Specific Phobia - PowerPoint Presentation

Slide1

Specific Phobia

Anxiety disorders:(Simple phobia)Slide2

Definition:A. Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood). Slide3

Definition:B. Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response,

Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging. Slide4

Definition:C. The person recognizes that the fear is excessive or unreasonable.

Note: In children, this feature may be absent.D. The phobic situation(s) is avoidedSlide5

Definition:E. The avoidance, anxious anticipation, or distress in the feared situation(s)

interferes significantly with the person's normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia. Slide6

Definition:

F. In individuals under age 18 years, the duration is at least 6 months. G. The anxiety, panic attacks, or phobic avoidance associated with the specific object or situation are not better accounted for by another mental disorder, such as OCD

(e.g., fear of dirt in someone with an obsession about contamination),

PTSD

(e.g., avoidance of stimuli associated with a severe stressor),

SAD

(e.g., avoidance of school),

social phobia

(e.g., avoidance of social situations because of fear of embarrassment),

panic disorder with agoraphobia, or agoraphobia without history of panic disorder.Slide7

Specify type::

1. Animal type

2

.

Natural environment type

(e.g., heights, . storms, water)

3

.

Blood-injection-injury type

4

.

Situational type

(e.g., airplanes, elevators, . enclosed places)

5

. Other type (e.g., fear of choking, vomiting, . or contracting an illness; in children, fear . of loud sounds or costumed characters)     Slide8

Final diagnose:Normal - abnormal barrier ? : “clinically significant” distressImpaired functioning ?

Clinical judgmentOrganizing ideas: Empiricism/ E-B Medicine / Translational Science/ . Development Slide9

epidemiologyMany people report subclinical fears of specific objects

12 month prevalence: 1/9 % in china to 8/7% in USLife time prevalence: 1/5 to 10/8 percentBoys: 1 - 7.7 Girls: 2 – 17.8 percentBimodal age of onset: childhood peak

for animal, natural, and blood -injury phobias

Early adulthood

peak for others (situational) Slide10

social Phobia

Anxiety disorders:(

social anxiety disorder

)Slide11

epidemiology

Life time prevalence of anxiety disorders in IRAN (CTP): agoraphobia: 0.7% social phobia: 0.8 GAD: 1.3% panic: 1.5% OCD: 1.8% All anxiety disorders : 8.4%

Life time prevalence of social

phobia in IRAN:

0/8

%

Mohammadi

MR,

Davidian

H,

Noorbala

AA,

Malekafzali

H,

Naghavi

HR: An epidemiological survey of psychiatric disorders in Iran. Clinic

Pract Epidemio Ment Health. 2005;26; 1:16.Mohammadi MR, Ghanizadeh, A, Mohammadi M, Mesgarpour B: Prevalene of social phobia and its comorbidity with psychiatric disorders in Iran. Depress Anxiety. 2006;23(7) : 405.Slide12

epidemiology

Social phobia : 0.2 – 15%Highest prevalence in new zealandthe lowest prevalence = Asian countries ( china & Korea= 0/2)more common in Female than menBoys: 2 – 8% Girls: 2 – 14%

Onset: late childhood and early adulthoodSlide13

Definition:A

-A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears will be humiliating or embarrassing.Note: In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not just in interactions with adults. Slide14

Definition:B- Exposure to the feared social situation almost provokes anxiety,

Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from social situations with unfamiliar people. C- The person recognizes that the fear is excessive or unreasonable.

Note

: In children, this feature may be absent. Slide15

Definition:D-The feared social or performance situations are avoided or else are endured with intense anxiety or distress.

E-The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia. Slide16

Definition:F-

In individuals under age 18 years, the duration is at least 6 months. G-The fear or avoidance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition and is not better accounted for by another mental disorder (e.g.,

panic disorder with or without agoraphobia, separation anxiety disorder, body

dysmorphic

disorder, a pervasive developmental disorder, or schizoid personality disorder). Slide17

Definition:H-

If a general medical condition or another mental disorder is present, the fear in Criterion A is unrelated to it (e.g., the fear is not of stuttering, trembling in Parkinson's disease, or exhibiting abnormal eating behavior in anorexia nervosa or bulimia nervosa).

Specify

if:

   Generalized

: if the fears include most social situations

(also consider the additional diagnosis of avoidant personality disorder)Slide18
Slide19
Slide20

Etiology of phobiasBehavioral factors

: classic stimulus response theory operant conditioning theoryPsychoanalytic factors: phobic neurosis/ signal anxiety ( id, separation, castration, superego) defense mechanisms: repression, displacement, symbolization, avoidance

Environmental stressors

: humiliation, criticismSlide21

Etiology of phobias

Genetic factors: Specific phobia tends to run in families. The blood-injection-injury type has a particularly high familial tendency. First-degree relatives of social phobia are about three times more likely to be affected with social phobia. Monozygotic twins are more often concordant than are dizygotic

twins

Neurochemical

Factors:

peformance

phobia : release more

norepinephrine

or epinephrine generalized social phobia:

dopaminergic

activitySlide22

managementFirst step

: exclude medical illness ( asthma, hypoglycemia, cardiac problems and seizure, hyperthyroidism, pheochromocytoma, tumor, drug use or withdrawalIn general, appropriate management initially involves pharmacotherapy & CBT

Beta adrenergic antagonists

:

propranolol

20- 40 mg per dose &

atenolol

25 – 50 mg per dose for performance anxiety or 30 – 60 minutes before performance situation. Slide23

managementantidepressants

: SSRIs & venlafaxine for general social anxiety : effective doses are the same for depression but to start with lower initial doses than in depression and titrate upward more slowly. Therapeutic response 8 -12 weeks at an optimized dose.Slide24

management

Benzodiazepines: PRN basis in performance anxiety ( alprazolam

/

lorazepam

/

clonazepam

) BNZ add to antidepressants for better effect in less than optimal response to

antidep

.

Atypical antipsychotics:

limited to augmentation of antidepressants- resistant anxiety

Duration:

1 to 2 years then

tapering: 10 to 25% every 1 to 2 months.

CBT: exposure ( systematic Desensitization / vivo exposure / imaginal exposure) is the treatment of choice for specific phobia and social phobia.Slide25

گزارش موردپسر كلاس اول دبستان. چپ دست / پدر كمرو / روابط اجتمايي محدود

كلاس دوم راست دستش مي كنند در سالهاي بعدي:كمرو (خجالتي)دبيرستان: آشكار شدن فوبياي اجتماييورود به دانشگاه با تداوم فوبياي اجتماييورود به دوره دستياري : اقدام به درمان براي اولين بار: شناخت درماني + مواجهه سازي + ايندرالSlide26

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