"Social phobia" not shyness, researchers say

New York: The controversial diagnosis "social phobia" is a legitimate psychiatric condition and is not the same as shyness, government researchers say in a new report.

Based on a large national survey, they found cases of social phobia among teens who described themselves as shy as well as among those who didn`t.

"Shyness is not necessarily social phobia and that`s the point of our paper," said Kathleen Merikangas of the National Institute of Mental Health in Bethesda, Maryland.

Her team also found that fewer than eight percent of adolescents with social phobia said they had been treated with antidepressants.

According to the new report, in the journal Pediatrics, that suggests social phobia isn`t a concept created to sell medications to people experiencing common emotions like shyness, as some critics have worried.

"I think their article is a welcome reminder that psychiatric diagnoses aren`t some kind of conspiracy on the part of the pharmaceutical industry," said Ian Dowbiggin, a historian and the author of The Quest for Mental Health: A Tale of Science, Medicine, Scandal, Sorrow, and Mass Society.

But to him, the new findings don`t challenge the idea that "social phobia" is just a new label for experiences that were once considered normal.

"They left out the whole debate about how much our society and culture influence the way people report their emotional states," Dowbiggin, of the University of Prince Edward Island in Charlottetown, Canada, told Reuters Health.

"We are currently living in a culture of `therapism,`" he said. "It encourages shy people to conclude that they suffer from a significant impairment in their social functioning."

According to the National Institute of Mental Health, social phobia is characterized by "persistent, intense and chronic fear of being watched and judged by others and being embarrassed or humiliated by their own actions."

And the condition is tied to a host of problems in daily life, Merikangas added.

"Many of these kids won`t go to school on days they have to speak in class, or they won`t go to parties," she told Reuters Health. "They are so upset by having to be in some of these social contexts that it really does impair their educational performance."

Merikangas said that many of teens with social phobia can be helped by education, talk therapy or medications such as antidepressants.

Her team also found that adolescents who fit the American Psychiatric Association`s criteria for the disorder were more likely to be depressed, have behavioral problems and abuse drugs than teens who were just shy.

The researchers assessed shyness by asking teens directly to rate their "shyness around people their own age who they didn`t know very well" on a four-point scale, and asked parents to rate their own children on the same question.

Around half of the more than 10,000 U.S. teens interviewed in the survey said they were shy to some degree, whereas only about nine percent met the criteria for social phobia.

One in eight of the self-described shy children were estimated to have had social phobia, also called social anxiety disorder, at some point. That compared to one in 20 of those who weren`t shy.

Glen Spielmans, a psychologist at the Metropolitan State University in Saint Paul, Minnesota, cautioned that the study`s estimates are fraught with uncertainty.

"With most psychiatric disorders, we have to be a little careful," he told Reuters Health. "What often happens is the people who are doing the interviews are not mental health professionals."

That means they might be too quick, or slow, to diagnose a certain disorder.

Spielmans also said the study was "dated," noting that the interviews had been done in 2001 and 2002 and that prescription of antidepressants has shot up since then.

What`s more, he said, medications for social phobia have primarily been marketed to adults, not children.

"The extent to which we might be anthologizing normal behavior in adults is still an open question that could benefit from some investigation," Spielmans said.

Heart failure hospital stays fall, saving billions

Chicago: Hospital stays for heart failure fell a remarkable 30 percent in Medicare patients over a decade, the first such decline in the United States and forceful evidence that the nation is making headway in reducing the billion-dollar burden of a common condition.

But the study of 55 million patients, the largest ever on heart failure trends, found only a slight decline in deaths within a year of leaving the hospital, and progress lagged for black men.

"While heart failure hospitalizations have decreased nationally overall, certain populations haven`t seen the full benefit of that decrease," said lead author Dr. Jersey Chen of Yale University School of Medicine.

Possible explanations for the decline in hospital stays abound, including healthier hearts, better control of risk factors like high blood pressure, and more patients treated in emergency rooms and clinics without being admitted to hospitals, said Dr. Mariell Jessup, medical director of the Penn Heart and Vascular Center in Philadelphia.

"I think it`s extraordinary news," said Jessup, who wasn`t involved in the new research. "Many efforts at changing the natural history of this disease seem to be having an effect, especially with the hospitalization rate. But it`s still a very problematic disease."

More than 5 million Americans and 22 million people globally have heart failure. Their hearts strain to pump blood because of damage, often from a heart attack or from high blood pressure. Fluid backing up into the lungs can leave people struggling to breathe.

Heart disease contributes to heart failure. Last week, federal health officials reported that the prevalence of self-reported heart disease in the U.S. decreased from nearly 7 percent to 6 percent from 2006 to 2010.

Fewer hospital stays saves Medicare a lot of money because heart failure is the most common cause of hospitalization in older patients.

From 1998 to 2008, the rate fell from 2,845 hospitalizations per 100,000 Medicare beneficiaries to 2,007 per 100,000, according to research appearing in Wednesday`s Journal of the American Medical Association.

If the rate had remained the same, there would have been 229,000 more heart failure hospital stays in 2008 at an additional cost to Medicare of $4.1 billion, Chen said.

Other reasons for declining hospital stays may include specialized pacemakers and better use of medications such as ACE inhibitors that relax blood vessels, diuretics that prevent fluid buildup, digoxin that boosts heartbeat strength and beta blockers that ease strain on the heart.

Shortness of breath sent heart failure patient Maria Marure to several Chicago hospitals this year. In August, the 56-year-old spent a week at Our Lady of the Resurrection Medical Center, where leaders are focused on keeping heart failure patients healthy once they`re home and avoiding readmissions. Next year, the nation`s new health law begins punishing hospitals with high readmission rates for heart failure by shrinking Medicare payments.

The Chicago hospital made sure Marure had a medical interpreter to translate a nurse`s instructions into Spanish and convey her questions. Marure said it was the first time she understood her heart failure and why it was important for her to watch her weight — which can signal excess fluid. The hospital sent her home with a scale, made sure she had home care and a nurse called her periodically.

Even with all that, in less than three weeks, Marure was struggling to breathe again. A doctor sent her to a different hospital, where she was admitted for four days.

That patient`s experience illustrates why heart failure is still a challenge, despite the new findings — as does the one-year death rate found in the study. The proportion of patients who died within a year after being discharged fell, but only slightly, from about 32 percent to about 30 percent during the decade.

"The death rate is still unacceptably high," said Dr. Mihai Gheorghiade of Northwestern University`s Feinberg School of Medicine in Chicago. Hospitals need to aggressively treat heart failure patients` other ailments and immediately schedule follow-up care after discharge, said Gheorghiade, who wrote an accompanying editorial in the journal.

"It is a sign of hope. However, we are far from achieving our goals," he said.

Bureau Report

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