Agoraphobia

Agitation mechanisms A2-Globulm Agnosia b2-Agonists Agoraphobia... 

F40.0 Agoraphobia. 00 Without panic disorder. 01 With panic disorder... 

PHOBIC DISORDERS profound fear of, and avoidance of, a dreaded object or situation. Agoraphobia. Fear of places or situations from which escape is difficult—can occur with or without a history of panic disorder Social phobia. Fear of social or performance situations Specific phobia. Fear of a specific object or situation... 

Anxiety disorders are characterized as chronic in nature with low rates of spontaneous symptom remission and high rates of relapse. Research illustrates that symptoms of anxiety disorders tend to wax and wane, with less than a third of patients remitting spontaneously.7 In a 12-year follow-up study of anxiety disorder patients, recurrence rates were similar between PD with and without agoraphobia (56% and 58%, respectively) despite great differences seen in reported rates of remission (48% and 82% with treatment, respectively).8 Fifty-eight percent of treated GAD patients experienced symptom remission, with 55% experiencing recurrence during the follow-up period. While individuals with SAD had the lowest remission rate with treatment (37%), those who did respond had the lowest rate of recurrence (39%) compared with patients with other anxiety disorders. 

Treatment options include medication, psychotherapy (e.g., CBT preferred), or a combination of both. In some cases, pharmacotherapy will follow psychotherapy treatments when full response is not realized. Patients with panic symptoms without agoraphobia may respond to pharmacotherapy alone. Agoraphobic symptoms generally take longer to respond than panic symptoms. The acute phase of PD treatment lasts about 12 weeks and should result in marked reduction in panic attacks, ideally total elimination, and minimal anticipatory anxiety and phobic avoidance. Treatment should be continued to prevent relapse for an additional 12 to 18 months before attempting discontinuation. 6 49 Patients who relapse following discontinuation of medication should have therapy resumed.49... 

Panic disorder Agoraphobia with panic disorder Agoraphobia without panic disorder Specific phobia Social phobia Generalised anxiety disorder Mild anxiety and depression disorder Obsessive compulsive disorder Acute stress disorder Post-traumatic stress disorder (PTSD) Adjustment disorder Panic disorder without agoraphobia Panic disorder with agoraphobia Agoraphobia Specific phobia Social phobia (also called social anxiety disorder) Generalised anxiety disorder Obsessive compulsive disorder Acute stress disorder Post-traumatic stress disorder (PTSD)... 

The answer is c. (tiardman, p 372. Katzung, p 375.) Compared with other benzodiazepines, alprazolam is selective for treating agoraphobia and panic disorders. 

Charney, D. S.,Heninger, G. R. and Breier,A. Noradrenergic function in panic anxiety. Effects of yohimbine in healthy subjects and patients with agoraphobia and panic disorder. Arch. Gen. Psych. 41 751-763,1984. 

Many patients eventually develop agoraphobia, which is avoidance of specific situations (e.g., crowded places, bridges) where they fear a panic attack might occur. Patients may become homebound. 

Most patients without agoraphobia improve with pharmacotherapy alone, but if agoraphobia is present, CBT typically is initiated concurrently. 

Anxiety disorders such as Panic Disorder, PTSD, and phobias such as Social Phobia and Agoraphobia... 

Standardized cognitive behavioral therapy manuals, which ensure adherence to a treatment protocol, have been developed for many different anxiety disorders, including phobias, generalized anxiety, panic, social anxiety, Agoraphobia,... 

The loss of my teaching career was very major. I had a very distinct loss of self-esteem, I can tell you. I saw myself first as a teacher and then as a wife and mother. I didn t understand why this person who had been a lifelong ham suddenly could not be around people. Every time I went to a movie or any event where there were a lot of people, I would get very panicky and just want to bolt. People thought it was agoraphobia. I now know it was because of the fragrances. 

Avoiding situations that might trigger attacks May occur with or without agoraphobia. 

The result is that panic disorder, particularly when associated with agoraphobia, confers considerable social impairment. Patients with panic disorder are less productive at work, are prone to absenteeism, are less satished in family roles, and have higher mortality and suicide rates. In addition, the physical symptoms of panic disorder are frequently misattributed to medical conditions such as emphysema or heart disease and lead to the costly and inappropriate use of emergency room and other medical services. Panic disorder is costly both from an economic and a social perspective. 

As noted above, panic disorder is commonly accompanied by agoraphobia as avoidant behaviors develop in what are usually partially successful attempts to reduce the frequency and intensity of panic attacks. Estimates for the co-occurrence of agoraphobia in patients with panic disorder range from 30% to 50%. 

Panic disorder is typically a chronic condition, but its severity often waxes and wanes over time. Some experience continuous symptoms whereas others have long periods of remission interspersed with periodic outbreaks of panic attacks. When agoraphobia accompanies panic disorder, it usually begins within the first year or so of panic attacks. The course of agoraphobia varies. The severity of the agoraphobic avoidance can either fluctuate with the frequency of panic attacks or remain constant despite changing severity in the panic attacks themselves. 

The differential diagnosis of panic disorder includes other psychiatric illnesses, medical illnesses, and substances that can cause panic attacks. Also included are medical illnesses that cause symptoms resembling panic attacks. It should be mentioned that these other conditions, which are described below, and panic disorder are not necessarily mutually exclusive. In fact, there is a high rate of comorbidity between panic disorder, other anxiety disorders, and mood disorders. Because panic disorder is frequently accompanied by agoraphobia, the differential diagnosis also includes illnesses that are associated with symptoms resembling the avoidance of the agoraphobic patient. 

Post-traumatic Stress Disorder (PTSD). The same distinction holds true for PTSD. Reminders of the tranma (e.g., sexual intimacy for a rape survivor loud noises for a combat veteran) can trigger panic attacks. Furthermore, PTSD is associated with a variety of avoidant behaviors that can resemble agoraphobia. In the case of PTSD, the avoidance is specifically targeted at reminders of the trauma. For example, places or people who in some way cue memories of the traumatic event are avoided. As for agoraphobia, the avoidance tends to be less specific. It is any sitnation from which it would be difficult to escape should a panic attack occur that is avoided. 

Panic Disorder. Panic attacks are commonly experienced by patients with PTSD. In addition, the avoidant symptoms of PTSD resemble agoraphobia, and the hyperarousal symptoms of PTSD bear some semblance to certain panic symptoms. The key discriminating factor is that patients with panic disorder will, at some point in the course of the illness, experience spontaneous panic attacks arising in the absence of any traumatic reminder or other precipitating stressor. 

Agoraphobia. Agoraphobia also resembles the Cluster C disorders (in particular APD). In both APD and agoraphobia, patients avoid social interaction. The difference lies in the underlying motivation. The patient with APD avoids social contact for fear of criticism and potential humiliation. The agoraphobic patient instead fears being trapped in a situation in which escape would be difficult or embarrassing, especially in the event of a panic attack. 

The analysis of the relationship between panic disorder and major depression has produced conflicting results. The possible link between these disorders has been provided by the frequent occurrence of major depression in patients with panic disorder and agoraphobia, both... 

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