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Agoraphobia
- refers to public meeting places (agora = market)
- fear includes
- being in places form which escape is difficult or embarrassing
- falling ill
- having panic in public
- leads to avoidance and anticipatory anxiety
Diagnosis
- ICD-10
- 2 of 4 from fear /avoidance of
- crowds
- public places
- travelling alone
- travelling far from home
- DSM-IV
- central role of panics / fear of having panic
History
- Worse when alone or far from home
- better with trusted companion
- often associated with panics, depressive and obsessional symptoms
- may be generalised anxiety
- loss of libido but no increase in marital problems
- may be associated with dependant personality traits
- onset typically 18-35 years, earlier in those with childhood seperation
anxiety
- precipitants unclear but increased life events prior to onset
- 2x more prevalent among women (lifetime rate 6-10%)
Course
- fluctuating
- if last 1yr then unchanged at 5 yr without treatment
Treatment
- Tricyclics (imipramine) build dose slowly to typically 150mg/d
- MAOIs (Phenelzine 45mg/d)
- Benzodiazepines not recommended in UK,
(alprazolam licensed in US)
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