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. 2001 May;26(3):190–202.

Toward an integrative understanding of social phobia.

D Li 1, P Chokka 1, P Tibbo 1
PMCID: PMC1408296  PMID: 11394189

Abstract

Our objective was to examine the neurobiology of social phobia from the perspectives of basic sciences, genetics, immunology, neuroendocrinology, neurotransmission and neuroimaging and to provide an integrated understanding of social phobia in the framework of a hypothetical neural circuit. Family and twin studies provide evidence that social phobia is heritable with significant genetic influence, and molecular genetics offers possibilities in understanding the nature of the trait that is transmitted. The biologic distinctiveness of social phobia from anxiety disorders and physiological validation of differences between generalized and discrete social phobia subtypes have been implicated in genetic, naturalistic and chemical challenge studies. Evidence of specific dysfunction of dopaminergic, serotonergic, noradrenergic and GABAergic (gamma-aminobutyric acid) neurotransmitter systems has been presented in animal models, challenge studies and treatment investigations. Preliminary neuroimaging research supports previous studies suggesting striatal dopaminergic dysfunction in social phobia and suggests the importance of functional circuits. A neural circuit involving the striatum, thalamus, amygdala and cortical structures may provide a framework for integrating much of the current knowledge on the neurobiology of social phobia.

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Selected References

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  1. Baldwin D., Bobes J., Stein D. J., Scharwächter I., Faure M. Paroxetine in social phobia/social anxiety disorder. Randomised, double-blind, placebo-controlled study. Paroxetine Study Group. Br J Psychiatry. 1999 Aug;175:120–126. doi: 10.1192/bjp.175.2.120. [DOI] [PubMed] [Google Scholar]
  2. Bell C. J., Malizia A. L., Nutt D. J. The neurobiology of social phobia. Eur Arch Psychiatry Clin Neurosci. 1999;249 (Suppl 1):S11–S18. doi: 10.1007/pl00014162. [DOI] [PubMed] [Google Scholar]
  3. Benjamin J., Li L., Patterson C., Greenberg B. D., Murphy D. L., Hamer D. H. Population and familial association between the D4 dopamine receptor gene and measures of Novelty Seeking. Nat Genet. 1996 Jan;12(1):81–84. doi: 10.1038/ng0196-81. [DOI] [PubMed] [Google Scholar]
  4. Blier P., de Montigny C., Chaput Y. Modifications of the serotonin system by antidepressant treatments: implications for the therapeutic response in major depression. J Clin Psychopharmacol. 1987 Dec;7(6 Suppl):24S–35S. [PubMed] [Google Scholar]
  5. Breier A., Kestler L., Adler C., Elman I., Wiesenfeld N., Malhotra A., Pickar D. Dopamine D2 receptor density and personal detachment in healthy subjects. Am J Psychiatry. 1998 Oct;155(10):1440–1442. doi: 10.1176/ajp.155.10.1440. [DOI] [PubMed] [Google Scholar]
  6. Burke K. C., Burke J. D., Jr, Regier D. A., Rae D. S. Age at onset of selected mental disorders in five community populations. Arch Gen Psychiatry. 1990 Jun;47(6):511–518. doi: 10.1001/archpsyc.1990.01810180011002. [DOI] [PubMed] [Google Scholar]
  7. Chase T. N., Oh J. D., Blanchet P. J. Neostriatal mechanisms in Parkinson's disease. Neurology. 1998 Aug;51(2 Suppl 2):S30–S35. doi: 10.1212/wnl.51.2_suppl_2.s30. [DOI] [PubMed] [Google Scholar]
