Phobias & Somatisation Flashcards
What are phobias?
Phobias are described as a group of disorders in which anxiety is experiences only, or predominantly, in certain well-defined situations that are not dangerous. There situations are avoided or endured with dread.
What is Agoraphobia?
Anxiety and panic symptoms with places or situations where escape may be difficult - crowds, public places, travelling alone. Closely associated with panic disorder.
How is agoraphobia treated?
Antidepressants SSRI - Citalopram
Behavioural methods - exposure techniques focused on particular situations, relaxation training and anxiety management.
Patient education
What are social phobias?
Symptoms of incapacitating anxiety that are not secondary to delusion or obsessive thoughts and are restricted to to particular social situations, leading to a desire for escape or avoidance.
How do social phobias present?
1) Somatic symptoms of blushing, trembling, dry mouth, perspiration.
2) Avoidance of situations may lead to difficulty in maintaining social/sexual relationships, vocational problems and educational problems.
3) Suicidal thoughts
How are social phobias managed?
1) Psychological - CBT with graded exposure, relaxation techniques, anxiety management
2) Pharmacological - SSRI Escitalopram, SNRI Venlafaxine, Betablockers Atenolol (reduce autonomic arousal)
What are specific phobias?
Recurring excessive psychological or autonomic symptoms of anxiety in the presence of a specific feared object or situation (clowns, spiders, dentist) leading to avoidance.
How specific phobias are treated?
Psychological - Behavioural therapy with graded exposure, relaxation techniques and anxiety management. Patient education.
Pharmacological treatment not generally used - diazepam perhaps to help patients engage in exposure, atoll to reduce autonomic arousal.
What is somatisation disorder?
A disorder in which there is repeated presentation with medically unexplained symptoms affecting multiple organ systems, presenting before the age of 40. It is associated with psychological distress, functional impairment and risk of iatrogenic harm. Severe form - Briquets syndrome.
Risk factors of somatisation disorder?
1) Childhood illnesses
2) Childhood sexual abuse
3) History of parental anxiety to illness
4) First degree relative
Presentation of somatisation disorder?
Patients have long complex medical histories, with multiple reoccurring and frequently changing physical symptoms that have no medical explanation.
1) GI - N,V, diarrhoea, constipation, food intolerance, pain.
2) Urinary - dysuria, retention, incontinence, frequency
3) Sexual - ED, decreased libido, irregular menses
4) Neurological - Motor and sensory disturbance, coordination and balance problems, seizures, swallowing difficulty
Differentials for Somatisation disorder?
1) Soatoform pain disorder
2) Hypochondriasis
3) Facitious disorder
How to diagnose Somatisation disorder?
1) More than 2 yr history of multiple, reoccurring symptoms with no physical explanation.
2) Persistant refusal to be reassured there is no explanation for symptoms.
3) Some degree of impaired social/family functioning due to these symptoms.
Treatment of Somatisation disorder?
1) Acknowledge severity of symptoms and do appropriate examinations and investigations.
2) Explain link between symptoms and stress.
3) Treat co-morbid psychiatric problems - anxiety, depression and panic
4) CBT
