Notes

Outline

Panic, Agoraphobia and Simple Phobia Carol Watkins, MD

“It feels like you’re going to die..”

Panic Disorder Most often starts in late adolescence or adulthood Can occur in children or young adolescents Panic with agoraphobia is more common that without agoraphobia in youth.

Agoraphobia Anxiety about being in a place from which escape might be difficult or embarrassing. Fear of going somewhere associated with previous anxiety. The individual avoids the feared situation, or if he does not avoid them, experiences discomfort when he goes to these places. Can occur with or without panic attacks High rate of co-morbid depression

Consequences Adult panic disorder is associated with a high suicide rate Adult panic disorder associated with increased substance abuse Adult and child panic disorder is associated with other psychiatric disorders, especially depression and other anxiety disorders

Treatment of Panic Disorder Therapy Education Proper breathing Relaxation techniques Moving outside oneself and observing the panic Hierarchy Adequate sleep, meals, etc.

Panic Disorder-Medications SSRIs Zoloft (sertraline) Paxil (paroxetine) Prozac (fluoxetine) Benzodiazepines Beta Blockers Tricyclic antidepressants

Agoraphobia: Treatment Relaxation Hierarchy Progressive exposure (family may help although the child must set the pace)

Simple Phobia Biphasic onset: Childhood and mid-adulthood Fairly common “only a problem if it’s a problem” Treatment includes relaxation and gradual desensitization. Medications used less frequently