Patient Care Neurology & Psychiatry - November 2007 - (Page 22)

I Specific phobias tions, and, preferably, long-term followup. Assessment of fear during exposure is Phobias seen in primary care that often usually measured in subjective units of are not specific phobias distress (SUDS) from 0 (no distress) to 100 (maximum distress). The SUDS conIf the presentation is . . . Consider cept is useful for self-conducted exposure “Illness phobia” OCD; hypochondriasis and for tracking progress. When presented with a possible pho“Germ or toxin phobia” OCD bia, the primary care physician should clarify the course, distress, avoidance, and “Claustrophobia” Panic disorder; PTSD disruption to daily living. Assessment “Driving phobia” Panic disorder; PTSD should focus on 2 points: • Whether the symptoms and course are “Bridge/heights phobia” Panic disorder or OCD with intrusive best accounted for by one of the other thoughts about losing control anxiety disorders with different treatment implications “Flying phobia” Panic disorder (fear of panic), often combined with specific phobia (fear • Whether a program of graduated expoof crashing) sure is indicated, either through patient education and self-conducted exposure “Fear of being alone” OCD with self-harm obsessions; or through specialty referral. PTSD; separation anxiety disorder Specific phobias are highly comorbid “School phobia” Willful refusal; reaction to bullying; with other anxiety disorders. Note, too, separation anxiety disorder; social that apparent “phobias” seen in primary anxiety disorder; panic attacks; care are often not specific phobias per se ADD; learning disorder and may have quite different implications Key: ADD, attention deficit disorder; OCD, obsessive-compulsive disorder; PTSD, for treatment (see Table 1). For example, posttraumatic stress disorder. a patient who has panic attacks only in response to a single specific phobic stimbeen reported that difficult-to-control childhood ulus that is perceived as dangerous may well have a experiences (such as chronic parental violence) can specific phobia. Panic attacks in response to bodily 15 influence specific phobia onset. In summary, the arousal that is perceived as dangerous and ocetiology of specific phobias is likely to be multifaccurring in multiple situations suggest the diagnosis torial with variation across phobia types and indiof panic disorder. In this case, a selective serotonin viduals. reuptake inhibitor (SSRI) and/or cognitive behavioral treatment (CBT) that emphasizes interoceptive Assessment exposure to bodily arousal is indicated. (InteroIn addition to the Fear Survey Schedule, which is ceptive exposure involves using other means to reavailable for screening, many other questionnaires create the feared bodily sensations that occur in the focus on particular specific phobias (eg, heights, phobic situation—exercise for tachycardia, hyperclaustrophobia, spiders, snakes, dental or medical ventilation for lightheadedness, bodily spinning for procedures).16 However, none of these is likely to be dizziness.) useful in primary care. Similarly, panic attacks in response to intrusive Outcome studies assess the actual behavioral apthought content (“What if I lose control of myself proach to the phobic stimulus in analogue situations and drive my car off the bridge?”) may indicate ob(eg, video, pictures, virtual reality), real world situasessive-compulsive disorder rather than a specific TABLE 1 22 PATIENT CARE NEUROLOGY & PSYCHIATRY www.patientcareonline.com http://www.patientcareonline.com

Table of Contents Feed for the Digital Edition of Patient Care Neurology & Psychiatry - November 2007

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

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.