Source 丨21 Healthnews21 original work
Author 丨 Tang Weike
Editor 丨Xu Xu
Image source 丨 Figureworm
The New Year was originally a festive day for family reunions, but as the Spring Festival of the Year of the Tiger approached, a group of people began to feel uneasy in their hearts.
The most obvious are young people in their 20s. Although I will not be asked how the final exam results are, "how well will I pass the examination" makes everyone who is eager to go ashore frightened; after the age of receiving the red envelope, they are faced with the concern of "how much salary" and "when are you going to get married"; and even will be persuaded that "it is better to go home"... For young people, the pressure is greater than the sweetness, and the traditional New Year scene has become a high incidence of "social fear".
However, these appearances of life stress are only jokingly called "social fear", not the real social fear disease.
True "social phobia" refers to "social phobia", which is a subtype of phobia. Phobia, originally called phobia neurosis, is a kind of neurosis, is a real disease, not only to cure, but also to cure.
Social phobia is manifested by excessive and unreasonable fear of an objective object or situation in the outside world, and the patient knows that this fear response is excessive or unreasonable, but it still recurs and is difficult to control. Episodes of fear are often accompanied by significant anxiety and autonomic symptoms, and patients try to avoid objective objects or situations that cause fear, or tolerate them with fear, thus affecting their normal activities. Common phobia subtypes include agoraphobia, social phobia, and special phobia. In addition to psychotherapy, it is also necessary to intervene through medication.
Recently, VistaGen Therapeutics' PH94B nasal spray clinical trial application was approved by the Drug Review Center (CDE) of the State Food and Drug Administration for the treatment of anxiety symptoms of adult social anxiety disorder (SAD). In December 2019, PH94B was granted a fast-track qualification by the U.S. FDA for on-demand treatment of SAD. At present, it has entered Phase 3 clinical research worldwide, and this is the first time that it has been approved in China.
PH94B is a GABAA receptor modulator, administered intranasally in microgram doses, with the characteristics of tasteless, fast onset of action (within 15min) and good safety. Unlike current anxiolytic drugs, including benzodiazepines such as diazepam, PH94B triggers neural circuits in the brain that inhibit fear and anxiety by activating neurons in the nasal chemical sensing neurons, requiring no systemic absorption and distribution to take effect quickly, with good safety and potential in the treatment of postpartum anxiety, post-traumatic stress disorder, preoperative anxiety, panic disorder, and other anxiety-related disorders.
"Social fear" is common
According to Magee et al., the lifetime prevalence of three phobia subtypes in the United States is 6.7 percent for agoraphobia, 13.3 percent for social fear, and 11.3 percent for special phobias. The median age of onset of the three phobias was 29, 16 and 15 years, with more women than men. It is most prevalent in the 25- to 44-year-old age group.
Most patients with phobias have a prolonged course of illness, with a tendency to become chronic, and the longer the course of the disease, the worse the prognosis. The prognosis is better in childhood onset and monophobia, and poorer prognosis in people with widespread fear.
Last year, the social platform Tantan, together with China Youth Daily and the Chinese Academy of Social Sciences, launched a questionnaire survey for users aged 18 to 35 in the tantan platform, and a total of more than 4,000 valid questionnaires were recovered. The results showed that more than 40% of the respondents called themselves "social phobias" and believed that they had different degrees of social problems.
Among them, 17.7% said they were "afraid to talk to strangers", 21.4% said they "feel nervous in public", and 20.7% said that if there is a social activity, they will start anxiety long in advance.
Recently, social has become a hot word on the Internet, and for a time, many netizens have said that the company is really envious, which also reflects the popularity of social anxiety in cyberspace.
However, in this regard, Sun Ping, an assistant researcher at the Institute of Journalism and Communication of the Chinese Academy of Social Sciences, believes that the term "social terror" has been generalized, and in the cognition of many people, people who can talk about it will talk crazy, and if they can't talk, they will simply put a "social terror" label to avoid it.
Liu Xiangxin, director of the office of the Guangdong Provincial Mental Health Center and a public health science expert, told the 21st Century Business Herald reporter that do not simply attribute "social fear" to introverts, or shyness, introverts just like to work quietly and will not be afraid of people, people should be distinguished.
How to identify yourself from "social terror"?
