Anxiety -social, specific, agoraphobia

Question 1

What is agoraphobia (def)

Answer 1

cluster of phobias emrbacing fears of leaving home, entering shops, crowds and public places, travelling alone in bus/plames/trains

can be uniting fear- inability to escape to safe space (overwheliing urge to return home to safety)
or porblem situations - travelling, queuing, supermarkets etc
some agoraphobics are very good at avoiding these situations and show little anxiety

Question 2

What are the RF and Sx of agoraphobia

Answer 2

Onset -20-35, gradual
Or precipitated by anxiety attack
F>M

Sx -
Panic attacks,
avoidance of phobic behaviours +/- isolation
associated features of depressive/obnessive, social phobia

Question 3

mx of Agoraphobia

Answer 3

Education reassurance and self help
Exposure response prevention–
without actual harm the body can be anxious for 45mins after which habituation occurs (or extinction )
Therapy -desensitise (gradual approach)(
Pt identify goal (eg holding a slug) and makes hierachy of fears
pt tackles hierachy from least to most
aim to stay in a situation until anxiety subsite

or CBT
reduce patients expectation of fear, - explore likelihood and impact of the anticipated catastrophe
test the situtation
impove self confidence

NEVER LONG TERM BDZ FOR ANXIETY

Question 4

What is social phobia

Answer 4

ICD10- fear of scrutiny by other people that lead to avoiding of social situations-
assocaited with low self esteem and fear of criticism
M=F

Question 5

Sx of social Phobia

Answer 5

complains of anxiety attack sx in social situations ( blushing, hand tremors, nausea, urinary, etc) –EXPLORE THE SITUTATIONs
Self medications with aclhol /drugs to desensitise
Panic attacks

NB important tolerates crowds (unlike agoraphobia) but smaller groups spike anxiety

Question 6

Mx of social phobia

Answer 6

Education, reassurance and self help
Exposure response situation
CBT
SSRi
NEVER LONG TERM BDZ FOR ANXIETY

Question 7

What is specific phobia

Answer 7

ICD10- phobias resticted to highly specific situations (eg -holding a snail, spiders, sea food)

Question 8

Sx of Specific phobia

Answer 8

Specific to the situation
contact invokes panic (screaming, barricading bedroom, anxiety attack, etc)
Usually have FHX of phobia and past reasoning of why they have this fear (negative reinforcing in child and/or classical conditioning by Fh_
Most phobias lead to tachycardia (except blood/injury phboias -can lead to tachy followed by vasovagal brady/hypo)

Question 9

Mx of specific phobia

Answer 9

Education reassurance and self help
Exposure response prevention
Relaxation therapy and breathing technique
short term BDZ for specific one time phobias (like dental injections) -NEVER LONG TERM FOR ANXIETY