr 2011 1 Comment

It is a familiar problem a crowded party, a group of strangers, and increasing levels of anxiety as the small talk dries up.

But for those who suffer from blushes and shyness, help could soon be at hand. The NHS is considering offering drugs or even surgery to treat such conditions.

Rationing body the National Institute of Health and Clinical Excellence (NICE) is drawing up plans to treat the millions of people it claims suffer from "social anxiety disorder" leaving them struggling to make conversation at parties, or dreading making speeches.

NICE says that one in eight people suffer from the disorder, and is considering whether the health service should routinely fund therapy, treatment with pills such as antidepressants or even surgery to prevent blushing.

But the body stands accused of attempting to "medicalise" basic human characteristics, and pouring money into the pockets of drug companies, regardless of the bill for taxpayers.

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Plans drawn up by NICE say that around 12 per cent of the population suffers from "social anxiety disorder" at some point in their life around half of whom seek treatment.

Its draft proposals, which set out the treatments under consideration, say the "generalised" version of the anxiety leaves sufferers fearful in many social situations, such as meeting new people, talking to authority figures, parties and "performance situations", such as making speeches.

NICE will also examine treatments for those whose nerves are largely confined to public speaking, the paper says.

Dr Joanna Moncrieff, a consultant psychiatrist and senior lecturer at University College London, said she was "extremely concerned" that so many common fears were being treated as symptoms of medical disorders.

She said: "It worries me that NICE is defining these categories so broadly.

"Some people will find parties and public speaking more difficult than others, but I think it can be extremely damaging to label them with a medical disorder that needs treatment; effectively that is telling people that they can't deal with things themselves."

The psychiatrist said the concept of social anxiety disorder had "barely existed" until a decade or so ago, when the pharmaceutical industry began heavily promoting it in the United States.

The rationing body will examine the effectiveness of treatments including psychotherapy, counselling and antidepressant drugs, as well as surgical interventions, including surgery for facial blushing and the beauty treatment Botox which involves injections of the poison botulinum toxin A under the arms, to prevent sweating.

Currently, around 200 patients a year who suffer from excessive blushing or sweating are given keyhole surgery, via incisions under the armpits, to break the nerve chain which supplies the sweat glands to the face, armpits and hands.

Some NHS Primary Care Trusts also fund the use of regular Botox underarm injections to reduce sweating, though most do not.

Dr Louise Foxcroft, a medical historian, and author of Hot Flushes, Cold Science, said medicine had gone too far in attempting to categorise normal behaviours and responses as symptoms of disease.

She said: "You have to question the role of the pharmaceutical industry and the influence they hold over the medicalisation of so many behaviours and emotions which are common to most of us. This is big business."

The historian likened current trends to those in n times, when increasing numbers of women were diagnosed as suffering from "moral insanity" or "hysteria" and given treatments ranging from opium to incarceration.

Dr Foxcroft said: "The language used is extremely important, instead of seeing shyness at parties and fear of public speaking as common responses to social situations, here it becomes a 'disorder'.

"Telling people they have got a medical problem that needs treatment means often people will feel both stigmatised by that diagnosis, and then reliant on the drugs they are given."

But Dr Tim Kendall, consultant psychiatrist from Sheffield Health and Social Care trust, and director of the National Collaborating Centre for Mental Health said: "For people who suffer from serious anxiety disorder it can ruin their life this isn't about common shyness, this is about a level of anxiety that can prevent people from establishing relationships and put their livelihood at risk.

"In these kinds of cases, it is really important to get the right help, whether that is cognitive and behavioural therapy, or any other treatment."

However, he questioned whether one in eight people should end up receiving treatment.

"What is really important is what criteria end up being used to define this kind of disorder if the criteria is too broad it would end up encompassing an awful lot of people," he said.

NICE said its assertion that one in eight people suffers from social anxiety disorder was based on US research published in 2005. The draft recommendations on treatment will be published next year.

http://www.telegraph.co.uk/health/healthnews/8455624/Shy-at-parties-NHS-considers-treatment-to-save-your-blushes.html

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Anonymous

Stakeholder list:

April 16 2011, 10:39 PM

Stakeholder list:

