Patient Care Neurology & Psychiatry - November 2007 - (Page 20)

Help for your patients who suffer from specific Unlike other anxiety disorders, specific phobias generally do not respond well to medication. Here is how primary care physicians can help their phobic patients find relief from their paralyzing fears. S Article at a glance I I I I I I Specific phobias are characterized by marked, persistent, and unreasonable anxiety or panic when faced with specific situations or objects. Most phobias seen in primary care are not specific phobias. When individuals with specific phobias present for treatment, it is usually because their education, health care, employment, relationships, or mobility is significantly disrupted by fearful avoidance. The hallmark of cognitive behavioral treatment for specific phobias is graduated exposure to the phobic stimulus leading to gradual habituation or extinction. Unlike the other anxiety disorders, specific phobias are generally not responsive to medication. Specialist referrals should be considered when the initial assessment is unclear or selfconducted treatment proves insufficient. pecific phobias are the most prevalent and primordial of anxiety disorders. Long lists of phobias with myriad Greek roots are often cited in consumer press articles on anxiety, but these terms are of little use to clinicians. The research and clinical literature, as well as the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), suggest a much more limited constellation of phobias.1 Specific phobias are characterized by marked, persistent, and unreasonable anxiety or panic when a person is faced with specific situations or objects (eg, flying, heights, animals, receiving an injection, seeing blood). Escape and avoidance are common. Individual specific phobias are highly comorbid with other anxiety disorders. The DSM-IV-TR “clinical significance” criterion may be especially important when you are diagnosing a specific phobia, since many phobias are present for a lifetime without significant disruption of everyday life.2 When individuals with specific phobias do present for treatment, it is usually because their education, health care, employment, relationships, or mobility is significantly disrupted by fearful avoidance. Prevalence and course Prevalence of a current specific phobia ranges over the life span from 10% of children in primary care to 8.9% in an urban, multiracial sample of people older than 55.3,4 Lifetime prevalence is 12.5%.5 Specific phobia is twice as common in women than in men; women are more prone to animal phobias, but men are more likely to fear heights.6 Three out of 4 people with a specific phobia have more than one, and the “number of fears, independent of type, powerfully predicted impairment, co-morbidity, illness course, demographic features, and family psychopathology.”6 CONTRIBUTORS STEVEN L. SHEARER, PhD, is Coordinator of Behavioral Science Training, Family Medicine Residency Training Program, Franklin Square Hospital Center, Baltimore, Md; and a founding partner of the Anxiety and Stress Disorders Institute of Maryland, Towson. MICHAEL X. DWYER, MD, is on the faculty, Family Medicine Residency Training Program, Franklin Square Hospital Center, Baltimore, Md. 20 PATIENT CARE NEUROLOGY & PSYCHIATRY www.patientcareonline.com http://www.patientcareonline.com

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Patient Care Neurology & Psychiatry - November 2007 Contents Research Digest Medicine in the News The 15-Minute Visit Dementia workup and treatment: Do the drugs really work? Help for Your Patients Who Suffer from Specific Phobias Clinical Clips Case & Comment The Science of Healing Classified Advertising

Patient Care Neurology & Psychiatry - November 2007

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