Agoraphobia & Social

phobia

Agorapho
bia
Agora phobos fear of
marketplace
Fear of or anxiety regarding
places from which escaping
might be difficult.
Patient recognized the fear
as irrational and unjustified
females > male affected
* the most disabling

of phobia patient
gradually preoccupied
with the phobia and
phobic object
May occur with panic
attack

Social anxiety
disorder
(social phobia)
Fear of social
situations
(contact with
Intense and
persistent FEAR
strangers)
of an object / situation and
there is insight
Vague, non specific
fear of embarassing
oneself
females> male
affected
Peak onset : teens, but
common at 5 y/o and 35
y/o
May have h/o of other anxiety
disorder (mood, Susbst. Related,
bulimia )

etiology
Agorapho
bia

Most cases are

thought to be
caused by panic
disorder
Stressfull life
events

Social anxiety
disorder
(social phobia)
Neurochemical factors
adrenergic receptor
antagonists decrease
epinephrine/
norepinephrine

Genetic factors
First degree relatives
3 times likely to have.
monozygotic>
dizygotic twins

pho
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bia

DSM-5 diagnostic criteria

Soc
i al a
nx
(soc iety di
s
ial p
hob order
ia)

a)
Fear // anxiety
a) Fear
anxiety when;
when;
1)
1) Use
Use public
public transportation
transportation
(bus
(bus ,trains
,trains ,, car
car ,, planes)
planes)
2)
2) In
In an
an open
open space
space
3)
In
an
enclosed
3) In an enclosed space
space
4)
4) In
In a
a crowd
crowd or
or people
people standing
standing in
in line
line
5)
Alone
outside
the
home
5) Alone outside the home

a)

Marked fear /anxiety about

one/more social situations
where the individual is
exposed to possible
scrutiny by others

b.
b. Scared
Scared because
because he/she
he/she is
is thinking
thinking that
that an
an
escape
escape will
will be
be difficult
difficult // help
help might
might not
not
available
available in
in the
the event
event of
of panic-like
panic-like symp/other
symp/other
incapacitating
/
embarassing
symp.
incapacitating / embarassing symp.

b)

The individual fears that

when he/she show anxiety
symptom it will be
negatively evaluated

Agoraphobia
Agoraphobia is
is diagnosed
diagnosed irrespective
irrespective of
of the
the
presence
presence of
of panic
panic disorder.
disorder.

c.
d.
e.
f.
g.
h.
i.

Agoraphobic/ SAD situation almost ALWAYS provoke fear /anxiety.

Fear/anxiety is out of proportion of actual danger
Fear , anxiety, avoidance that usually lasts for 6 months or more.
Fear, anxiety, avoidance cause clinically significant distress/ impairment
social , occupational or other imp. functioning.
If there is another medical medical cond. , fear , anxiety, avoidance is
clearly excessive
The social situations are avoided / endured with INTENSE fear or anxiety
Fear , anxiety , avoidance is not better explained by the symptom of

Ago

raph
bia o

Agorapho
bia

Prognosis
Agoraphobia
WITHOUT history of
Panic disorder is
INCAPACITATING and
CHRONIC

Differential diagnosis
Includes ALL medical
disorder that can cause
anxiety or depression
MDD,PPD, APD, DPD

Social anxiety
disorder
(social phobia)
Prognosis
existing epidemiological
findings indicate it is a
chronic case.
Over many years it
can distrupt the life of the
pt. (ex: job performance)

Differential
diagnosis
agoraphobia,
panic disorder,
APD, SPD

Agorapho
bia

Treatment
(pharmacotherapy)
BZD Alprazolam,
lorazepam
SSRI antidepressant
*Tricyclic
clomipramine ,
imipramine
Psychotherapy
Supportive psychotherapy.
Insight oriented
Behavior therapy
Cognitive therapy
Virtual therapy

Social anxiety
disorder
(social phobia)
Treatment pharmacotherapy
1)SSRIs
2)BZD alprazolam, clonazepam
3)Venlafaxine
4)Busiprone
5)Severe cases - irreversible MAOi
(phenelazine)
- reversible MAOi
( moclobemide)
* Performance situation
beta adrenergic antagonist (atenolol)

Psychotherapy - behavioral and

cognitive method
a)Cognitive retraining
b)Desensetization
c)Rehearsal during session
d)A range of homework assignment