http://guidance.nice.org.uk/CG/Wave24/1/SHRegistration/SHList/pdf/English

1. Alder Hey Children's NHS Foundation Trust

2. Anxiety UK

3. Association for Cognitive Analytic (ACAT) Therapy

4. Association For Family Therapy and Systemic Practice in the UK (AFT)

5. Association for Rational Emotive Behaviour Therapy

6. Association for the advancement of meridian energy techniques (AAMET)

7. Association of Psychoanalytic Psychotherapy in the NHS

8. BMJ

9. Bolton Council

10. Bradford District Care Trust

11. British Association for Counselling and Psychotherapy

12. British Association for Psychopharmacology

13. British Medical Association (BMA)

14. British National Formulary (BNF)

15. British Psychodrama Association

16. British Psychological Society, The

17. Care Quality Commission (CQC)

18. CCBT Ltd

19. Cerebra

20. Citizens Commission on Human Rights

21. Cochrane Depression, Anxiety & Neurosis Group

22. College of Mental Health Pharmacy

Social anxiety disorder: Stakeholder list 2 of 5

23. College of Occupational Therapists

24. Commissioning Support for London

25. Connecting for Health

26. Critical Psychiatry Network

27. Department for Communities and Local Government

28. Department of Health

29. Department of Health Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI)

30. Department of Health, Social Services & Public Safety, Northern Ireland (DHSSPSNI)

31. Faculty of Occupational Medicine

32. Greater Manchester West Mental Health NHS Foundation Trust

33. Hertfordshire Partnership NHS Trust

34. Humber NHS Foundation Trust

35. Institute of Psychiatry

36. Kent & Medway NHS and Social Care Partnership Trust

37. Lambeth Community Health

38. Lancashire Care NHS Foundation Trust

39. Liverpool Community Health

40. Lundbeck Ltd

41. Medicines and Healthcare Products Regulatory Agency (MHRA)

42. Mental Heath and Vascular Wellbeing Service

43. MIND

44. Ministry of Defence (MoD)

45. National CAMHS Support Service

46. National Patient Safety Agency (NPSA)

Social anxiety disorder: Stakeholder list 3 of 5

47. National Treatment Agency for Substance Misuse

48. NEt (North East Together)

49. NETSCC, Health Technology Assessment

50. NHS Bath and North East Somerset

51. NHS Buckinghamshire

52. NHS Clinical Knowledge Summaries Service (SCHIN)

53. NHS Direct

54. NHS Milton Keynes

55. NHS Plus

56. NHS Quality Improvement Scotland

57. NHS Sheffield

58. NHS Western Cheshire

59. Northumberland, Tyne & Wear NHS Foundation Trust

60. Nottinghamshire Healthcare NHS Trust

61. OCD - UK

62. PERIGON Healthcare Ltd

63. Pfizer Limited

64. Public Health Wales

65. Rotherham NHS Foundation Trust

66. Royal College of Anaesthetists

67. Royal College of General Practitioners

68. Royal College of General Practitioners Wales

69. Royal College of Midwives

70. Royal College of Nursing

71. Royal College of Obstetricians and Gynaecologists

Social anxiety disorder: Stakeholder list 4 of 5

72. Royal College of Paediatrics and Child Health

73. Royal College of Pathologists

74. Royal College of Physicians London

75. Royal College of Psychiatrists

76. Royal College of Radiologists

77. Royal College of Surgeons of England

78. Royal Pharmaceutical Society of Great Britain

79. Royal Society of Medicine

80. Scarborough and North Yorkshire Healthcare NHS Trust

81. ish Intercollegiate Guidelines Network (SIGN)

82. Sensory Integration Network

83. Sheffield Health and Social Care Foundation Trust

84. Social Care Institute for Excellence (SCIE)

85. Social Exclusion Task Force

86. Solent Healthcare

87. South Essex Partnership NHS Foundation Trust

88. Sussex Partnership NHS Foundation Trust

89. Tees Esk & Wear Valleys NHS Trust

90. University of Edinburgh

91. Welsh Assembly Government

92. Welsh Scientific Advisory Committee (WSAC)

93. West London Mental Health NHS Trust

94. Western Health and Social Care Trust

95. Whitstone Head Educational (Charitable) Trust Ltd

96. Worcestershire PCT

Social anxiety disorder: Stakeholder list 5 of 5

97. York Teaching Hospital NHS Foundation Trust

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Anonymous

scoping workshop notes .... 6 to 8 year olds !!!!

April 16 2011, 10:43 PM

http://www.nice.org.uk/nicemedia/live/12950/53739/53739.pdf

extract -

Scope - Are we on the right track? Have we struck an appropriate balance

between the need to keep the scope manageable and covering the most

important clinical issues?

Group A

The group was concerned about the age limit of the population that the guideline

will cover (4.1.1 b in the scope) and perhaps there is a need to look at

interventions earlier than from 8 years old. It was suggested that children aged 6

and over could be looked at to address any school phobia issues and lessen the

burden of disability and subsequent learning disabilities etc.

The group felt that BME groups (especially women) should be added as a

subgroup to the population being looked at in the guideline.

It was also suggested that the following evidence could be looked at:

Publics perception/ stigma of social anxiety disorder (SAD) [particularly childrens literature/ educational settings]

International literature

Group B

The group felt that the remit should be changed to include recognition i.e.

To produce a clinical guideline on the recognition, diagnosis and treatment of social anxiety disorder.

The group looked at the Epidemiology section of the scope (3.1) and thought

the following points need to be added:

Negative effects of social networking e.g. bullying on Facebook

Potential of the internet for treatment e.g. positive effects of support groups

and self help (but awareness that this can also lead to avoidance of seeking

necessary help)

Computer therapy effective for those that do not like being part of a group

Comorbidities SAD can occur alongside schizophrenia and other psychotic

illnesses

Adults and adolescents with SAD are drawn to drugs and alcohol as a form

of self medication. Psychological treatments can be effective for those

involved in substance misuse. It was suggested that the alcohol dependence

guideline could be looked at to see if there are treatment recommendations

for service users with SAD

Genetic factors e.g. the likelihood of identical twins both having SAD.

With regards to the Current practice section in the scope (3.2), the group stated

that the following points should also be addressed:

Early diagnosis (possibly at school)

Renowned pessimism regarding treatment outcomes (drug company

pressures to raise awareness)

Stigma of the disorder