  8. Cosoff S. J., Hafner R. J. The prevalence of comorbid anxiety in schizophrenia, schizoaffective disorder and bipolar disorder. Aust N Z J Psychiatry. 1998 Feb;32(1):67–72. doi: 10.3109/00048679809062708. [DOI] [PubMed] [Google Scholar]
  9. Coupland N. J., Bell C., Potokar J. P., Dorkins E., Nutt D. J. Flumazenil challenge in social phobia. Depress Anxiety. 2000;11(1):27–30. doi: 10.1002/(sici)1520-6394(2000)11:1<27::aid-da4>3.0.co;2-o. [DOI] [PubMed] [Google Scholar]
  10. Davidson J. R., Hughes D. L., George L. K., Blazer D. G. The epidemiology of social phobia: findings from the Duke Epidemiological Catchment Area Study. Psychol Med. 1993 Aug;23(3):709–718. doi: 10.1017/s0033291700025484. [DOI] [PubMed] [Google Scholar]
  11. Davidson J. R., Hughes D. L., George L. K., Blazer D. G. The epidemiology of social phobia: findings from the Duke Epidemiological Catchment Area Study. Psychol Med. 1993 Aug;23(3):709–718. doi: 10.1017/s0033291700025484. [DOI] [PubMed] [Google Scholar]
  12. Davidson J. R., Krishnan K. R., Charles H. C., Boyko O., Potts N. L., Ford S. M., Patterson L. Magnetic resonance spectroscopy in social phobia: preliminary findings. J Clin Psychiatry. 1993 Dec;54 (Suppl):19–25. [PubMed] [Google Scholar]
  13. Davidson J. R., Potts N., Richichi E., Krishnan R., Ford S. M., Smith R., Wilson W. H. Treatment of social phobia with clonazepam and placebo. J Clin Psychopharmacol. 1993 Dec;13(6):423–428. [PubMed] [Google Scholar]
  14. Den Boer J. A., Van Vliet I. M., Westenberg H. G. Recent advances in the psychopharmacology of social phobia. Prog Neuropsychopharmacol Biol Psychiatry. 1994 Jul;18(4):625–645. doi: 10.1016/0278-5846(94)90073-6. [DOI] [PubMed] [Google Scholar]
  15. Ebstein R. P., Nemanov L., Klotz I., Gritsenko I., Belmaker R. H. Additional evidence for an association between the dopamine D4 receptor (D4DR) exon III repeat polymorphism and the human personality trait of Novelty Seeking. Mol Psychiatry. 1997 Oct-Nov;2(6):472–477. doi: 10.1038/sj.mp.4000333. [DOI] [PubMed] [Google Scholar]
  16. Ebstein R. P., Novick O., Umansky R., Priel B., Osher Y., Blaine D., Bennett E. R., Nemanov L., Katz M., Belmaker R. H. Dopamine D4 receptor (D4DR) exon III polymorphism associated with the human personality trait of Novelty Seeking. Nat Genet. 1996 Jan;12(1):78–80. doi: 10.1038/ng0196-78. [DOI] [PubMed] [Google Scholar]
  17. Emde R. N., Plomin R., Robinson J. A., Corley R., DeFries J., Fulker D. W., Reznick J. S., Campos J., Kagan J., Zahn-Waxler C. Temperament, emotion, and cognition at fourteen months: the MacArthur Longitudinal Twin Study. Child Dev. 1992 Dec;63(6):1437–1455. [PubMed] [Google Scholar]
  18. Falloon I. R., Lloyd G. G., Harpin R. E. The treatment of social phobia. Real-life rehearsal with nonprofessional therapists. J Nerv Ment Dis. 1981 Mar;169(3):180–184. doi: 10.1097/00005053-198103000-00005. [DOI] [PubMed] [Google Scholar]
  19. Farde L., Gustavsson J. P., Jönsson E. D2 dopamine receptors and personality traits. Nature. 1997 Feb 13;385(6617):590–590. doi: 10.1038/385590a0. [DOI] [PubMed] [Google Scholar]
  20. File S. E., Johnston A. L. Lack of effects of 5HT3 receptor antagonists in the social interaction and elevated plus-maze tests of anxiety in the rat. Psychopharmacology (Berl) 1989;99(2):248–251. doi: 10.1007/BF00442817. [DOI] [PubMed] [Google Scholar]
  21. Fyer A. J., Mannuzza S., Chapman T. F., Liebowitz M. R., Klein D. F. A direct interview family study of social phobia. Arch Gen Psychiatry. 1993 Apr;50(4):286–293. doi: 10.1001/archpsyc.1993.01820160056007. [DOI] [PubMed] [Google Scholar]
