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Aim: This systematic review is aimed to update and reintegrate the pharmacotherapy of social anxiety disorder (SAD), including the Japanese medical database. Methods: We conducted a systematic review and meta‐analysis of pharmacotherapy of SAD according to the Medical Information Distribution Service. We used data from a most recent systematic review, and updated search were conducted using MEDLINE, PubMed, CENTRAL, ICTRP, and ICHUSHI from August 1st, 2017 to January 31st, 2022. The outcome were response rates assessed by Clinical Global Impressions Improvement, efficacy assessed by the Liebowitz Social Anxiety Scale (LSAS), and dropout rates. We performed a random effect of meta‐analysis to obtain the differences in each outcome between active medication and placebo. We used RevMan version 5.3 for analyses. Results: We identified 5 studies through update search and performed meta‐analysis for 33 studies on selective serotonin reuptake inhibitor (SSRI) and 6 studies on serotonin noradrenalin reuptake inhibitor (SNRI). The response rate (RR = 1.62) and the LSAS score reduction (mean difference = −9.65) of SSRI, and the response rate (RR = 1.57) and the LSAS score reduction (mean difference = −11.72) of SNRI were significantly different from placebo. The dropout rates of SSRI or SNRI were not significant. The response rates of SSRIs in both Japanese studies (RR = 1.44) and countries other than Japan (RR = 1.67) were significant. Most findings were based on low quality of evidence. Conclusion: SSRIs are valid option for pharmacotherapy of SAD including Japanese patients. SNRIs are another effective option. However, the results should be interpreted cautiously due to several risk of bias. [ABSTRACT FROM AUTHOR]

Aim The aim of the current study was to study the psychometric properties of the Japanese version of the Social Phobia Inventory ( SPIN-J) among Japanese subjects with social anxiety disorder ( SAD). Method The sample consisted of 86 subjects with SAD and 86 controls. Diagnosis was based on a modified version of the Structured Clinical Interview for the DSM-IV. In addition to the SPIN-J, clinician-administered and self-rating scales, including the Japanese versions of the Liebowitz Social Anxiety Scale, the Social Phobia Scale, and the Social Interaction Anxiety Scale, were used. Results The SPIN-J showed adequate internal consistency (0.82-0.96) for the total and subscales. Correlations between the SPIN-J and the Liebowitz Social Anxiety Scale, the Social Phobia Scale, and the Social Interaction Anxiety Scale ranged from 0.83 to 0.89 and indicated adequate concurrent validity. A cut-off point of 22 between subjects with SAD and controls showed a sensitivity of 96.5% and specificity of 87.2%, indicating robust discriminant validity. Conclusion The SPIN-J showed adequate reliability and validity for use as a screening tool for social anxiety disorder in Japanese clinical settings. [ABSTRACT FROM AUTHOR]

The article discusses a study which evaluated comorbid social withdrawal or hikikomori in outpatients with social anxiety disorder (SAD). The study enrolled 141 consecutive patients with SAD diagnosed according to DSM-IV criteria by a semi-structured interview and were treated with a combination of psychotherapy, pharmacotherapy and group activity. It found no diagnostic differences between hikikomori and non-hikikomori SAD patients.

Recent studies have revealed the possibility that the offensive subtype of social anxiety disorder (SAD) may no longer be a culture-bound syndrome; however, detailed clinical pictures have never been reported. This study investigated the differences between the offensive and non-offensive subtypes of SAD in terms of the background and axis I and II comorbidity. A total of 139 patients with SAD based on DSM-IV criteria were studied by conducting a semi-structured interview including the Structured Clinical Interview for DSM-IV axis I and II disorders, and the Liebowitz Social Anxiety Scale. Fifty-two (37%) patients were classified with the offensive subtype. There were no significant differences in most demographic variables and axis I lifetime comorbidity between offensive and non-offensive subtype patients. On logistic regression analysis, offensive subtype patients showed a more frequent history of parental physical abuse, higher Liebowitz Social Anxiety Scale scores, and more frequently exhibited obsessive-compulsive personality disorders than non-offensive subtype patients. Yamashita (1977) reported that the majority of offensive subtype patients were doted on by their parents, although current offensive subtype patients are more likely to have had a troubled childhood, show severer forms of SAD, and more frequently exhibit an inflexible personality. This study suggested that the offensive subtype might not be essentially different from the non-offensive subtype (quantitative rather than qualitative). [ABSTRACT FROM AUTHOR]

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. Depression and Anxiety 23:168–174, 2006. © 2006 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Taijin-Kyofusho (TKS) is a Japanese culture-bound syndrome similar to social anxiety disorder. Recent studies have shown antidepressants to be effective in treating TKS. The effects on insight or coping strategies have not, however, been studied. The present study investigated changes in insight and stress coping strategies during treatment with milnacipran. The study was a 12-week open trial in 16 patients with offensive type TKS. Offensive anxiety was assessed by an original TKS scale. Insight regarding TKS symptoms was assessed by the “Insight into obsessions and compulsions” subscale of the Yale-Brown Obsessive Compulsive Scale. Coping strategies were assessed by the Coping Inventory for Stressful Situations. The primary efficacy variable was global improvement on the Clinical Global Impression scale (CGI). Of the sixteen patients, only 10 completed the study and seven patients responded to the drug (a score of 2 or less on CGI at endpoint). Six patients dropped out in the first few days because of nausea. Last observation carried forward analysis ( N =16) showed a significant reduction of offensive anxiety of TKS. Insight and emotional coping strategies were also significantly improved. The results suggested that not only TKS symptoms, but also insight and stress coping, may be improved by treatment with milnacipran. [ABSTRACT FROM AUTHOR]

Abstract: Background: There have been only a limited number of cross-cultural studies of social anxiety disorder (SAD), especially as diagnosed with modern operationalized diagnostic criteria and as measured with recently developed assessment instruments. We examined the symptomatological structure and clinical subtypes of patients with DSM-IV SAD among the Japanese clinical population. Methods: We performed confirmatory and exploratory factor analyses of the joint Social Interaction Anxiety Scale and Social Phobia Scale [Mattick, R.P., Clarke, J.C., 1998. Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behav. Res. Ther. 36, 455–470.] from 149 psychiatric patients diagnosed with SAD. Based on the derived symptom factors, we further ran cluster analysis to identify patient subgroups. Results: Factor analyses revealed three factors which were named “scrutiny fears”, “conversation fears” and “relationship fears”. The first two appeared common to Western clinical populations but the third appeared unique to the Japanese. Cluster analysis based on these three factor scores yielded three subgroups, which were externally validated and which overall corresponded with mild, moderate and pervasive subtypes of social phobia. Limitations: Both factor analysis and cluster analysis employed in the present study are exploratory in nature. Further empirical examination in different settings and cultures is necessary to provide definitive answers. Conclusions: It is suggested that we may need three symptom subscales and three subtypes in order to better account for cultural variations in the presentation of SAD. [Copyright &y& Elsevier]