AGORAPHOBIA

CASE: With repeated such attacks Mr Sumant was so afraid that he would not travel alone anywhere. Whenever it was absolutely necessary, wife or any other relative (even a seven year old nephew) would accompany him and then he would be able to travel. Due to his illness he changed the office to a nearby area so that he did not have to travel by train. The patient improved with antidepressant line of therapy along with psychotherapy particularly cognitive behavioral therapy. Within three months he was travelling long distances all by himself.

The essential feature of Agoraphobhia is anxiety of fear about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having a panic attack. The feat typically leads to avoidance of a variety of situations that may include being alone outside the home, being in crowded places or in train, bus, car or airplane, being in an elevator. Often an individual is better able to confront a feared situation when accompanied by a companion even a young child. A person avoids going out and/or does accept responsibilities of requiring travelling work particularly if the person has to do so alone.

Many patients with panic disorder present with chest pain, palpitation, tachycardia and are frequently seen in cardiology practices and clinics where their syndromes are often unrecognized and not treated properly. Many patients with panic disorder have consulted 5 or more physicians prior to having their disease correctly diagnosed and their medical histories include a numerous negative procedures and treatments which are not effective. The studies suggest that the majority of patients with chest pain and normal stress test probably have a panic disorder and require treatment accordingly.

TREATMENT

With treatment most patients have a dramatic improvement in symptoms of panic disorder and agoraphobia. The most effective treatments are medication and cognitive therapy. Family therapy may help affected patients and their family members to adjust to the fact that patients have the illness and to the psychosocial difficulties the illnesses may have precipitated.

MEDICATION

Antidepressant medication (trycyclics, specific serotonin reuptake inhibitors) and benzodiazepines are effective drugs. Panic attacks are controlled by medication.

COGNITIVE THERAPY

The two major foci of cognitive therapy are instructions regarding the patients’ false belief and information regarding panic attacks. The patient is made to understand that he does not have a serious illness. The attacks remain for a short period and time-limited. The patient is encouraged to continue work or travel further once the panic attack is over.

The patients are taught techniques of relaxation (meditation, shavasana, yoga etc.,) that will help them through panic attack and would install self confidence.