  22. Gelernter C. S., Uhde T. W., Cimbolic P., Arnkoff D. B., Vittone B. J., Tancer M. E., Bartko J. J. Cognitive-behavioral and pharmacological treatments of social phobia. A controlled study. Arch Gen Psychiatry. 1991 Oct;48(10):938–945. doi: 10.1001/archpsyc.1991.01810340070009. [DOI] [PubMed] [Google Scholar]
  23. Gorman J. M., Liebowitz M. R., Fyer A. J., Stein J. A neuroanatomical hypothesis for panic disorder. Am J Psychiatry. 1989 Feb;146(2):148–161. doi: 10.1176/ajp.146.2.148. [DOI] [PubMed] [Google Scholar]
  24. Grant K. A., Shively C. A., Nader M. A., Ehrenkaufer R. L., Line S. W., Morton T. E., Gage H. D., Mach R. H. Effect of social status on striatal dopamine D2 receptor binding characteristics in cynomolgus monkeys assessed with positron emission tomography. Synapse. 1998 May;29(1):80–83. doi: 10.1002/(SICI)1098-2396(199805)29:1<80::AID-SYN7>3.0.CO;2-7. [DOI] [PubMed] [Google Scholar]
  25. Gray T. S. Functional and anatomical relationships among the amygdala, basal forebrain, ventral striatum, and cortex. An integrative discussion. Ann N Y Acad Sci. 1999 Jun 29;877:439–444. doi: 10.1111/j.1749-6632.1999.tb09281.x. [DOI] [PubMed] [Google Scholar]
  26. Heimberg R. G., Hope D. A., Dodge C. S., Becker R. E. DSM-III-R subtypes of social phobia. Comparison of generalized social phobics and public speaking phobics. J Nerv Ment Dis. 1990 Mar;178(3):172–179. doi: 10.1097/00005053-199003000-00004. [DOI] [PubMed] [Google Scholar]
  27. Hervé D., Pickel V. M., Joh T. H., Beaudet A. Serotonin axon terminals in the ventral tegmental area of the rat: fine structure and synaptic input to dopaminergic neurons. Brain Res. 1987 Dec 1;435(1-2):71–83. doi: 10.1016/0006-8993(87)91588-5. [DOI] [PubMed] [Google Scholar]
  28. Hofmann S. G., Newman M. G., Ehlers A., Roth W. T. Psychophysiological differences between subgroups of social phobia. J Abnorm Psychol. 1995 Feb;104(1):224–231. doi: 10.1037//0021-843x.104.1.224. [DOI] [PubMed] [Google Scholar]
  29. Hollander E., Kwon J., Weiller F., Cohen L., Stein D. J., DeCaria C., Liebowitz M., Simeon D. Serotonergic function in social phobia: comparison to normal control and obsessive-compulsive disorder subjects. Psychiatry Res. 1998 Jul 13;79(3):213–217. doi: 10.1016/s0165-1781(98)00041-9. [DOI] [PubMed] [Google Scholar]
  30. Insel T. R. A neurobiological basis of social attachment. Am J Psychiatry. 1997 Jun;154(6):726–735. doi: 10.1176/ajp.154.6.726. [DOI] [PubMed] [Google Scholar]
  31. James I. M., Griffith D. N., Pearson R. M., Newbury P. Effect of oxprenolol on stage-fright in musicians. Lancet. 1977 Nov 5;2(8045):952–954. doi: 10.1016/s0140-6736(77)90890-x. [DOI] [PubMed] [Google Scholar]
  32. James I., Savage I. Beneficial effect of nadolol on anxiety-induced disturbances of performance in musicians: a comparison with diazepam and placebo. Am Heart J. 1984 Oct;108(4 Pt 2):1150–1155. doi: 10.1016/0002-8703(84)90599-4. [DOI] [PubMed] [Google Scholar]
  33. Johnson M. R., Lydiard R. B., Zealberg J. J., Fossey M. D., Ballenger J. C. Plasma and CSF HVA levels in panic patients with comorbid social phobia. Biol Psychiatry. 1994 Sep 15;36(6):425–427. doi: 10.1016/0006-3223(94)91217-3. [DOI] [PubMed] [Google Scholar]
