Drug treatment of phobias. Efficacy and optimum use.

In the last decade anxiety disorders have been the focus of intensive research in the psychiatric community, resulting in a rapid growth in our understanding of these illnesses. Diagnostic, biological, and psychopharmacological investigations have revealed important distinctions among these disorders which enable the clinician to make well-informed therapeutic choices and frequently ameliorate or even eliminate anxiety symptoms and related phobic behaviour. The principles of treatment can be simply stated: 1. Careful diagnostic evaluation through history and exclusion of medical and psychiatric conditions which mimic anxiety disorders. 2. Treatment selection based on diagnosis and formulation with the patient of the goals and expected outcome of pharmacotherapy. 3. Systematic application of each drug treatment in sufficient dosage and for an adequate duration permitting progression to the next agent when results are not optimal. 4. Addition of non-pharmacological interventions, usually behavioural therapy, to decrease phobic behaviour. 5. Development of a maintenance or discontinuation strategy tailored to the needs of the patient.