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WELCOME PHOBIC ANXIETY DISORDERS -Presented by Ms. Krantee More Definition of anxiety disorders • Abnormal states in which the most striking features are mental and physical symptoms of anxiety, occurring in the absence of organic brain disease or another psychiatric disorder. Types of anxiety disorders • Generalized anxiety disorders anxiety continuous • Phobic anxiety disorders anxiety intermittent, situational • Panic disorder anxiety intermittent, unrelated to situation • Obsessive-compulsive disorder Phobic anxiety disorders Phobic anxiety disorders are neurotic disorders which are a less severe form of Psychiatric disorders where patients show either excessive or prolonged emotional reaction to any given stress. • Anxiety is a normal phenomena which is characterized by a state of apprehension or uneasiness arising out of anticipation of danger. • Normal anxiety becomes pathological when it causes significant subject distress and impairment of functioning of individual DEFINITION Phobia is defined as a fear caused by presence or anticipation of specific object or situation, exposure to which almost invariably provokes an immediate anxiety response or panic attack even though the subject recognizes that the fear is excessive or unreasonable. R. Shreeveni CLASSIFICATION ACCORDING TO ICD X • 3 syndromes: a) Specific phobia b) Social phobia c) Agoraphobia Specific phobia • Men 4% • Women 13% • Age of onset: animals: 7 yrs blood: 9 yrs dental: 12 yrs Clinical features • Inappropriately anxious in the presence of one or more objects or situations • Loss of control, fainting or panic response • Anticipatory anxiety, worry • Escape or avoidance from feared situation • Impaired social or work functioning Types of specific phobia • Animals • natural environment : Height • Blood, injections, injuries: different autonomic response; tachycardia f/b vaso vagal response, tensed muscles • Situations: flying • Dental and medical situations: phobia of illness • Phobia of choking some specific phobias.. Terminology Meaning Acrophobia Fear of height Haematophobia Fear of sight Claustrophobia Fear of closed spaces Gamophobia Fear of marriage Insectophobia Fear of insects Zoophobia Fear of animals Micro phobia Fear of germs Brontophobia Fear of thunder Algophobia Fear of pain Social Phobia • Inappropriate anxiety is experienced in situations in which the person is observed and could be criticized. • E.g. speaking in public, urinating in public restrooms. • One year prevalence: Male: Female: 7% 9% • Onset : 17 – 30 yrs • 1 st episode in public places without apparent reason • Special mention: Phobia of excretion Phobia of vomiting Clinical features • Avoid social situations • Avoid making conversations • Sit in least conspicuous places • Hyperventilation, sweating • Palpitations, confusion, GI symptoms • Cold clammy hands • Blushing and trembling of hands and voice frequent • Even thought of such situations anxiety provoking • Preoccupied by ideas that will be observed critically (but knows that this ideas are baseless) Co-morbidity • Depressive disorder • Suicide attempts • Alcohol and substance misuse common Differential diagnosis • Avoidant personality disorder (no specific onset, lifelong shyness) • Social inadequacy • Other anxiety disorders, depression and schizophrenia Course and prognosis • Average 20 yrs duration • Persists in spite of treatment • DSH only if co-morbid depression and alcohol misuse Agoraphobia • Anxiety when patients are away from home, in crowds or in situations that they cannot leave easily • Life time prevalence: 6 to 10 % Clinical features • Situational anxiety: Characterized by panic attacks and anxious cognitions about fainting and loss of control. • Avoidance of situations which provoke anxiety • 3 common themes: distance from home crowding confinement Clinical features • Anxiety reduced if accompanied by companion, pet dog or child • Anticipatory anxiety • Other symptoms: commonly depressive, depersonalization and obsessive thoughts. Onset and course • Early or middle 20’s • First episode typically while waiting for public transport or shopping • Extreme anxiety (with palpitations and fainting) with quick recovery on reaching home or hospital • As condition progresses – increased dependence on spouse or others ETIOLOGY 1. 2. 3. 4. 5. Psychodynamic theory Learning theory Cognitive theory Biological aspects Life experiences DIAGNOSTIC CRITERIA DIAGNOSTIC EVALUATIONS • No specific diagnostic test. • Diagnosis is confirmed if ICD X criteria met. • History of anxiety when exposed to anticipated specific entity or situation. MANAGEMENT 1. Pharmacotherapy: • Benzodiazepines are the treatment of choice. • T. Alprazolam class: anxiolytic Benzodiazepines dose: oral, adults: 0.25mg BD or TDS 2. T. Diazepam • class: Benzodiazepine • dose: oral: 2-10 mg BD to QDS parental: 2 to 10 mg may be repeated in 3-4 hrs if needed. • Along with Benzodiazepines antidepressants are also administered to patients with phobic anxiety. • Commonly used are Imipramine, Sertraline. NURSING MANAGMENT Nursing assessment: • Assessment parameters focus on physical symptoms, precipitating factors, avoidance behavior with phobia, impact of anxiety on physical functioning etc. • History & MSE: • Assess for communication patterns • Ability to perform or complete the task. • Attention to anxiety reducing behaviors such as going to bathroom, leaving group therapy. NURSING DIAGNOSIS • Fear related to a specific stimulus or causing embarrassment to self in front of others evidenced by behavior directed towards avoidance of feared object/ situation. objective: Patient will be able to function in the presence of a phobic object/ situation without experiencing panic anxiety. • Social isolation related to fear of being in a place from which one is unable to escape evidenced by staying alone, refusing to leave room/ home. objective: Client will voluntarily spend time with other clients & staff members activities in group activities by time of discharge. SUMMARY CONCLUSION