Abstract

Aim: Approach to a case with social phobia that presented with recurrent transient delusions of reference and persecution and responded with anti-anxiety medication without the need for antipsychotics. Background: Social phobia presents with symptoms of fear of scrutiny by other people in public, usually leading to avoidance of social situations. It is uncommon to have associated referential or persecutory ideations in it. In the present case study, we bought about a case with a social phobia that presented with recurrent transient delusions of reference and persecution, which responded to anti-anxiety measures alone. Discussion: Paranoid symptoms in the background of severe anxiety in social phobia may be explained by three models (a) Inability to challenge suspected criticism; (b) Presence of stressor leading to transient psychotic breakdown; (c) Understanding the disorder itself as a primary thought abnormality rather than an effective disturbance. In our case, despite paranoia, the patient responded satisfactorily to anti-anxiety measures alone, without the need of antipsychotics. Conclusion: Acute onset paranoia arising in a patient with a history of social phobia should get the benefit of being treated with anti-anxiety measures before starting antipsychotics, as they may respond satisfactorily to anti-anxiety measures alone and exposing patients to long-term side effects of antipsychotics may be unwarranted.

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