  34. Johnson M. R., Marazziti D., Brawman-Mintzer O., Emmanuel N. P., Ware M. R., Morton W. A., Rossi A., Cassano G. B., Lydiard R. B. Abnormal peripheral benzodiazepine receptor density associated with generalized social phobia. Biol Psychiatry. 1998 Feb 15;43(4):306–309. doi: 10.1016/S0006-3223(97)00390-9. [DOI] [PubMed] [Google Scholar]
  35. Jönsson E. G., Nöthen M. M., Grünhage F., Farde L., Nakashima Y., Propping P., Sedvall G. C. Polymorphisms in the dopamine D2 receptor gene and their relationships to striatal dopamine receptor density of healthy volunteers. Mol Psychiatry. 1999 May;4(3):290–296. doi: 10.1038/sj.mp.4000532. [DOI] [PubMed] [Google Scholar]
  36. Jönsson E. G., Nöthen M. M., Gustavsson J. P., Neidt H., Brené S., Tylec A., Propping P., Sedvall G. C. Lack of evidence for allelic association between personality traits and the dopamine D4 receptor gene polymorphisms. Am J Psychiatry. 1997 May;154(5):697–699. doi: 10.1176/ajp.154.5.697. [DOI] [PubMed] [Google Scholar]
  37. Jönsson E. G., Nöthen M. M., Gustavsson J. P., Neidt H., Forslund K., Mattila-Evenden M., Rylander G., Propping P., Asberg M. Lack of association between dopamine D4 receptor gene and personality traits. Psychol Med. 1998 Jul;28(4):985–989. doi: 10.1017/s0033291798006837. [DOI] [PubMed] [Google Scholar]
  38. Kagan J. Temperament and the reactions to unfamiliarity. Child Dev. 1997 Feb;68(1):139–143. [PubMed] [Google Scholar]
  39. Katzelnick D. J., Kobak K. A., Greist J. H., Jefferson J. W., Mantle J. M., Serlin R. C. Sertraline for social phobia: a double-blind, placebo-controlled crossover study. Am J Psychiatry. 1995 Sep;152(9):1368–1371. doi: 10.1176/ajp.152.9.1368. [DOI] [PubMed] [Google Scholar]
  40. Kendler K. S., Karkowski L. M., Prescott C. A. Fears and phobias: reliability and heritability. Psychol Med. 1999 May;29(3):539–553. doi: 10.1017/s0033291799008429. [DOI] [PubMed] [Google Scholar]
  41. Kendler K. S., Neale M. C., Kessler R. C., Heath A. C., Eaves L. J. The genetic epidemiology of phobias in women. The interrelationship of agoraphobia, social phobia, situational phobia, and simple phobia. Arch Gen Psychiatry. 1992 Apr;49(4):273–281. doi: 10.1001/archpsyc.1992.01820040025003. [DOI] [PubMed] [Google Scholar]
  42. Kennett G. A. 5-HT1C receptor antagonists have anxiolytic-like actions in the rat social interaction model. Psychopharmacology (Berl) 1992;107(2-3):379–384. doi: 10.1007/BF02245165. [DOI] [PubMed] [Google Scholar]
  43. Kessler R. C., McGonagle K. A., Zhao S., Nelson C. B., Hughes M., Eshleman S., Wittchen H. U., Kendler K. S. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994 Jan;51(1):8–19. doi: 10.1001/archpsyc.1994.03950010008002. [DOI] [PubMed] [Google Scholar]
  44. King R. J., Mefford I. N., Wang C., Murchison A., Caligari E. J., Berger P. A. CSF dopamine levels correlate with extraversion in depressed patients. Psychiatry Res. 1986 Dec;19(4):305–310. doi: 10.1016/0165-1781(86)90123-x. [DOI] [PubMed] [Google Scholar]
  45. Knutson B., Wolkowitz O. M., Cole S. W., Chan T., Moore E. A., Johnson R. C., Terpstra J., Turner R. A., Reus V. I. Selective alteration of personality and social behavior by serotonergic intervention. Am J Psychiatry. 1998 Mar;155(3):373–379. doi: 10.1176/ajp.155.3.373. [DOI] [PubMed] [Google Scholar]
  46. Laakso A., Vilkman H., Kajander J., Bergman J., paranta M., Solin O., Hietala J. Prediction of detached personality in healthy subjects by low dopamine transporter binding. Am J Psychiatry. 2000 Feb;157(2):290–292. doi: 10.1176/appi.ajp.157.2.290. [DOI] [PubMed] [Google Scholar]
