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.
Read this blog to get a quick overview of this important Psychiatry topic for NEET PG/NExT exam preparation.
Panic Attack
Panic attack is an acute attack of intense anxiety, with a ‘feeling of impending doom.’
Diagnosis of panic disorder: recurrent and unexpected panic attacks.
Important information
- Expected panic attack
- E.g. When you are in the examination hall, you are asked question s of higher level, you will have an unexpected panic attack.
- In panic disorder, the patient will have unexpected panic attacks
Usual symptoms
- Sudden chest pain
- Difficulty in breathing
- Hyperventilation
- Sweating
Differential Diagnosis of Panic disorders
- Cardiac causes: MI, angina, cardiac arrhythmias, MVP
- Respiratory causes: Acute asthma, COPD, PE
- Endocrine disorders: Pheochromocytoma, carcinoid syndrome, hyperthyroidism, hypoglycemia, anemia, temporal lobe epilepsy.
Treatment
- 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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