the RIMA, moclobemide in the same doses as for depression. These achieve equivalent degrees of improvement; phenelzine has a slightly faster onset of action but produces more adverse effects. Some benzodiazepines and other SSRIs are reported to provide benefit but evidence for their therapeutic efficacy is less conclusive, ^-adrenoceptor blockers continue to be widely used despite their having no proven efficacy in social phobia. But they have a place in the treatment of specific performance anxiety in, e.g. musicians, when management of the tremor is crucial.
The duration of treatment is as for depression or longer, for this can be a lifelong condition.
POST-TRAUMATIC STRESS DISORDER (PTSD)
Symptoms characteristically follow exposure to an extreme traumatic stressor event. These include persistent re-experiencing of the traumatic event, persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness, and persistent symptoms of increased arousal. In taking a history the association with the event is usually obvious. PTSD is differentiated from acute stress disorder (below) by its persistence—the symptoms of the latter resolve within about 4 weeks. Depression quite commonly coexists with PTSD and should be enquired for in the history.
Treatment is poorly researched; there have been few properly controlled trials and almost all open trials have been conducted on small numbers of patients long after the causative incident. The wide range of drugs that has been reported to provide some benefit includes benzodiazepines, TCAs and MAOIs; paroxetine (SSRI) (20-50 mg/day p.o.) is now licenced for this indication in the UK. The preferred treatfnent immediately following the
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