Psychiatry Social Phobia: Review Questions William R. Marchand, MD Dr. Marchand is acting chief of psychiatry, George E. Wahlen Veterans Affairs Medical Center, and assistant professor of clinical psychiatry, University of Utah, Salt Lake City, UT. This work was supported by the Veterans Administration VISN 19 MIRECC. Choose the single best answer for each question.
	1. A 21-year-old man reports that he has always been “somewhat shy.” He states that he becomes nervous when meeting members of the opposite sex for the first time. After a few minutes with someone new, he usually feels calm. He is single and dates regularly. He has a few very close friends but enjoys more time alone than many of his peers. What is this patient’s most likely diagnosis? Agoraphobia without history of panic disorder Anxiety disorder not otherwise specified Generalized anxiety disorder No psychiatric diagnosis Social phobia Click here to compare your answer. 2. A 30-year-old man with a history of alcohol dependence presents to his primary care physician for routine medical care. He states that he has not used alcohol for 3 months. He also states that he wants to find work now that he is not drinking, but he has an intense fear of job interviews. He is terrified that he will do something to embarrass himself at an interview and cannot summon the courage to apply for a job. What is the most appropriate next step in the management of this patient? Encourage the patient to attend more Alcoholics Anonymous groups Evaluate for avoidant personality disorder Evaluate for social phobia No action required Referral to a psychiatrist Click here to compare your answer. 3. A 15-year-old girl with social phobia presents to her primary care physician with her parents. The parents request treatment, but the patient is unwilling to take psychiatric medication. What is the most appropriate next step in this patient’s management? Psychologic testing Referral to a psychiatrist Referral to a psychotherapist experienced in social phobia Suggest exercise and good nutrition Tell the patient that medication is the only treatment available Click here to compare your answer.		4. A 45-year-old woman presents to her primary care physician. She is a professional musician and reports severe performance anxiety at large concerts. Symptoms include intense anxiety, sweating, and tremor. A diagnosis of social phobia is made. Which of the following is the most appropriate first-line treatment? Atenolol 50 to 100 mg 1 hour before each performance Imipramine 25 mg daily Maintenance treatment with clonazepam 0.5 mg 3 times/day Phenelzine 45 mg daily Quetiapine 100 mg daily at bedtime Click here to compare your answer. 5. Which of the following would be the most appropriate first-line treatment for the generalized type of social phobia in a patient with no history of substance abuse and no comorbid psychiatric or medical illness? ß-Adrenergic receptor antagonist Low-dose lithium Mirtazapine 15 mg daily at bedtime Selective serotonin reuptake inhibitor (SSRI) Trazodone 50 mg 3 times/day Click here to compare your answer.
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