Panic disorders and phobias are considered important topics in Psychiatry for the NEET PG exam as these are among the most common mental health conditions, affecting a large number of individuals. Panic disorder and phobias can significantly impair an individual's quality of life, leading to social isolation, decreased work performance, and decreased overall functioning. A good understanding of these conditions can help medical professionals to diagnose and treat these conditions effectively.
Benzodiazepines (Immediate treatment in acute episode): Short term
SSRIs: Long term
Cognitive behavioral therapy (CBT)
AGORAPHOBIA
Fear of places from which escape is difficult (from where it is difficult to run out)
Fear of open spaces
Fear of crowded places
Fear of enclosed places
Fear of traveling alone (Patient gradually becomes homebound)
Fear of public transport
Important Information
Anticipatory Anxiety
Person is anxious that the next panic attack is just about to happen (feared to occur out of the blue)
Person starts avoiding situations where he/she may have a panic attack
Many patients with panic disorder later develop Agoraphobia
Important Information
Agoraphobia and panic disorder are usually comorbid and coexist together
But agoraphobia can happen without panic disorder too
Treatment
Benzodiazepines: Short term
SSRIs: Long term
Behavioral therapy
Important Information
For treating phobias
Behavioral therapy > Cognitive behavioral therapy
SPECIFIC PHOBIAS
Phobia
Irrational Fear of an object or a situation
Examples
Acrophobia: Fear of heights
Thanatophobia: Fear of death
Claustrophobia: Fear of enclosed spaces
Nyctophobia: Fear of dark
Treatment
Benzodiazepines: Short term
SSRIs: Long term
Behavioral therapy
Systematic desensitization: There is a stepwise exposure with the use of relaxation techniques like deep breathing and progressive muscle relaxation which have a calming impact.
Purpose: The patient will be exposed to a feared stimulus, increased in a stepwise manner while he is relaxing using one of the techniques.
E.g. The patient is afraid of rats
Step 1: Show the picture of a rat while he is doing deep breathing or muscle relaxation (No anxiety)
Step 2: Show him a video of a rat, along with relaxation techniques (not much anxiety)
Step 3: Show him a rate from a distance along with relaxation techniques
Step 4: Bring the rat nearby
Step 5: Bring the rat right up to the person
Therapeutic graded exposure: There is a stepwise exposure without using relaxation techniques
Step 1: Show the picture of a rat without using any relaxation techniques. Wait for the anxiety to come down on its own and then move to the next step.
Step 2, 3, 4 & 5 follow similarly without the use of relaxing techniques
Usually this is used in clinical practices
Flooding: In this maximal exposure is given in one go
E.g. Send the patient to a room full of rats and lock the door from outside
Patient will become anxious, and will start crying and shouting. But his anxiety will come down after sometime
This is not a preferred technique: Person may have a panic attack or even worse may happen (like Myocardial Infarction)
Participant modeling: Here the learning happens by observation
Therapist acts as a model
Therapist goes nearby a rat and stands close to it
The patient observes the therapist and learns that the rat is not dangerous
Important Information
Anxiety develops and goes up initially, but it has to come down after sometime on its own.
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