Avoidance, phobic

Lesk and Chothia did find, however, that there is a striking preferential conservation of the hydrophobic character of the amino acids at the 59 buried positions, but that no such conservation occurs at positions exposed on the surface of the molecule. With a few exceptions on the surface, hydrophobic residues have replaced hydrophilic ones and vice versa. However, the case of sickle-cell hemoglobin, which is described below, shows that a charge balance must be preserved to avoid hydrophobic patches on the surface. In summary, the evolutionary divergence of these nine globins has been constrained primarily by an almost absolute conservation of the hydro-phobicity of the residues buried in the helix-to-helix and helix-to-heme contacts. 

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... 

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... 

Antidepressants have a delayed onset of antipanic effect, typically 4 weeks, with optimal response at 6 to 12 weeks. Reduction of anticipatory anxiety and phobic avoidance generally follows improvement in panic symptoms. PD patients are more likely to experience stimulant-like side effects than patients with depression, and they should be initiated on lower doses (Table 37-6) of antidepressant than those that are used for depression or other... 

Evaluate patients for symptom improvement frequently (e.g., weekly) during the first 4 weeks of therapy. The goal is to alleviate panic attacks and reduce anticipatory anxiety and phobic avoidance with resumption of normal activities. Alter the therapy of patients who do not achieve a significant reduction in panic symptoms after 6 to 8 weeks of an adequate dose of antidepressant or 3 weeks of a benzodiazepine. Regularly evaluate patients for adverse effects, and educate them about appropriate expectations of drug therapy. 

The efficacy of paroxetine, sertraline, and escitalopram was established in large controlled trials.58-60 SSRIs improve social anxiety and phobic avoidance and reduce overall disability. 

Benzodiazepines are used commonly in SAD however, there are limited data supporting their use. Clonazepam has been effective for social anxiety, fear, and phobic avoidance, and it reduced social and work disability during acute treatment.58 Long-term treatment is not desirable for many SAD patients owing to the risk of withdrawal and difficulty with discontinuation, cognitive side effects, and lack of effect on depressive symptoms. Benzodiazepines may be useful for acute relief of physiologic symptoms of anxiety when used concomitantly with antidepressants or psychotherapy. Benzodiazepines are contraindicated in SAD patients with alcohol or substance abuse or history of such. 

The long carbon chain of decyl alcohol is hydrophobic (hydro, water phobic, fearing or avoiding — water avoiding . 

The goals of treatment of SAD are to reduce the physiologic symptoms and phobic avoidance, increase participation in desired social activities, and improve quality of life. 

Clonazepam is the most extensively studied BZ for treatment of generalized SAD. It improved fear and phobic avoidance, interpersonal sensitivity, fears of negative evaluation, and disability measures. Adverse effects include sexual dysfunction, unsteadiness, dizziness, and poor concentration. Clonazepam should be tapered at a rate not to exceed 0.25 mg every 2 weeks. 

Charges are heavily delocalized in organic ions, which complicate the theoretical analysis of ion pairing. Between neutral polar molecules the electrostatic contributions comes mostly from dipole-dipole interactions. Perhaps van der Waals interactions are the most important class of dipole-dipole interactions where one or both molecules do not have a permanent dipole. These interactions are valid for any two atoms that come into close contact with each other, and are called van der Waals interactions. Another very important noncovalent interaction is the hydro-phobic interaction. As the term hydrophobic suggests, this interaction is an effective interaction between two nonpolar molecules that tend to avoid water and, as a result, prefer to cluster around each other. 

Specific Phobia. This diagnosis is appropriate when exposure to a traumatic event leads to a phobic avoidance of some specific reminder of the trauma in the absence of other PTSD symptoms. For example, a survivor of a terrible automobile accident might avoid driving on freeways or traveling in cars altogether. If such avoidance occurs in the absence of other PTSD symptoms, then a specific phobia, rather than PTSD, could indeed be diagnosed. 

Anxiety or phobic avoidance that do not meet criteria for any of the specific anxiety disorders... 