Normal people will also have a certain nervousness and anxiety about social activities, the key is to look at the rationality of this fear, the frequency of occurrence, the degree of fear, whether it is accompanied by autonomic symptoms, whether it obviously affects social function, whether there is avoidance behavior, etc. to consider comprehensively.
Social phobia is also distinguished from other neurotic disorders. Both phobias and anxiety disorders have anxiety as the core symptom, but anxiety in social phobia is caused by specific objects or situations, and is situational and episodic, while anxiety disorders often have no specific object and often persist.
Obsessive-compulsive fear stems from certain thoughts or ideas within oneself, fearing loss of self-control, not fear of external things. People with hypochondria may show fear of the disease due to excessive attention to their condition, and such patients think their suspicions and concerns are justified.
Depressive disorders are also one of the manifestations, some depressive disorders are accompanied by transient fear, and some people with social phobias are also accompanied by depressed moods, and the coexistence of phobia and depression can aggravate fear. Diagnosis is based on whether each disorder meets the diagnostic criteria at the time. If the symptoms of fear have previously met the criteria for depressive disorder, the diagnosis of depressive disorder should be preferred.
Temporal lobe epilepsy may present as paroxysmal fear, but the fear is not specific, and seizures of impaired consciousness, EEG changes, and neurological signs can be differentiated.
How to treat "social phobia"?
At present, there are professional therapies for the treatment of "social phobia", such as CBT (cognitive behavioral therapy), learning to solve cognitive, emotional and behavioral related problems, improving and improving the level of individual function, and how to replace negative solidified thoughts with positive thinking; and exposure therapy combined with VR (virtual reality) technology, exposing "social phobia" people to virtual reality, and then training step by step, gradually overtaking and adapting to the real social environment.
In China, mindfulness therapy is more popular, advocating decentralization, that is, the ability to focus on the present, not to judge thoughts and feelings, and to accept them, prompting the individual to change from the mode of action (thinking about the past and worrying about the future) to the mode of existence (acceptance, living in the present without judgment).
Currently, PH94B is in phase III clinical phase. It was a randomized, multicenter, double-blind, placebo-controlled study to evaluate the efficacy, safety, and tolerability of PH94B in the treatment of ADULT SAD.
In June 2020, Yunheng Pharmaceutical entered into a strategic partnership with VistaGen to acquire the interest in developing and commercializing PH94B in Greater China, South Korea and Southeast Asia for US$177 million (US$5 million down payment + US$172 million milestone payment). In October 2020, Aimer Medical and Yunheng Pharmaceutical reached a final merger agreement, and the merged company was named Aimer Medical, with Dr. Zhao Dayao as the CHIEF Executive Officer.
Psychotherapy in the treatment of social phobia has a great effect. Behavioral therapy is the preferred method of treatment for phobias. Systemic desensitization therapy and exposure shock therapy work well for social phobia. The basic principle is to eliminate the conditional link between the object of fear and the anxiety fear response; the second is to combat the avoidance response. Many patients have learned how to avoid objects and situations that cause them to fear during the course of the disease without affecting their daily social functioning.
Systemic desensitization treatment is more used, and it can be divided into real-scene desensitization and imaginary desensitization. The first stage is relaxation training. In the second stage, patients are asked to make a list of relevant situations that induce social fear according to the severity of the fear response, and then start with the situation that causes the weakest fear response, and let the patient be in it one by one, or imagine that they are in these situations. Each step is done until the patient adjusts and feels completely relaxed, and then proceeds to the next more stressful situation until the strongest level of situation does not cause fear.
In addition, drug treatment, drugs can not simply eliminate the patient's fear, but the use of benzodiazepines and propranolol and other drugs can alleviate the somatic anxiety response caused by fear and reduce the autonomic nervous response. SSRIs such as paroxetine, sertraline, etc. are effective in treating social anxiety disorders, tricyclic antidepressants mipamin and clomipramine, monoamine oxidase inhibitors moclobemide also have efficacy in phobia, but adverse reactions of drugs limit the use.
In addition, Liu Xiangxin, a public health science expert, also told the 21st Century Business Herald reporter that patients should start from breaking the stereotype thinking, such as not always speculating about the psychology of others, putting themselves "in the right seat", thinking that others are paying attention to and evaluating themselves, and giving themselves a negative evaluation. In fact, others don't pay so much attention to your every move, and they don't think you're bad. This is a problem with the logic of thinking, blindly labeling yourself and arbitrarily drawing conclusions for yourself.