agoraphobia

1. EDSON MUTANDWA
MBBS IV

2. OUTLINE
 INTRODUCTION
 AETIOLOGY
 CLINICAL FEATURES
 DIAGNOSTIC CRITERIA
 PROGNOSIS
 MANAGEMENT

3. INTRODUCTION
 The term "agoraphobia" is used here with a wider meaning
than it had when originally. It is now taken to include fears
not only of opens paces but also of related aspects such as
the presence of crowds and the difficulty of immediate easy
escape to a safe place (usually home).
 Most sufferers are women and the onset is usually early in
adult life.
 Depressive and obsessional symptoms and social phobias
may also be present
 In the absence of effective treatment, agoraphobia often
 becomes chronic, though usually fluctuating

4. AETIOLOGY
Theories of onset
 The cognitive hypothesis
 The biological theory
 The psychoanalytic theory
Theory of spread and maintenance
 Learning theories
 Personality
 Family influences

5. CLINICAL FEATURES
ANXIETY SYMPTOMS
Psychological arousal
Autonomic arousal
Gastrointestinal
Respiratory
Cardiovascular
Muscle tension
Hyperventilation
Sleep disturbance

6. CLINICAL FEATURES
SITUATIONS
Many situations provoke anxiety and avoidance but they
are three main themes or situations that provoke anxiety
and avoidance;
1. Distance from home
2. Crowding
3. Confinement

7. CLINICAL FEATURES
ANTICIPATORY ANXIETY
Anxiety appears hours before the person enters the
feared situation
OTHER SYMPTOMS
Depressive symptoms
Depersonalization

8. ICD-10 DIAGNOSTIC CRITERIA
All of the following criteria should be fulfilled for a definite
diagnosis:
a) the psychological or autonomic symptoms must be
primarily manifestations of anxiety and not
b) secondary to other symptoms, such as delusions or
obsessional thoughts;
c) the anxiety must be restricted to (or occur mainly in) at
least two of the following situations:
d) crowds, public places, travelling away from home, and
travelling alone; and
e) avoidance of the phobic situation must be, or have been,
a prominent feature

9. DSM-V DIAGNOSTIC CRITERIA
A. Marked fear or anxiety about two or more of the following five situations; (1)
Using public transport, (2) being in open spaces, (3) Being in enclosed
places (4) Standing in line or being in a crowd, (5) Being outside of the home
alone
B. The individual fears or avoids these situations
C. The agoraphobic situations almost always provoke fear or anxiety
D. The fear or anxiety is out of proportion to the actual danger posed by the
agoraphobic situations and to the sociocultural context
E. These situations are avoided or endured with stress
F. The fear, anxiety or avoidance is persistence typically lasting for 6 months or
more
G. The fear, anxiety or avoidance causes clinically significant distress or
impairment in social, occupational or other areas of functioning
H. If another medical condition is present, the fear, anxiety or avoidance is
excessive
I. The fear, anxiety or avoidance is not better explained by the symptoms of
another mental disorder

10. PROGNOSIS
Wittchen Iet al., 2010 state that agoraphobia that has
lasted for 1 year generally remains for the next 5 years,
and usually the illness runs a chronic course. Brief
episodes of depression are common during the chronic
course and more people are likely to seek help during
these episodes

11. MANAGEMENT
 Psychological treatment-exposure treatment
 Cognitive-behavioral therapy- anxiety management; in
short term is as effective as medications and in the
long term is probably more effective
 medications-; anxiolytic drugs, antidepresants drugs

12. REFERENCES
 Shorter Oxford textbook of Psychiatry by Philip
Cowen