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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