  47. LeDoux J. E. Emotion: clues from the brain. Annu Rev Psychol. 1995;46:209–235. doi: 10.1146/annurev.ps.46.020195.001233. [DOI] [PubMed] [Google Scholar]
  48. Liebowitz M. R., Campeas R., Hollander E. MAOIs: impact on social behavior. Psychiatry Res. 1987 Sep;22(1):89–90. doi: 10.1016/0165-1781(87)90054-0. [DOI] [PubMed] [Google Scholar]
  49. Liebowitz M. R., Fyer A. J., Gorman J. M., Dillon D., Davies S., Stein J. M., Cohen B. S., Klein D. F. Specificity of lactate infusions in social phobia versus panic disorders. Am J Psychiatry. 1985 Aug;142(8):947–950. doi: 10.1176/ajp.142.8.947. [DOI] [PubMed] [Google Scholar]
  50. Liebowitz M. R., Quitkin F. M., Stewart J. W., McGrath P. J., Harrison W., Rabkin J., Tricamo E., Markowitz J. S., Klein D. F. Phenelzine v imipramine in atypical depression. A preliminary report. Arch Gen Psychiatry. 1984 Jul;41(7):669–677. doi: 10.1001/archpsyc.1984.01790180039005. [DOI] [PubMed] [Google Scholar]
  51. Liebowitz M. R., Schneier F., Campeas R., Hollander E., Hatterer J., Fyer A., Gorman J., Papp L., Davies S., Gully R. Phenelzine vs atenolol in social phobia. A placebo-controlled comparison. Arch Gen Psychiatry. 1992 Apr;49(4):290–300. doi: 10.1001/archpsyc.49.4.290. [DOI] [PubMed] [Google Scholar]
  52. Lightowler S., Kennett G. A., Williamson I. J., Blackburn T. P., Tulloch I. F. Anxiolytic-like effect of paroxetine in a rat social interaction test. Pharmacol Biochem Behav. 1994 Oct;49(2):281–285. doi: 10.1016/0091-3057(94)90422-7. [DOI] [PubMed] [Google Scholar]
  53. Lundberg J. M., Franco-Cereceda A., Lacroix J. S., Pernow J. Neuropeptide Y and sympathetic neurotransmission. Ann N Y Acad Sci. 1990;611:166–174. doi: 10.1111/j.1749-6632.1990.tb48930.x. [DOI] [PubMed] [Google Scholar]
  54. Maj J., Moryl E. Effects of sertraline and citalopram given repeatedly on the responsiveness of 5-HT receptor subpopulations. J Neural Transm Gen Sect. 1992;88(2):143–156. doi: 10.1007/BF01244819. [DOI] [PubMed] [Google Scholar]
  55. Malhotra A. K., Virkkunen M., Rooney W., Eggert M., Linnoila M., Goldman D. The association between the dopamine D4 receptor (D4DR) 16 amino acid repeat polymorphism and novelty seeking. Mol Psychiatry. 1996 Nov;1(5):388–391. [PubMed] [Google Scholar]
  56. Mancini C., van Ameringen M., Szatmari P., Fugere C., Boyle M. A high-risk pilot study of the children of adults with social phobia. J Am Acad Child Adolesc Psychiatry. 1996 Nov;35(11):1511–1517. doi: 10.1097/00004583-199611000-00020. [DOI] [PubMed] [Google Scholar]
  57. Mannuzza S., Schneier F. R., Chapman T. F., Liebowitz M. R., Klein D. F., Fyer A. J. Generalized social phobia. Reliability and validity. Arch Gen Psychiatry. 1995 Mar;52(3):230–237. doi: 10.1001/archpsyc.1995.03950150062011. [DOI] [PubMed] [Google Scholar]
  58. Martel F. L., Hayward C., Lyons D. M., Sanborn K., Varady S., Schatzberg A. F. Salivary cortisol levels in socially phobic adolescent girls. Depress Anxiety. 1999;10(1):25–27. doi: 10.1002/(sici)1520-6394(1999)10:1<25::aid-da4>3.0.co;2-o. [DOI] [PubMed] [Google Scholar]
  59. Martinson E. A., Goldstein D., Brown J. H. Muscarinic receptor activation of phosphatidylcholine hydrolysis. Relationship to phosphoinositide hydrolysis and diacylglycerol metabolism. J Biol Chem. 1989 Sep 5;264(25):14748–14754. [PubMed] [Google Scholar]
  60. Mikkelsen E. J., Detlor J., Cohen D. J. School avoidance and social phobia triggered by haloperidol in patients with Tourette's disorder. Am J Psychiatry. 1981 Dec;138(12):1572–1576. doi: 10.1176/ajp.138.12.1572. [DOI] [PubMed] [Google Scholar]
