definition, classification , etiology,clinical features, treatment,nursing management

1. PHOBIC ANXIETY DISORDER

2. PHOBIC ANXIETY DISORDER
 Anxiety is a normal phenomenon, which is
characterized by a state of apprehension or
uneasiness arising out of anticipation of danger.
Normal anxiety becomes pathological when it causes
significant subject distress and impairment of
functioning of the individual.
 A phobia is an unreasonable fear of a specific object,
activity or situation.

3. CLASSIFICATION
F40.0:- AGORAPHOBIA
F40.1 :-SOCIAL PHOBIA
F40.2:- SPECIFIC PHOBIA
F40.8 :-OTHER PHOBIC
ANXIETY DISORDER
F40.9 :- PHOBIC ANXIETY
DISORDER,UNSPECIFIED

4. TYPES OF PHOBIA
SIMPLE PHOBIA
SOCIAL PHOBIA
AGORAPHOBIA

5. SIMPLE PHOBIA (SPECIFIC PHOBIA)
IRRATIONAL FEAR OF A
SPECIFIC OBJECT OR
STIMULUS. SIMPLE PHOBIAS
ARE COMMON IN CHILDHOOD.
BY EARLY TEENAGE,MOST OF
THESE FEARS ARE LOST,BUT A
FEW PERSIST TILL ADULTS
LIFE.

6. SIGNS AND SYMPTOMS OF SPECIFIC PHOBIA
 IRRATIONAL AND PERSISTENT FEAR OF
OBJECT OR SITUATION.
 IMMEDIATE ANXIETY ON CONTACT WITH
FEARED OBJECT OR SITUATION
 LOSS OF CONTROL,FAINTING OR PANIC
RESPONSE
 AVOIDANCE OF ACTIVITIES INVOLVING FEAR
STIMULUS.

7. ANXIETY WHEN THINKING
ABOUT STIMULUS
WORRY ABOUT ANTICIPATORY
ANXIETY
POSSIBLE IMPAIRED SOCIAL OR
WORK FUNCTIONING.

8. SOCIAL PHOBIA
It is an irrational fear of performing
activities in the presence of other
people or interacting with others.
The patient is afraid of his own
actions being viewed by others
critically, resulting

9. Signs and symptoms
 Hyperventilation
 Sweating ,cold and clammy hands
 Blushing
 Palpitation
 Confusion
 Gastrointestinal symptoms
 Trembling hands and voices
 Urinary urgency
 Muscle tension
 Anticipatory anxiety

10. AGORAPHOBIA
 It is characterized by an irrational fear of being in
places away from the familiar setting of in crows,
or in situation that the patient cannot leave easily

11. SIGNS AND SYMPTOMS
 OVERRIDING FEAR OF OPEN OR PUBLIC
SPACES
 AVOIDANCE OF PUBLIC PLACES AND
CONFINEMENT TO HOME
 WHEN ACCOMPAINED BY PANIC
DISORDER,FEAR THAT HAVING PANIC ATTACK
IN PUBLIC WILL LEAD TO EMBARRASSMENT OR
INABILITY TO ESCAPE(FOR SYMPTOMS OF
PANIC ATTACK).

12. ETIOLOGY
 PSYCHODYNAMIC THEORY :- According to this
theory, anxiety is usually dealt with repression.
When repression fails to function adequately. other
secondary defense mechanisms of ego come in to
action. In phobia this secondary defense
mechanism is displacement.by displacement
anxiety is transferred from a really dangerous or
frightening object to the neutral object.

13.  The neutral objectives chosen unconsciously is the
one that can be easily avoided in day to day activities,

14.  Learning objectives :- according to classical
conditioning a stressful stimulus produces an
unconditioned response-fear when the stressful
stimulus is repeatedly paired with a harmless object,
the harmless object alone produces the fear.which is
now a conditioned response,if the person avoid the
harmless object to avoid fear,the fear becomes a
phobia

15.  Cognitive theory :- Anxiety is the product of faulty
cognitions or anxiety inducing self instruction.
Cognitive theorists believe that some individual
engage in negative and irrational thinking that
produce anxiety reactions.

16. DIAGNOSIS
 NO SPECIFIC DIAGNOSTIC TEST,DIAGNOSIS
CONFIRMED IF ICD 10 CRITERIA MET
 HISTORY OF ANXIETY WHEN EXPOSED TO OR
ANTICIPATING SPECIFIC ENTITY OR SITUATION

17. TREATMENT
 PHARMACOTHERAPY :-
BENZODIAZEPINES (FOR EXAMPLE :-
ALPRAZOLAM,CLONAZEPAM,LORAZEPAM.)
ANTIDEPRESSANTS (FOR EXAMPLE :-
IMIPRAMINE,)
 BEHAVIOR THERAPY
PSYCHOTHERAPY

18. NURSING MANAGEMENT
 NURSING ASSESSMENT :-
FOCUS ON physical symptoms, precipitating factors,
avoidance behavior associated with phobia, impact
of anxiety on physical functioning, normal coping
ability ,thought content and social support system.
 HISTORY AND MSE

19. NURSING DIAGNOSIS
 Fear related to a specific stimulus (simple phobia),or
causing embarrassment to self in front of others as
evidenced by behavior directed towards avoidance of
the feared object/situation.
 Social isolation related to fear of being in a place
from which one is unable to escape as evidenced by
refusing to leave the room