Salin-Pascual RJ, Fuentes-Romero N, Arroyo-Guzmán A

Language: Spanish
References: 23
Page: 12-19
PDF size: 178.19 Kb.

ABSTRACT

Social anxiety (SA), is one of the top anxiety disorders, with highest prevalence worldwide. Main treatments is focus on Serotonin Selective Recapture Inhibitors (SSRIs), like escitalopram. The other nonpharmacological strategy is graduated exposure to a series of particular tasks that the patient avoids, for fear of being ridiculized. That estrategy is part of cognitive behavioral therapy. Treatment with SSRIs, although decreases anticipatory anxiety, does not favor that patients could be exposed to some scheduled tasks. Methylphenidate is a drug that is used commercially in attention deficit disorder, and has increased dopaminergic tone, specially in some reward regions of the brain. The main objetive of this open study was to figure out if the reward stimulation of methylphenidate could improve the exposure to SA patientes to social activities that otherwise they avoided at all. In this study two groups SA of patients were evaluated. Both of them were administered escitalopram 10 mg/daily, and in one group the combination of escitalopram 10 mg/day and methylphenidate (20mg/day - 10 mg Early in the morning and 10 mg before lunch). Change were evaluated on both Lebowitz social anxiety scale and Hamilton anxiety scale, at baseline and 8 weeks later. Each patient was followed along four consultations, two weeks apart and were asked to complete a series of tasks exposure related of the things that they avoided. The study was open, and nonparametric statistics was applied to evaluate the results. Fiveteens patients were studied, divided into two groups, those with methylphenidate (MPES) and those without (ES). Both groups received escitalopram 10 mg/d. There were no difference in basal rating scale or scales Liebowitz and HAM-A, at basline. The methylphenidate group and escitalopram showed significant differences in Leibowitz at the end of the study. Pretreatment MPES: 33.29 + 2.87; postreatment MPES 13.71 + 3.5 (Wilcoxon sign test p ‹ 0.031). While in the group with monotherapy, ES Pretreatment and Postreatment were not significant (32.15 + 5.2 vs. 24.1 + 8.4, p = 0.68). The same was observed in the HAM-A, MPES showed differences between baseline states 21.85 + 7.0 and posttreatment 9.14 + 1.95 (U-Mann-Whitney p ‹ 0.031) but not in the group with escitalopram monotherapy, pre: 26.25 + 7.04 and 21.25 + 7.4 post (Wilcoxon test p = sign 0.125). There were also differences in the level of tasks exposure in tne MPES group over the eight-week study, while differences in the monotherapy group were significant but smaller. It can be concluded that although monotherapy SSRI is effective, as has been shown in previous studies in SA; the addition of methylphenidate may shorten the exposure time to the tasks that regularly are avoided by the patients, so that relief can be achieved in less time. They require similar paradigms controlled before major conclusions about studies.

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