  61. Morimoto K. [Benzodiazepine receptor imaging in the brain: recent developments and clinical validity]. Kaku Igaku. 1999 May;36(4):307–313. [PubMed] [Google Scholar]
  62. Munjack D. J., Baltazar P. L., Bohn P. B., Cabe D. D., Appleton A. A. Clonazepam in the treatment of social phobia: a pilot study. J Clin Psychiatry. 1990 May;51 (Suppl):35–53. [PubMed] [Google Scholar]
  63. Ninan P. T. The functional anatomy, neurochemistry, and pharmacology of anxiety. J Clin Psychiatry. 1999;60 (Suppl 22):12–17. [PubMed] [Google Scholar]
  64. Nutt D. J., Bell C. J., Malizia A. L. Brain mechanisms of social anxiety disorder. J Clin Psychiatry. 1998;59 (Suppl 17):4–11. [PubMed] [Google Scholar]
  65. Pande A. C., Davidson J. R., Jefferson J. W., Janney C. A., Katzelnick D. J., Weisler R. H., Greist J. H., Sutherland S. M. Treatment of social phobia with gabapentin: a placebo-controlled study. J Clin Psychopharmacol. 1999 Aug;19(4):341–348. doi: 10.1097/00004714-199908000-00010. [DOI] [PubMed] [Google Scholar]
  66. Papp L. A., Gorman J. M., Liebowitz M. R., Fyer A. J., Cohen B., Klein D. F. Epinephrine infusions in patients with social phobia. Am J Psychiatry. 1988 Jun;145(6):733–736. doi: 10.1176/ajp.145.6.733. [DOI] [PubMed] [Google Scholar]
  67. Potts N. L., Book S., Davidson J. R. The neurobiology of social phobia. Int Clin Psychopharmacol. 1996 Jun;11 (Suppl 3):43–48. doi: 10.1097/00004850-199606003-00008. [DOI] [PubMed] [Google Scholar]
  68. Potts N. L., Davidson J. R., Krishnan K. R., Doraiswamy P. M., Ritchie J. C. Levels of urinary free cortisol in social phobia. J Clin Psychiatry. 1991 Nov;52 (Suppl):41–42. [PubMed] [Google Scholar]
  69. Prisco S., Esposito E. Differential effects of acute and chronic fluoxetine administration on the spontaneous activity of dopaminergic neurones in the ventral tegmental area. Br J Pharmacol. 1995 Sep;116(2):1923–1931. doi: 10.1111/j.1476-5381.1995.tb16684.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  70. Raleigh M. J., McGuire M. T., Brammer G. L., Pollack D. B., Yuwiler A. Serotonergic mechanisms promote dominance acquisition in adult male vervet monkeys. Brain Res. 1991 Sep 20;559(2):181–190. doi: 10.1016/0006-8993(91)90001-c. [DOI] [PubMed] [Google Scholar]
  71. Rosenbaum J. F., Biederman J., Bolduc-Murphy E. A., Faraone S. V., Chaloff J., Hirshfeld D. R., Kagan J. Behavioral inhibition in childhood: a risk factor for anxiety disorders. Harv Rev Psychiatry. 1993 May-Jun;1(1):2–16. doi: 10.3109/10673229309017052. [DOI] [PubMed] [Google Scholar]
  72. Ross B. D. Biochemical considerations in 1H spectroscopy. Glutamate and glutamine; myo-inositol and related metabolites. NMR Biomed. 1991 Apr;4(2):59–63. doi: 10.1002/nbm.1940040205. [DOI] [PubMed] [Google Scholar]
  73. Schneider F., Weiss U., Kessler C., Müller-Gärtner H. W., Posse S., Salloum J. B., Grodd W., Himmelmann F., Gaebel W., Birbaumer N. Subcortical correlates of differential classical conditioning of aversive emotional reactions in social phobia. Biol Psychiatry. 1999 Apr 1;45(7):863–871. doi: 10.1016/s0006-3223(98)00269-8. [DOI] [PubMed] [Google Scholar]
  74. Schneier F. R., Johnson J., Hornig C. D., Liebowitz M. R., Weissman M. M. Social phobia. Comorbidity and morbidity in an epidemiologic sample. Arch Gen Psychiatry. 1992 Apr;49(4):282–288. doi: 10.1001/archpsyc.1992.01820040034004. [DOI] [PubMed] [Google Scholar]
