Agoraphobia

Question 1

what does agoraphobia mean?

Answer 1

fear of open spaces

Question 2

How does ICD-10 define agoraphobia?

Answer 2

‘A fairly well-defined cluster of phobias embracing fears of leaving home, entering shops, crowds and public places, or travelling alone in trains, buses or planes. Panic disorder is a frequent feature of both present and past episodes. Depressive and obsessional symptoms and social phobias are also commonly present as subsidiary features. Avoidance of the phobic situation is often prominent, and some agoraphobics experience little anxiety because they are able to avoid their phobic situations’

Question 3

how does agoraphobia usually manifest?

Answer 3

as a fear of crowds, public places, travel or events away from home

Question 4

What does agoraphobia usually lead to?

Answer 4

social anxiety and avoidance

Question 5

What are the three basic elements of agoraphobia?

Answer 5

phobia
avoidance (of situations that may provoke anxiety)
severe anxiety

Question 6

What is the epidemiology?

Answer 6

• Tends to affect females more than males (twice as common in females)
• Most common age is 25-35 years old
• Affects up to 1/3 of patients with panic disorders and can occur before onset of attack

Question 7

How is it diagnosed?

Answer 7

Diagnosis based on history, usually including marked fear or anxiety of:
• Public transport
• Open spaces
• Being in shops, theatres, cinemas
• Standing in a queue or being on a crowd
• Being outside of the home alone in other situations

Question 8

What are the Ddx?

Answer 8

• Social Anxiety Disorder
• GAD
• Depression
• PTSD
• Physical disorders which cause reluctance to leave the home e.g. coronary heart disease

Question 9

What are the lifestyle changes that may help manage this condition?

Answer 9

• Avoid anxiety-provoking substances e.g. caffeine, alcohol, drugs
• Exercise

Question 10

What psychological mx is offered?

Answer 10

• Education on disorder
• CBT
• Self-help groups – focus on relaxation and breathing exercises

Question 11

what pharmacological Tx may be offered?

Answer 11

• SSRI  review after 2 weeks to check for side-effects and efficacy and then at 4, 6 and 12 weeks (then after that review at 8-12 weekly ntervals)
• Imipramine and clomipramine can be considered if no improvement on SSRI after 12 weeks