phobia
DESCRIPTION
Psychology, Mental Health NursingTRANSCRIPT
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Phobia Dr. Jayesh Patidar
www.drjayeshpatidar.blogspot.com
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Introduction It is persistent avoidance behavior
Secondary to irrational fear of a specific object, activity or situation.
Phobic reaction results in a disruption of the persons ability to function in life. Phobias are very common mental disorders & approximately 5 to 10% of the population is affected with phobia.
They must be recognized, otherwise they can lead to psychiatric complications
Phobias are often responsive to treatment with cognitive and behavioral psychotherapies, and to treatment with specific pharmacotherapy.
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Classification According to DSM IV
agoraphobia,
specific phobia and
social phobia
ICD-10 , includes phobic anxiety
disorders under the broad group of
neurotic.
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Epidemiology Life time prevalence of agoraphobia - 0.6 to
6%. half of the agoraphobic patients have panic
disorder.
Specific phobia is the most common mental
disorder among women and the second most
common in men
Six months prevalence being 5 to 10 % females
suffering twice as compared to males
Six months prevalence for social phobia is
about 2 to 3%
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Age of onset is usually in childhood and
adolescence
Onset is earliest in animal phobias, intermediate
in social phobias and latest in agoraphobia.
Patients with agoraphobia consistently have the
highest rate of co-morbidity, animal and
situational phobias the lowest, while social
phobias intermediate
Patients with social phobia have an increased
rate of suicidal ideation, financial dependency
and having sought medical treatment.
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Etiology Behavioral Factors
Stimulus response model
Operant Conditioning Theory
Psychoanalytic Theories
Genetic-Environmental Factors
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Behavioral Factors
Stimulus response model:- Anxiety is
aroused 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.
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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.
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Genetic-Environmental Factors
The subtypes of phobias can be place along
an etiologic continuum. At one end of
this continuum lies agoraphobia and at
the other end of this continuum lie the
simple phobias.
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Clinical Features Agoraphobia
Patients rigidly avoid situations. 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. The
patients may insist that they be
accompanied every time they leave the
house. Severely affected patients may
simply refuse to leave the house. 30/04/2015 www.drjayeshpatidar.blogspot.com 11
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Specific phobia
Specific phobias have been classified
according to the phobic stimulus. The
DSM-IV identifies subtypes of the most
common specific phobias.
Animal type
Natural Environment type
Blood-injection-injury type
Situational type
Other type
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Classification Fear
Acrophobia Height
Ailurophobia Cats
Algophobia Pain
Anthophobia Flowers
Anthropophobia People
Aquaphobia Water
Arachnophobia Spiders
Astraphobia Lightning
Belonophobia Needles
Brontophobia Thunder
Claustrophobia Closed spaces
Cynophobia Dogs
Dementophobia Insanity
Equinophobia Horses 30/04/2015 www.drjayeshpatidar.blogspot.com 13
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Classification Fear
Herpetophobia Lizards, reptiles
Mikrophobia Germs
Murophobia Mice
Mysophobia Dirt, germs, contamination
Numerophobia Numbers
Nyctophobia Darkness
Ophidiophobia Snakes
Pyrophobia Fire
Sidrodromophobia Railways
Taphaphobia Being buried alive
Thanatophobia Death
Trichphobia Hair
Triskaidekaphobia 13 Persons at a table
Xenophobia Strangers
Zoophobia Animals
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Social Phobia
The presence of social phobia may be associated with a higher morbid risk for major depression. Rate of social phobia are highest among women and persons who are younger (age, 18 to 29 years), less educated, single, and of lower socioeconomic class.
Symptoms associated with social phobia usually involve blushing, muscle twitching, and anxiety about scrutiny.
According to DSM-IV, social phobia is characterized by a marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way that will be humiliating or embarrassing.
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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
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Specific Phobia
Hypochondriasis
Obsessive compulsive disorder
Paranoid personality disorder
Social phobia
Major depressive disorder
Schizoid personality disorder
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Agoraphobia
All medical conditions causing anxiety or
depression
Major depressive disorder
Schizophrenia
Paranoid personality disorder
Avoidance personality disorder
Dependent personality disorder
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Course and Prognosis Agoraphobia without a history of panic
disorder is often incapacitating and chronic.
Depressive disorders and alcohol dependence often complicate the course of
agoraphobia.
As social phobia and specific phobia are relatively new diagnoses, little is known about
their course and prognosis.
The development of associated substance related disorders can also adversely affect the
course and the prognosis of the disorders.
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Treatment Psychotherapy:-
Insight-oriented psychotherapy enables the
patient to understand the origin of the
phobia, the phenomena of secondary gain
and the role of resistance, and enables the
patient to seek healthy way of dealing with
anxiety provoking stimuli.
Cognitive-behavior therapy and various
techniques of behavior therapy like
desensitization, flooding and social skill
training are used.
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All the three types of behavior therapies are useful in the treatment.
The key aspects of successful behavior therapy are:
The patients commitment to treatment,
Clearly identified problems and objectives, and
Available alternative strategies for copying with the patients feelings. In the special situation of blood/injection/injury phobia, some therapists recommend patients to tense their bodies during the exposure to help avoid possibility of fainting from vaso-vagal reaction to phobic stimulation.
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Pharmacotherapy For generalized type or social phobia,
Phenelzine,
Tranylcypromine,
Clonazepam,
Alprazolam,
Moclobemide and
Serotonin reuptake inhibitors (possibly)
Phenelzine is superior to atenolol and somewhat more than moclobemide.
Patients treated with phenelzine are none improved on measure of work and social disability.
The treatment of social phobia associated with performance situation frequently involves use of b-adrenergic antagonists atenolol and propranolol.
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