The key feature of specific phobia is an intense and persistent fear of circumscribed situations or specific stimuli (e.g. exposure to animals, blood). Confrontation with the situation or stimulus provokes almost invariably an immediate anxiety response. Often, the situation or stimulus is therefore avoided or endured with considerable dread. Adolescents and adults with this disorder recognize that this anxiety reaction is excessive or unreasonable, but this may not be the case in children. For a diagnosis according to DSM-IV, the avoidance, fear or anxious anticipation of the phobic stimulus must interfere with the persons daily life or the person must be markedly distressed about having the phobia. Further, the phobic reactions are not better explained by another mental disorder, such as, for example, social phobia. 

Much phobia treatment involves behavioral therapy, which involves working with a therapist to try to reduce fear of an object through the use of particular exercises, often without using drugs. Extinction is the natural process by which exposure to a feared object in a safe environment reduces the fear of that object over time. It is thought that part of the reason extinction does not work well with phobias is that phobic people are rarely presented with the feared stimulus in a safe environment, since phobias lead to avoidance behavior. Often, behavioral therapy involves exposing the individual to the stimulus (or parts of the stimulus) until the fear is reduced. These sessions can last a few months. 

The core features of social phobia center on the intense, irrational fear of scrutiny of others and the anticipation of humiliation (Table 25-2). Individuals with this disorder avoid or endure with marked distress the phobic situations. They realize that their fear is unreasonable or excessive. The disorder has been divided into subtypes. Individuals who have anxiety in well-circumscribed situations (e.g., public speaking) have been designated as having a performance subtype those who experience anxiety in a broader spectrum of interpersonal social situations are designated as having a generalized subtype of social phobia. As social phobia has become better character-... 

Behavioral symptoms, such as social withdrawal, excessive dependency, and phobic avoidance... 

Avoiding drugs that lower the threshold for panic symptoms, such as caffeine or over-the-counter stimulants, may also help. Some phobic symptoms are managed by in vivo exposure or cognitive therapy. In general, the best approach is a combination of pharmacotherapy and psychotherapy, in particular, cognitive behavioral techniques. 

Formerly called simple phobia, specific phobia is a marked, excessive, or unreasonable and persistent fear of a specific object or situation (e g., snakes, heights, thunderstorms). Exposure to the phobic stimulus provokes immediate and intense anxiety that the individual recognizes as excessive or unreasonable. The degree of impairment frequently depends on whether the feared object or situation is commonly encountered or can be easily avoided. The diagnosis should only be made if avoidant behavior interferes with the person s normal routine, social activities, or relationships, or if there is marked distress about having the fear. Differential diagnosis may include the following ... 

A phobic avoidance of the places where such attacks occur... 

Like GAD, PD with or without phobic avoidance is a chronic, debilitating illness ( 12, 13, 14, 15 and 16). Although there is little consensus about the most effective drug treatments, options include the following ... 

In 1962, Klein and Fink (88) reported that imipramine blocked panic attacks but had only a minor effect on phobic avoidance or anticipatory anxiety. This clinical observation has been validated by approximately 15 double-blind studies, and TCAs have since been studied for their antipanic efficacy. Although many TCAs are effective antipanic agents, they differ in safety and efficacy, a fact that mandates fitting the drug to the individual patient based on the known advantages and potential adverse effects of each TCA (Table 13-4). 

PD and its related symptoms can be quite disabling. The recognition that specific drug therapies can effectively block the panic episodes has brought new found hope for thousands of patients. Optimal outcome, however, often requires the addition of various behavioral techniques to manage all related components of the disorder (e.g., panic attack, anticipatory anxiety, phobic avoidance). 

A related issue is the growing number of AIDS-phobic individuals, who often benefit from empathic, informed reassurance, thus avoiding HIV-antibody testing or the need for more intensive treatment. 

Addicts whose recovery is shaky are certainly well advised to avoid predictable occasions for their cravings but this avoidance does not fortify them against their addictions any more than the avoidance of phobic objects helps someone overcome a phobia. 

Diagnosis Spontaneous Panic Attacks Situational Panic Attacks Anticipatory Anxiety Symptoms of Autonomic Arousal Phobic Avoidance... 

---