Phobias

Question 1

Define phobia

Answer 1

an intense, irrational fear of an object, situation, place or person that is recognised as excessive or unreasonable

symptoms are restricted to feared situation

Question 2

Define agoraphobia

Answer 2

‘fear of the marketplace’ = fear of public spaces or fear of entering a public space from which immediate escape would be difficult in the event of a panic attack

Question 3

Define social phobia (social anxiety disorder)

Answer 3

a fear of social situations which may lead to humiliation, criticism or embarrassment

Question 4

Specific (isolated) phobia

Answer 4

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

Question 5

RFs phobias

Answer 5

• Aversive/prior experiences
• Stress + negative life events
• Other anxiety disorders
• Mood disorders
• Substance misuse disorders
• FHx

Question 6

Aetiology agoraphobia

Answer 6

Maintained by avoidance which prevents deconditioning + sets up a vicious cycle of anxiety

Question 7

Aetiology social phobia

Answer 7

• Uncertain aetiology

- Begins adolescence (concerned about impression they make on others)

Question 8

Aetiology specific phobia

Answer 8

• Conditioning event in life (e.g frightening experience)
• Learned behaviour (e.g. from parents)
  ME

Question 9

CFs phobia

Answer 9

SYMPTOMS OF ANXIETY IN THE FEARED SITUATION

Biological
- Tachycardia
- Vasovagal response (bradycardia) – esp. in phobias of blood, injection and injury
→ can lead to syncope

Psychological

• Anticipatory anxiety (when there is prospect of encountering the feared situation) → differentiates it from GAD
• Inability to relax
• Urge to avoid situation
• Fear of dying

Question 10

Ix phobias

Answer 10

• Usually straightforward Dx because symptoms occur in defined situation
• Questionnaires:
o Social phobia inventory
o Liebowitz Social Anxiety Scale

Question 11

General phobia mx

Answer 11

• Establish good rapport w/ pt (esp. social phobia as may have been a challenge for pt to attend appointment)
• Advise avoidance of anxiety-inducing substances (e.g. caffeine)
• Screen for significant co-morbidities (substance misuse and personality disorders)
• Refer to specialist

FLOODING → not any better than graded exposure

Question 12

mx agoraphobia

Answer 12

Psychological: CBT
o Behavioural aspect of CBT used: desensitisation + graduated exposure techniques → e.g. walking ^ distances from home

Pharmacological: SSRIs (= first line)

Question 13

mx social phobia

Answer 13

Psychological: CBT
o Behavioural aspect of CBT used: desensitisation + graduated exposure techniques

Pharmacological: SSRIs (= first line) → SNRI (venlafaxine) → MAO-I (moclobemide)

If CBT + pharmacology declined → psychodynamic psychotherapy

Question 14

mx specific phobias

Answer 14

• EXPOSURE!!!!! → either by self-help or CBT

- Short term: BDZs (e.g. if pt needs urgent CT but they are claustrophobic or if the pt wants to fly)