اعتراض شديد اللهجة ... لبورداب الخرطوم

Quote: Background: A phobia is defined as an irrational fear that produces a conscious avoidance of the feared subject, activity, or situation. The affected person usually recognizes that the reaction is excessive. Phobic disorders can be divided into 3 types: specific phobias, social phobia, and agoraphobia. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) defines specific phobia as a strong, persisting fear of an object or situation, whereas social phobia is a strong, persisting fear of an interpersonal situation in which embarrassment can occur. Agoraphobia is defined as the fear of being alone in public places (eg, a supermarket), particularly places from which a rapid exit would be difficult in the course of a panic attack. At least 75% of patients with agoraphobia experience panic disorder as well. Specific phobia is more common than social phobia. Examples of specific phobia include animal type, natural environment type (eg, height, water, storm), blood injection/injury type, situational type (eg, planes, elevators, enclosed spaces), and other types. Collectively, these disorders are the most common forms of psychiatric illness, surpassing rates of mood disorders and substance abuse. Anxiety linked to a specific object or situation is the most common subtype. Severity can range from mild and unobtrusive to severe and can result in incapacity to work, travel, or interact with others. Pathophysiology: Sympathetic nervous system activation is common in the phobic disorders, resulting in elevations in heart rate and blood pressure, as well as symptoms such as tremor, palpitations, sweating, dyspnea, dizziness, and/or paresthesias. Cognitive distortions, such as fear of scrutiny by others or fear that one is trapped without escape, also are common. Several theories are postulated for the biological etiology of phobic disorders, most focusing on the dysregulation of endogenous biogenic amines. Genetic factors also play a role in both social phobia and specific phobia, especially blood-injection-injury type, where two thirds to three fourths of patients have at least one affected first-degree relative. Psychological theories range from displacement of intrapsychic conflict to conditioning (learned) paradigms, depending on the background of the researcher. Many of these theories capture portions of the disorder and guide the clinician to choose appropriate treatments. A behaviorist would classify phobia as an unwanted conditioned response, perhaps paired with an originally neutral stimulus. Thus, social situations are avoided because of intense anxiety originally experienced in that setting. Nothing is dangerous in most social encounters, but an avoidance response becomes linked to these situations. Treatment from this perspective then would focus on de-linking this specific response from the stimulus. Likewise, a psychoanalyst would view social anxiety as a symptom of a deeper conflict—for instance, low self-esteem. The treatment then would focus on improving the patient's view of himself. Frequency: In the US: Occurrence of phobias as a whole is as follows: Prevalence of 1 month is 6.2%. Prevalence of 6 months is 7.7%. Lifetime rate is 12.5%. Occurrence of phobia by type is as follows: Specific phobia has a 6-month prevalence of 4.5-11.8%. Social phobia has a lifetime prevalence of 1.9-3.2%. Agoraphobia has a lifetime prevalence of 2.5-6.5%. Internationally: European data generally are similar to those of the United States. Mortality/Morbidity: Death is uncommon. Suicide can occur in cases of severe agoraphobia, especially in those associated with panic disorder. Significant morbidity is possible in terms of work and relationships, especially in social phobia and agoraphobia. Race: The occurrence of phobias appears equally distributed among races. Sex: Specific phobia has a female-to-male ratio of 2:1. Social phobia is more common in women, but more men seek treatment due to career issues. Agoraphobia has a female-to-male ratio of 2-3:1. Age: Most anxiety disorders appear earlier in life. Animal phobias are most common at the elementary school level. Other phobias appear later on. Agoraphobia and social phobia tend to reach a peak prevalence in later adolescence or early adulthood. Specific phobia: Age of onset depends on the phobia. In general, specific phobia appears earlier than social phobia or agoraphobia. Examples include the following: Animal phobia appears at a mean age of 7 years. Blood phobia appears at a mean age of 9 years. Dental phobia appears at a mean age of 12 years. Claustrophobia appears at a mean age of 20 years. Social phobia: Most social phobias begin before age 20 years. Agoraphobia: Agoraphobia usually begins in late adolescence to early adulthood. History: The physician will want to question the patient about any difficulties in social situations, such as speaking in public, eating in a restaurant, or using public washrooms. Fear of scrutiny by others or of being embarrassed or humiliated is described most commonly by people with social phobia. Furthermore, inquire about any intense anxiety reactions that occur when the patient is exposed to specific situations such as heights, animals, small spaces, or storms. Other areas of inquiry include fear of being trapped without escape (eg, being outside the home and alone; in a crowd of unfamiliar people; on a bridge, in a tunnel, in a moving vehicle [agoraphobia]). Phobias can cause emotional distress, leading to other anxiety disorders, major depressive disorders, and substance-related disorders, especially alcohol use disorder. The physician must inquire about these areas as well. Physical: A complete mental status examination (MSE) is indicated when evaluating psychiatric symptoms. A basic MSE would include a description of the patient's behavior and appearance, attitude toward the physician, and details about mood and affect. Speech is examined for prosody, rate, and volume. The physician also asks about any perceptual disturbances and any abnormalities in thought process or content. Level of alertness, orientation, memory, and other aspects of the patient's sensorium and cognition are noted. The physician finally comments on impulse control, judgment, and the patient's reliability. Anxiety is the most common feature in phobic disorders. Manifestations include the following (which should be asked about and examined): Elevated heart rate Elevated blood pressure Tremor Palpitations Diarrhea Sweating Dyspnea Paresthesias Dizziness Causes: Social phobia can be initiated by traumatic social experience (eg, embarrassment) or by social skills deficits that produce recurring negative experiences. A hypersensitivity to rejection, perhaps related to serotonergic or dopaminergic dysfunction, is present. Current thought is that social phobia appears to be an interaction between biological and genetic factors and environmental events. Specific phobia can be acquired by conditioning, modeling, traumatic experience, or even may have a genetic component (eg, blood-injury phobia). Agoraphobia may be the result of repeated, unexpected panic attacks, which, in turn, may be linked to cognitive distortions, conditioned responses, and/or abnormalities in noradrenergic, serotonergic, or gamma-aminobutyric acid (GABA)–related neurotransmission.