  75. Schneier F. R., Liebowitz M. R., Abi-Dargham A., Zea-Ponce Y., Lin S. H., Laruelle M. Low dopamine D(2) receptor binding potential in social phobia. Am J Psychiatry. 2000 Mar;157(3):457–459. doi: 10.1176/appi.ajp.157.3.457. [DOI] [PubMed] [Google Scholar]
  76. Stein M. B., Asmundson G. J., Chartier M. Autonomic responsivity in generalized social phobia. J Affect Disord. 1994 Jul;31(3):211–221. doi: 10.1016/0165-0327(94)90031-0. [DOI] [PubMed] [Google Scholar]
  77. Stein M. B., Chartier M. J., Hazen A. L., Kozak M. V., Tancer M. E., Lander S., Furer P., Chubaty D., Walker J. R. A direct-interview family study of generalized social phobia. Am J Psychiatry. 1998 Jan;155(1):90–97. doi: 10.1176/ajp.155.1.90. [DOI] [PubMed] [Google Scholar]
  78. Stein M. B., Hauger R. L., Dhalla K. S., Chartier M. J., Asmundson G. J. Plasma neuropeptide Y in anxiety disorders: findings in panic disorder and social phobia. Psychiatry Res. 1996 Jan 31;59(3):183–188. doi: 10.1016/0165-1781(95)02776-9. [DOI] [PubMed] [Google Scholar]
  79. Stein M. B., Heuser I. J., Juncos J. L., Uhde T. W. Anxiety disorders in patients with Parkinson's disease. Am J Psychiatry. 1990 Feb;147(2):217–220. doi: 10.1176/ajp.147.2.217. [DOI] [PubMed] [Google Scholar]
  80. Stein M. B., Huzel L. L., Delaney S. M. Lymphocyte beta-adrenoceptors in social phobia. Biol Psychiatry. 1993 Jul 1;34(1-2):45–50. doi: 10.1016/0006-3223(93)90255-c. [DOI] [PubMed] [Google Scholar]
  81. Stein M. B., Leslie W. D. A brain single photon-emission computed tomography (SPECT) study of generalized social phobia. Biol Psychiatry. 1996 May 1;39(9):825–828. doi: 10.1016/0006-3223(95)00570-6. [DOI] [PubMed] [Google Scholar]
  82. Stein M. B., Liebowitz M. R., Lydiard R. B., Pitts C. D., Bushnell W., Gergel I. Paroxetine treatment of generalized social phobia (social anxiety disorder): a randomized controlled trial. JAMA. 1998 Aug 26;280(8):708–713. doi: 10.1001/jama.280.8.708. [DOI] [PubMed] [Google Scholar]
  83. Stein M. B. Neurobiological perspectives on social phobia: from affiliation to zoology. Biol Psychiatry. 1998 Dec 15;44(12):1277–1285. doi: 10.1016/s0006-3223(98)00265-0. [DOI] [PubMed] [Google Scholar]
  84. Stein M. B., Tancer M. E., Uhde T. W. Heart rate and plasma norepinephrine responsivity to orthostatic challenge in anxiety disorders. Comparison of patients with panic disorder and social phobia and normal control subjects. Arch Gen Psychiatry. 1992 Apr;49(4):311–317. doi: 10.1001/archpsyc.49.4.311. [DOI] [PubMed] [Google Scholar]
  85. Strobel A., Wehr A., Michel A., Brocke B. Association between the dopamine D4 receptor (DRD4) exon III polymorphism and measures of Novelty Seeking in a German population. Mol Psychiatry. 1999 Jul;4(4):378–384. doi: 10.1038/sj.mp.4000535. [DOI] [PubMed] [Google Scholar]
  86. Sullivan G. M., Coplan J. D., Kent J. M., Gorman J. M. The noradrenergic system in pathological anxiety: a focus on panic with relevance to generalized anxiety and phobias. Biol Psychiatry. 1999 Nov 1;46(9):1205–1218. doi: 10.1016/s0006-3223(99)00246-2. [DOI] [PubMed] [Google Scholar]
  87. Sullivan P. F., Fifield W. J., Kennedy M. A., Mulder R. T., Sellman J. D., Joyce P. R. No association between novelty seeking and the type 4 dopamine receptor gene (DRD4) in two New Zealand samples. Am J Psychiatry. 1998 Jan;155(1):98–101. doi: 10.1176/ajp.155.1.98. [DOI] [PubMed] [Google Scholar]
  88. Tancer M. E. Neurobiology of social phobia. J Clin Psychiatry. 1993 Dec;54 (Suppl):26–30. [PubMed] [Google Scholar]
