“A case of Mis-categorization of different psychopathological domain”

BACKGROUND: Social anxiety disorder (SAD) is characterized by excessive fear of embarrassment, humiliation, or rejection when exposed to possible negative evaluation by others when engaged in a public performance or social interactions. Often, the diagnosis of SAD is missed due to lack of awareness and sometimes misclassified into other psychopathological domains. CASE REPORT: A 30-year-old male presented with c/c of fearfulness and suspiciousness in the form that whenever he sees any two individuals talking, he thinks that they are talking about him which were followed by panic like episodes and social avoidance. He consulted a psychiatrist and was prescribed Tab. Amisulpride 400mg/day, Tab. Aripiprazole 20mg/day, Tab. Olanzapine 10mg/day, Tab. Clozapine 100mg/day, Tab. Trifluoperazine 10mg/day+ Tab. Trihexyphenidyl 4mg/day, Tab. Alprazolam 1.5mg/day, Tab. Lorazepam 2mg/day, Tab. Clonazepam 0.5 mg/day and Tab. Propranolol 40mg/day. He didn't improve on these medications but took them for 5-6 years because he was able to sleep throughout the day and avoid social interactions. He visited us and detailed evaluation was done. During history taking, it was noted that his symptoms were actually fear of going in public as he used to think that people are talking that he is inferior to them and that people might misjudge or underestimate him. On detailed Mental Status Examination, it was noted that he suffered from social anxiety with avoidant behavior. CONCLUSION: It is important to categorize the symptoms into clinically relevant domain by detail history taking and MSE.