Mohaamad junaidallah OBJECTIVES: Definition. Etiology. Manifestations. Diagnosis. Management. WHAT DOES IT MEAN? The word phobia is derived from the Greek phobos, meaning extreme fear and flight. According to the American Psychiatric Association: Phobia is an irrational and excessive fear of an object or situation. Phobia is persistent avoidance behavior secondary to irrational fear of a specific object, activity or situation. Marks has defined phobia on the following four criteria: 1. The fear is out of proportion to the demands of the situation. 2. It cannot be explained or reasoned away. 3. It is beyond voluntary control. 4. The fear leads to an avoidance of the feared situation Epidemiology : Phobias are very common mental disorders. according to NIMH: approximately 5 to 10% of the population is affected with phobia(1%-12.5% of Americans have phobias). Typical age of onset of phobias is usually childhood and adolescence average age is 10. The age of onset is earliest in animal phobias, intermediate in social phobias and latest in agoraphobia. Women tend to be twice as likely to suffer from a phobia compared to men. Epidemiology: Patients with agoraphobia consistently have the highest rate of co-morbidity, animal and situational phobias the lowest, while social phobias intermediate. Agoraphobia is the commonest type of phobia encountered in clinical practice. Patients with social phobia have an increased rate of suicidal ideation. Etiology: 1.Behavioral Factors: Stimulus response model. Operant Conditioning Theory. 2.Psychoanalytic Theories. 3.Genetic-Environmental Factors. Behavioral Factors : Stimulus response model: Anxiety is produced by a naturally frightening stimulus. Operant Conditioning Theory: The conditioned stimulus gradually loses its potency to arouse a response. The symptom may last for years without any apparent external reinforcement. PSYCHOANALYTIC THEORIES: According to it the major function of anxiety is a signal to the ego, that a forbidden unconscious drive is pushing for conscious expression, thus altering the ego to strengthen and marshal its defenses against the threatening instinctual force. Genetic-Environmental Factors. According to DSM IV Types of phobia: Agoraphobia. Social Phobia. Specific Phobia (Simple). Agoraphobia: It is characterised by an irrational fear of being in places away from the familiar setting of home. It is the commonest type of phobia encountered in clinical practice. They prefer to be accompanied by a friend or a family member in such places as busy streets, crowded stores, closed-in spaces and closed-in vehicles. Signs &Symptoms Overriding fear of open or public spaces (primary symptom). Deep concern that help might not be available in such places. Avoidance of public places and confinement to home. When accompanied by panic disorder, fear that having panic attack in public will lead to embarrassment or inability to escape (for symptoms of a panic attack). Social Phobia: According to DSM-IV: marked and persistent fear of social performance situations in which the person is exposed to unfamiliar people or to possible analysing by others. Rate of social phobia are highest among women and persons who are younger (age, 18 to 29 years). Signs &Symptoms Hyperventilation. Sweating. cold, and clammy hands. Blushing. Palpitations. Confusion. Gastrointestinal symptoms. Trembling hands and voice. Urinary urgency. Muscle tension. Anticipatory anxiety. Specific Phobia (Simple): It is an irrational fear of a specific object or stimulus. Simple phobias are common in childhood. By early teenage most of these fears are lost, but a few persist till adult life. Sometimes they may reappear after a symptom-free period. Exposure to the phobic object often results in panic attack. Specific phobias types: The DSM-IV identifies subtypes of the most common specific phobias: Animal type. Natural Environment type. Blood-injection-injury type. Situational type. Other types. Signs &Symptoms Irrational and persistent fear of object or situation. Immediate anxiety on contact with feared object or situation. Loss of control, fainting, or panic response. Avoidance of activities involving feared stimulus. Anxiety when thinking about stimulus. Worry with anticipatory anxiety. Possible impaired social or work functioning. Diagnostic guidelines All of the following should be fulfilled for a definite diagnosis: (a)The psychological or autonomic symptoms must be primary manifestations of anxiety, and not secondary to other symptoms such as delusion or obsessional thought. (b) the anxiety must be restricted to the presence of the particular phobic object or situation. (c) the phobic situation is avoided whenever possible. Differential Diagnosis: Common for social and specific phobia: Appropriate fear and normal shyness. Non-psychiatric medical conditions (Central nervous system tumors, cerebro-vascular disease). Use of substances like hallucinogens. Schizophrenia. Panic disorder. Agoraphobia. Specific Phobia: Hypochondriasis. Obsessive compulsive disorder. Paranoid personality disorder. Social phobia: Major depressive disorder. Schizoid personality disorder. Agoraphobia : All medical conditions causing anxiety or depression. Schizophrenia. Paranoid personality disorder. Avoidance personality disorder. PSYCHOTHERAPY. COGNITIVE BEHAVIOUR THERAPY. PHARMACOTHERAPY. PSYCHOTHERAPY: Insight-oriented psychotherapy: enables the patient to understand the origin of the phobia. enables the patient to seek healthy way of dealing with anxiety provoking stimuli. BEHAVIOUARL THERAPY: Desensitization. Flooding. Social skill training. The key aspects of successful behavior therapy are: The patients commitment to treatment. Clearly identified problems and objectives Available alternative strategies for copying with the patients feelings. PHARMACOTHERAPY: Antidepressant : SSRI: sertraline. Beta-adrenergic antagonist: propranolol, atenolol Benzodiazepines: clonazepam, alprazolam, lorazepam, diazepam. Summary Phobia A nameless, unreasoning, unjustified terror. 3 types: Agoraphobia Socialphobia Aimplephobia Treated by: PSYCHOTHERAPY COGNITIVE BEHAVIOUR THERAPY PHARMACOTHERAPY Thank you References Textbook of Postgraduate Psychiatry v2 page epidemiology-clinical-manifestations-course-and-diagnosis