Phobia

The  woman  who  cannot  urinate  in a restroom because of embarrassment is probably suffering from social phobia. In social phobia, aspects of the social   situation   cause   irrational fear in the individual. There is no evidence in this woman of separation anxiety disorder or of a specific phobia (i.e. an irrational tear of something

Visual hallucinations

Neurosis

Agro phobia

Anxiety is usually dealt with the defense mechanism of repression.

When repression fails to function adequately, other secondary defence mechanisms of ego come into action.

In phobia, this secondary defense mechanism is displacement.

By using displacement, anxiety is transferred from a really dangerous or frightening object to a neutral object. These two objects are often connected by symbolic associations.

In agoraphobia there is fear of being in places where escape is impossible.

Travelling away from home will worsen anxiety symptoms.

Travelling by bus, train or flight can be difficult because it cannot be easily stopped or returned.

Familiar vehicles like private cars are much easier for patients.

It is the most disabling of anxiety diorders because it affects the social functioning.

It is often associated with Panic Disorder.

Symptoms of anxiety include, intense fear, palpitations, sweating, shakiness, diziness, blurred vision and fainting.

Ref: Kaplan & Sadock’s Synopsis of Psychiatry, By Benjamin J Sadock, M.D., Harold I. Kaplan, Virginia A Sadock, M.D, 10th Edition, Page : 265

B i.e. Modelling

A i.e. Phobias

B i.e. Agoraphobia

B i.e. Phobia

C i.e. Social phobia

A social phobic is socially normal, has friends & is cheerful until he is faced with a situation where he has to perform in presence of other; whereas in avoidant P.D. the person persistently feels tension & apprehension. Social phobia is a localized part of avoidant personality & the differences are:

Social Phobia

Irrational fear of performing activities in presence of other people or interacting with otherQ

Avoidant Personality Disorder

Persistent feeling of tension & apprehension

–    Excessive preoccupation with being criticized or rejected in social situation

–   Inferiority Complex (belief that one is socially inept personally unappealing or inferior to others)

–   Unwilling to be involved with people; Restriction in life style; Avoidance of social activities.

A i.e. Getting caught in places from where escape would be difficult

D i.e. Death

C i.e. Fear of closed spaces

C i.e. Irrational fear of activities

B i.e. Fear of heights

D i.e. Agoraphobia

Agoraphobia

• Patients with agoraphobia rigidly, avoid situations in which it would be difficult to escape or obtain help. They prefer to be accompanied by a friend or family member in busy streets, crowded stores, closed in places (eg. tunnels, bridges, and elevators), closed in vehicles (eg subways, buses, & air planes)Q.
• Patients may insist that they be accompanied every time they leave the house. Severely affected patient may refuse to leave house. The behaviour may result in marital discord.
• The situations are avoided (eg. travel is restricted) or else are endured with marked distress or anxiety about having a panic attack or panic like symptomsQ.
• The anxiety or phobic avoidance is not better accounted for by another mental disorder, such as social phobia (eg. avoidance limited to social situations because of fear of embarrassment), specific phobias (eg. avoidance limited to single situation like elevators), OCD (eg avoidance of dirt in some one with an obscession about contamination), post traumatic stress disorder (eg avoidance of stimuli associated with severe stressor), or separation anxiety disorder (eg avoidance of leaving home or relatives), Agoraphobia is usually associated with panic disorder. Agoraphobia without a h/o panic disorder is often incapacitating & chronic, and depressive disorder and alcohol dependence often complicates its curse.
• Treatment of panic disorder, treats agoraphobia. Treatment is started with SSRIs (paroxetine, sertraline, or fluvoxamine). Benzodiazepines have the most rapid onset of action against panic, within first week. BDZs can reasonably be used as first agent while a SSRI is being slowly titrated to a therapeutic dose (after 4 -12 weeks it can be tapered).

A i.e. Behaviour therapy

A i.e. Systemic desensitization; B i.e. Psychodynamic therapy; C i.e. Exposure therapy

Ans:D.)All

Selective serotonin reuptake inhibitors (SSRIs) are US-FDA approved drugs of first choice (line) for major Depression, Obscessive – compulsive disorder (OCD), Premenstrual dysphoric disorder, Post traumatic stress disorder (PTSD), Panic disorder, Eating disorder (bulimia nervosa), and Social phobia (social anxiety disorder)Q. Mn-SSRI for “DOPES” is 1^st choice.

SSRIs are also used in generalized anxiety disorder, treatment of premature ejaculation (paroxetiene is most useful), body dysmorphic disorders, compulsive buying, & kleptomania.

Psychotherapy (group, supportive) remains the treatment of choice for adjustment disordersQ. And medications are used only to treat specific symptoms for brief periods. Patients with severe anxiety bordering on panic can benefit from anxiolytics (diazepam); those in withdrawn or inhibited states may benefit from short course of psychostimulant drugs; those with signs of decompensation or impending psychosis may be helped by antipsychotic drugs; whereas, SSRIs are useful in treating symptoms of traumatic grief. There is recent trend of increased antidepressant use, however, to augment psychotherupy in adjustment disorder rather than serving as the primary modality. All SSRIs (except fluvoxamine) are US-FDA approved for treatment of major depression. Fluvoxemine is only used for treatment of OCD in US (b/o commercial reasons not d/t therapeutic profile as it is used for major depression in other countries). In US, citalopram is used only in major depression; escitalopram in major depression & GAD; paroxetine is only not used in bulimia nervosa; and setraline is not used in bulimia & GAD. Fluoxetine is not used in GAD, PTSD and social anxiety but is approved for treatment of bipolar depression (with olanzapine).

Ans. Generalized anxiety

Ans. Agoraphobia

Ans. Agoraphobia

Ans. Acrophobia