AGORAPHOBIAEDSON MUTANDWA

MBBS IV

OUTLINEINTRODUCTIONAETIOLOGYCLINICAL FEATURESDIAGNOSTIC CRITERIAPROGNOSISMANAGEMENT

INTRODUCTIONThe term "agoraphobia" is used here with a wider

meaning than it had when originally. It is now taken to include fears not only of opens paces but also of related aspects such as the presence of crowds and the difficulty of immediate easy escape to a safe place (usually home).

Most sufferers are women and the onset is usually early in adult life.

Depressive and obsessional symptoms and social phobias may also be present

In the absence of effective treatment, agoraphobia often

becomes chronic, though usually fluctuating

AETIOLOGYTheories of onsetThe cognitive hypothesisThe biological theoryThe psychoanalytic theoryTheory of spread and maintenanceLearning theoriesPersonalityFamily influences

CLINICAL FEATURES

ANXIETY SYMPTOMSPsychological arousalAutonomic arousalGastrointestinalRespiratoryCardiovascularMuscle tensionHyperventilationSleep disturbance

CLINICAL FEATURESSITUATIONSMany situations provoke anxiety and avoidance but they are three main themes or situations that provoke anxiety and avoidance;1. Distance from home2. Crowding3. Confinement

CLINICAL FEATURESANTICIPATORY ANXIETYAnxiety appears hours before the person enters the feared situationOTHER SYMPTOMSDepressive symptomsDepersonalization

ICD-10 DIAGNOSTIC CRITERIAAll of the following criteria should be fulfilled for a definite diagnosis:a) the psychological or autonomic symptoms must be

primarily manifestations of anxiety and notb) secondary to other symptoms, such as delusions or

obsessional thoughts;c) the anxiety must be restricted to (or occur mainly

in) at least two of the following situations:d) crowds, public places, travelling away from home,

and travelling alone; ande) avoidance of the phobic situation must be, or have

been, a prominent feature

DSM-V DIAGNOSTIC CRITERIAA. Marked fear or anxiety about two or more of the following five situations;

(1) Using public transport, (2) being in open spaces, (3) Being in enclosed places (4) Standing in line or being in a crowd, (5) Being outside of the home alone

B. The individual fears or avoids these situationsC. The agoraphobic situations almost always provoke fear or anxietyD. The fear or anxiety is out of proportion to the actual danger posed by the

agoraphobic situations and to the sociocultural contextE. These situations are avoided or endured with stressF. The fear, anxiety or avoidance is persistence typically lasting for 6 months

or moreG. The fear, anxiety or avoidance causes clinically significant distress or

impairment in social, occupational or other areas of functioningH. If another medical condition is present, the fear, anxiety or avoidance is

excessiveI. The fear, anxiety or avoidance is not better explained by the symptoms of

another mental disorder

PROGNOSISWittchen Iet al., 2010 state that agoraphobia that has lasted for 1 year generally remains for the next 5 years, and usually the illness runs a chronic course. Brief episodes of depression are common during the chronic course and more people are likely to seek help during these episodes

MANAGEMENTPsychological treatment-exposure treatmentCognitive-behavioral therapy- anxiety

management; in short term is as effective as medications and in the long term is probably more effective

medications-; anxiolytic drugs, antidepresants drugs

REFERENCESShorter Oxford textbook of Psychiatry by

Philip Cowen

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