Phobic 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... 

A considerable number of tricyclic antidepressants have been developed in the past, although with slight differences in their pharmacological activities, ah with similar efficacy. They are primarily indicated for the treatment of endogenous depression. However this does not exclude efficacy in patients in whom the depression is associated with organic disease or in patients with reactive depression or depression combined with anxiety. They may also benefit patients during the depressive phase of manic-depressive disorder. For some also efficacy has been claimed in panic states, phobic disorders, and in obsessive-compulsive disorders. 

Few studies have examined noradrenergic function in patients with phobic disorders. In patients with specific phobias, increases in subjective anxiety and increased heart rate, blood pressure, plasma NE, and epinephrine have been associated with exposure to the phobic stimulus (Nesse et al. 1985). This finding may be of interest from the standpoint of the model of conditioned fear, reviewed above, in which a potentiated release of NE occurs in response to a reexposure to the original stressful stimulus. Patients with social phobia have been found to have greater increases in plasma NE in comparison to healthy controls and patients with panic disorder (Stein et al. 1992). In contrast to panic disorder patients, the density of lymphocyte a-adrenoceptors is normal in social phobic patients (Stein et al. 1993). The growth hormone response to intravenous clonidine (a marker of central a2-receptor function) is blunted in social phobia patients (Tancer et al. 1990). 

Silverman, W, and Kurtines, W. (1996) Anxiety and Phobic Disorders A Pragmatic Approach. New York Plenum Press. 

Silverman, W.K., Kurtines, W.M., Ginsburg, G.S., Weems, C.E, Ra-bian, B. and Serafini, L.T. (1999c) Contingency management, self-control, and education support in the treatment of childhood phobic disorders a randomized clinical trial. / Consult Clin Psychol 67 675-687. 

Marks IM The clarification of phobic disorders. Br J Psychiatry 116 377-386, 1970 Marks IM Fears, Phobias, and Rituals. New York, Oxford University Press, 1987 Marks IM, Matthews AM Brief standard self-rating for phobic patients. Behav Res Ther 17 263-267, 1982... 

Limited data exist to support drug management in phobic disorders. Behavioral techniques, especially for specific phobic conditions, are currently the treatment of choice. MAOIs, SSRIs, clonidine, and alprazolam may benefit some patients. Figure 12-3 summarizes the management strategy we would recommend. 

Noyes R, Chaudry DR, Domingo DV. Pharmacologic treatment of phobic disorders. J Clin Psychiatry 1986 47 445-452. 

Bernadt MW, Silverstone T, Singleton W. b-Adrenergic blockers in phobic disorder. Br J Psychiatry 1980 137 452-457. 

Drug Treatments for Obsessive-Compulsive Disorder, Panic Disorder, and Phobic Disorders... 

III. Phobic disorders specific phobias, social phobia, and agoraphobia A. Clinical description of phobias and phobic disorders... 

Drag Treatments for Obsessive-Compulsive, Panic, and Phobic Disorders 341... 

---