  89. Tancer M. E. Neurobiology of social phobia. J Clin Psychiatry. 1993 Dec;54 (Suppl):26–30. [PubMed] [Google Scholar]
  90. Tancer M. E., Stein M. B., Gelernter C. S., Uhde T. W. The hypothalamic-pituitary-thyroid axis in social phobia. Am J Psychiatry. 1990 Jul;147(7):929–933. doi: 10.1176/ajp.147.7.929. [DOI] [PubMed] [Google Scholar]
  91. Tancer M. E., Stein M. B., Uhde T. W. Effects of thyrotropin-releasing hormone on blood pressure and heart rate in phobic and panic patients: a pilot study. Biol Psychiatry. 1990 Apr 1;27(7):781–783. doi: 10.1016/0006-3223(90)90592-p. [DOI] [PubMed] [Google Scholar]
  92. Tibbo P., Warneke L. Obsessive-compulsive disorder in schizophrenia: epidemiologic and biologic overlap. J Psychiatry Neurosci. 1999 Jan;24(1):15–24. [PMC free article] [PubMed] [Google Scholar]
  93. Tiihonen J., Kuikka J., Bergström K., Lepola U., Koponen H., Leinonen E. Dopamine reuptake site densities in patients with social phobia. Am J Psychiatry. 1997 Feb;154(2):239–242. doi: 10.1176/ajp.154.2.239. [DOI] [PubMed] [Google Scholar]
  94. Tupler L. A., Davidson J. R., Smith R. D., Lazeyras F., Charles H. C., Krishnan K. R. A repeat proton magnetic resonance spectroscopy study in social phobia. Biol Psychiatry. 1997 Sep 15;42(6):419–424. doi: 10.1016/S0006-3223(96)00501-X. [DOI] [PubMed] [Google Scholar]
  95. Turner S. M., Beidel D. C., Jacob R. G. Social phobia: a comparison of behavior therapy and atenolol. J Consult Clin Psychol. 1994 Apr;62(2):350–358. doi: 10.1037//0022-006x.62.2.350. [DOI] [PubMed] [Google Scholar]
  96. Uhde T. W. Anxiety and growth disturbance: is there a connection? A review of biological studies in social phobia. J Clin Psychiatry. 1994 Jun;55 (Suppl):17–27. [PubMed] [Google Scholar]
  97. Uhde T. W., Tancer M. E., Gelernter C. S., Vittone B. J. Normal urinary free cortisol and postdexamethasone cortisol in social phobia: comparison to normal volunteers. J Affect Disord. 1994 Mar;30(3):155–161. doi: 10.1016/0165-0327(94)90076-0. [DOI] [PubMed] [Google Scholar]
  98. Vandenbergh D. J., Zonderman A. B., Wang J., Uhl G. R., Costa P. T., Jr No association between novelty seeking and dopamine D4 receptor (D4DR) exon III seven repeat alleles in Baltimore Longitudinal Study of Aging participants. Mol Psychiatry. 1997 Sep;2(5):417–419. doi: 10.1038/sj.mp.4000309. [DOI] [PubMed] [Google Scholar]
  99. Versiani M., Nardi A. E., Mundim F. D., Alves A. B., Liebowitz M. R., Amrein R. Pharmacotherapy of social phobia. A controlled study with moclobemide and phenelzine. Br J Psychiatry. 1992 Sep;161:353–360. doi: 10.1192/bjp.161.3.353. [DOI] [PubMed] [Google Scholar]
  100. Wahlestedt C., Reis D. J. Neuropeptide Y-related peptides and their receptors--are the receptors potential therapeutic drug targets? Annu Rev Pharmacol Toxicol. 1993;33:309–352. doi: 10.1146/annurev.pa.33.040193.001521. [DOI] [PubMed] [Google Scholar]
  101. Weiller E., Bisserbe J. C., Boyer P., Lepine J. P., Lecrubier Y. Social phobia in general health care: an unrecognised undertreated disabling disorder. Br J Psychiatry. 1996 Feb;168(2):169–174. doi: 10.1192/bjp.168.2.169. [DOI] [PubMed] [Google Scholar]
  102. de Olmos J. S., Heimer L. The concepts of the ventral striatopallidal system and extended amygdala. Ann N Y Acad Sci. 1999 Jun 29;877:1–32. doi: 10.1111/j.1749-6632.1999.tb09258.x. [DOI] [PubMed] [Google Scholar]

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