Anxiety disorders: Phobic anxiety disorders

Question 1

Define Phobia

Answer 1

Intense/irrational fear of an object/situation/place that is recognised as excessive or unreasonable

Question 2

Define Agoraphobia

Answer 2

Fear of public places from which immediate escape in the case of a panic attack would be difficult

Question 3

What is Social Phobia?

Answer 3

The fear of social situations as they are perceived to lead to humiliation/criticism/embarrassment

Question 4

Describe the aetiology of Agoraphobia

Answer 4

Maintained by anxiety and avoidance which prevents deconditioning and sets up a viscous cycle of anxiety

Question 5

Describe the aetiology of Social Phobia

Answer 5

Usually begins in late adolescence as people are concerned about the impression they make on others

Question 6

Describe the aetiology of specific phobias

Answer 6

Conditioning early in life either from own frightening experience or learnt from parents

Question 7

Describe two biological and two psychological features of specific phobias

Answer 7

Biological : Tachycardia, Vasovagal
Psychological: Inability to relax, fear of dying

Question 8

Describe the ICD10 diagnosis of Agoraphobia

Answer 8

A - Marked fear and subsequent avoidance of two of crowds/public places/travelling alone

B - Atleast two symptoms of anxiety in feared situations

C- Significant emotional distress that is excessive or unreasonable

D - Symptoms restricted to feared situation

Question 9

Describe the ICD10 diagnosis of Social Phobias

Answer 9

A - marked fear of being focus of attention
B - At least two symptoms of anxiety plus blushing/fear of vomit/urgency
C - Significant emotional distress due to avoidance or anxiety symptoms
D - Symptoms are excessive/unreasonable
E- Symptoms restricted to feared situation

Question 10

Describe the ICD10 diagnosis of Specific Phobias

Answer 10

A - Marked fear/avoidance of situations
B - Symptoms of Anxiety in feared situation
C - Significant emotional distress that’s excessive or unreasonable
D - symptoms restricted to feared situation

Question 11

Describe the differences between phobic anxiety and GAD

Answer 11

PA occurs in specific situations
PA has anticipatory anxiety where there is a prospect of encountering the feared situation
PA has attempted avoidance of circumstances that precipitate anxiety

Question 12

Name two potential questionnaires for patients with phobic disorder

Answer 12

Social Phobia Inventory
Liebowitz Social Anxiety Scale

Question 13

Describe the general management of Phobic Disorders

Answer 13

• Good rapport with patient
• Avoidance of Anxiety Inducing Substances (Alcohol, Caffeine)
• Screen for Co Morbidities (Substance Misuse, Personality Disorder)
• Refer to specialist if there is risk of self harm, self-neglect or significant co-morbidity

Question 14

Name the two main psychological and 1 pharmacological interventions for Specific Phobias

Answer 14

CBT
Graduated Exposure

benzodiazepines may be used as anxiolytics in the short term (risk of dependence)

Question 15

What is the first line Pharmacological management of Phobic Disorders

Answer 15

SSRIs (Sertraline or Escitalopram)

2nd and 3rd line include SNRIs and Moclobamide

Question 16

what is a Specific (isolated) phobia?

Answer 16

fear restricted to a specific object or situation (excluding agoraphobia and social phobia)

Question 17

describe the MSE findings for phobic anxiety disorders

Answer 17

Question 18

management of Agoraphobia

Answer 18

CBT - psychological intervention of choice. includes graduated exposure

SSRIs - 1st line pharmacological

Question 19

management of social phobia

Answer 19

CBT including graduated exposure

pharmacological interventions include SSRIs, SNRIs, if no response MAOI

psychodynamic psychotherapy for those who decline CBT medication

Question 20

risk factors for phobias

Answer 20