Endoscopic sympathetic block--new treatment of choice for social phobia?

Social phobia is a neglected disorder, which can cause very debilitating consequences in patients' lives. The patients tend to isolate and suffer from comorbid disorders such as depression, other anxiety disorders, and drug and alcohol abuse. Traditional treatment methods such as medication and psychotherapy do not help everyone. A prospective, uncontrolled follow-up study with 169 social phobic patients was performed by uni- or bilateral endoscopic sympathetic block of the upper thoracic ganglia. The method is reversible by taking the compression block away, if needed. The selected patients had conservative treatment resistant social phobia according to DSM IV. Structured interview, Davidson's modified brief social phobia scale, and Liebowitz Quality of life questionnaire were used both pre- and postoperatively to assess the value of the treatment. All aspects of social phobia, both somatic and psychological, were highly significantly improved. Reflex sweating as the only remarkable side effect was less than in most series for other indications with sympathetic ablative surgery elsewhere. Endoscopic sympathetic block is recommended as the treatment of choice in severe, conservative therapy resistant social phobia.

ESB in the treatment of addiction. A case report.

Alcohol and drug addiction are common with people with psychiatric disorders and addiction problems can be primary, leading to psychiatric disorders, or secondary to psychiatric disorder. Treating the primary problem first often helps the patient to recover from the secondary problems also. We present a case of a lady with severe social phobia, who recovered from both from her social phobia and her addiction problems after ESB.

Sympathetic surgery for psychiatry. Case report.

One of the authors has, for many years, operated patients suffering from social phobias by using compression block on the sympathetic nerve (1). The Finnish health insurance system has not accepted this treatment as valid for reimbursement. We planned a research based on a design of pre- and post-surgery interviews conducted by a psychiatrist. Data collection was started in 1997. The sample now consists of 45 persons, of whom 20 have also been interviewed after the operation. The results are fascinatingly good. Only one person did not benefit from the operation. We present two illustrating examples. As a conclusion, we suggest that this treatment should be accepted as a valid treatment for patients who have found no relief to their symptoms of social phobic disorder from psychotherapies or pharmacotherapies.