Psychological Medicine
John S. Axford, Chris A. O'Callaghan in Medicine for Finals and Beyond, 2023
Anxiety is provoked in certain well-defined situations which are not objectively dangerous. The fear experienced is recognized as irrational by the individual, but it cannot be reasoned away and leads to an avoidance of such situations. Simple phobias are circumscribed fears of specific objects, situations or activities.Social phobia is a fear of humiliation or embarrassment in front of others.Agoraphobia is a fear of situations from which there is no easy escape (usually to home).
Case 6: Having a heart attack
Barry Wright, Subodh Dave, Nisha Dogra in 100 Cases in Psychiatry, 2017
Reassuring her and her husband that there is no serious physical illness is important but so is acknowledging the reality of her distress and the worry of her husband. Cognitive behaviour therapy with her will explain the link between emotions (fear), cognitions (belief that sleep may induce an attack) and safety (sleeping in the armchair) and how this is crucial as an explanation of the vicious cycle. It creates a link between sense of apprehension and physiological changes such as increased heart rate (see Figure 6.1). These bodily changes are interpreted catastrophically with fear of something awful happening (catastrophic misinterpretation) leading to more anxiety which leads to further sympathetic response and somatic symptoms perpetuating the vicious cycle. This explanation provides the basis for cognitive behaviour therapy which is the recommended treatment for panic disorder with or without agoraphobia. Recognizing signs of a panic attack and understanding the stress response can abort a panic attack. Cognitive therapy can be explained using the hot cross bun model pictured in Figure 6.2.
Anxiety Disorders
David F. O'Connell in Dual Disorders, 2014
Agoraphobia is a serious chronic anxiety disorder that can occur with or without panic attacks. Agoraphobia is characterized by a marked fear of being alone or in public places where escape is difficult or help unavailable in the case of sudden incapacitation. Fears of helplessness or humiliation are common. Because of such fears, the patient's normal daily activities become increasingly constricted as avoidant behavior dominates his/her life. The central features of agoraphobia are severe phobic anxiety and phobic avoidance of a variety of situations. The most common situations agoraphobics avoid are crowded stores, tunnels, bridges, elevators, and public transportation.
Is it possible to prevent relapse in panic disorder?
Published in Expert Review of Neurotherapeutics, 2023
Rafael C. R. Freire, Antonio E. Nardi
Up to 33.7% of the population is affected by an anxiety disorder during their lifetime according to large population-based surveys. Panic disorder (PD) has a lifetime prevalence of 1.6% to 5.2%, while the lifetime prevalence of agoraphobia is 0.8% to 2.6% in these studies [1]. PD is associated with functional, occupational, and quality of life impairments. Its economic impact on society is also significant. PD has been associated with suicide attempts, greater use of health care services and decreased work productivity [2]. Many treatments are available for PD and agoraphobia, including pharmacological treatments, cognitive-behavioral therapy (CBT)-based treatments, neurostimulation and physical exercise [2,3]. Despite all treatment options, only 64.5% of patients achieve remission in the first year of treatment, and 21.4% of PD patients have recurrences of panic attacks before completing one year of remission [4]. Typically, PD has a waxing and waning course. In the study from Andersch & Hetta [5], patients with PD were followed for 15 years after a clinical trial with imipramine and alprazolam. At the end of the follow-up phase, they found that 51% still presented with panic symptoms, 18% met the diagnostic criteria for PD and 20% had agoraphobia. Relapse after the end of a well-conducted treatment seems to be a common phenomenon regarding both pharmacological and psychological treatments.
Genes in treatment: Polygenic risk scores for different psychopathologies, neuroticism, educational attainment and IQ and the outcome of two different exposure-based fear treatments
Published in The World Journal of Biological Psychiatry, 2021
André Wannemüller, Robert Kumsta, Hans-Peter Jöhren, Thalia C. Eley, Tobias Teismann, Dirk Moser, Christopher Rayner, Gerome Breen, Jonathan Coleman, Svenja Schaumburg, Simon E. Blackwell, Jürgen Margraf
Patients of the mixed fear cohort were N = 153 individuals with predominantly middle-European ancestry (>92%). Participants’ primary diagnosis was a specific phobia in 39.2% of the cases (n = 60) with the ‘animal’ (n = 17; 11.1% of total) and ‘environmental’ (n = 18; 11.8%) subtypes being the most frequent subtypes, followed by the ‘situational’ (n = 12; 7.8%), ‘other’ (n = 10; 6.5%) and ‘blood-injection-injury’ subtypes (n = 3; 2.0%). In all other participants (n = 93; 60.8%), the primary diagnosis was agoraphobia. In the vast majority of cases (n = 87; 52.2% of total) agoraphobia was associated with a panic disorder. Only in 7 patients (4.6% of total), was agoraphobia present without a history of panic disorder. In addition to their primary diagnosis, 54 patients (35.3%) had at least one comorbidity, with specific phobias (n = 31) and social phobia (n = 12) most common. All patients aged between 18 and 70 years who sought treatment between December 2011 and November 2014 in an outpatient university clinic, for either agoraphobia or specific phobia were invited to participate in this study. Participants were excluded if they had comorbid bipolar disorder, psychotic disorder, alcohol/substance abuse or dependency (within the past 3 months, excluding nicotine). Prominent risk of self-harm, organic mental disorder and concurrent psychotherapeutic or psychopharmacological treatment also led to exclusion.
Anxiety Sensitivity and Panic Disorder: Evaluation of the Impact of Cognitive-Behavioral Group Therapy
Published in Issues in Mental Health Nursing, 2021
Andressa da Silva Behenck, Ana Cristina Wesner, Luciano Santos Pinto Guimaraes, Gisele Gus Manfro, Carolina Blaya Dreher, Elizeth Heldt
According to the DSM-5 criteria (APA, 2014), panic disorder (PD) is an anxiety disorder characterized by anxiety attacks accompanied by physical symptoms (e.g., tachycardia, diaphoresis, dizziness, trembling, shortness of breath, abdominal discomfort, and depersonalization) and by affective symptoms (e.g., fear of death, fear of becoming insane, and fear of losing control), which appear abruptly and reach peak intensity within minutes. These attacks tend to be followed by anticipatory anxiety, i.e., fear of suffering another crisis and/or persistent apprehension about the consequences of PD. Agoraphobia is also common, characterized by fear and avoidance of places or situations from which it would be difficult to escape or where it would be difficult to obtain help if another attack occurred (APA, 2014).
Related Knowledge Centers
- Anxiety
- Anxiety Disorder
- Phobia
- Separation Anxiety Disorder
- Mental Disorder
- Abnormality
- Panic Attack
- Genetics
- Specific Phobia
- Social Anxiety Disorder