1. PHOBIA الخوف Dr. Najat M. Al-Saffar Dr. Najat M. Al-Saffar

2. PHOBIA الخوف Definition : It is one of the Neurotic disorder in which fear is related to an object, person, action, place or situation It is one of the Neurotic disorder in which fear is related to an object, person, action, place or situation In phobic disorder : 1. Fear is out of proportion to the demand of the situation. 2. It is beyond voluntary control. 3. The fear leads to an avoidance of the feared situation. The causes of phobia 1. Psychogenic – It is due to frustration which leads the pt. to be unsafe and insecure. 2. Conditioned or learned phobia. It is based on Pavlove theory ex. The child learned to be afraid from events like thunder or animals such as mice frog, dog, cat Hysterical phobia-like fear from going out alone. 3. Obsessional phobia – pt. frightened that some thing might happen so he is compelled to think about it although he realize it silly and rediculus شحري او مضحك

3. Clinical types of phobia انواع حالات الخوف  Agoraphobia ( fear of open spaces ) 66% female, 34% male, mostly symptoms develop 15-35 years agemostly fear going out like for shopping. Predisposing factors 1. Passive, anxious and dependable premorbid personality type. 2. Often ppt. by major life events. 3. History of childhood fear and enurersis 4. May persist for many years.

4. 2. Social phobia ( fear of crowdede places) 2. Social phobia ( fear of crowdede places) 60% women, 40% men, usually developed after puberty and its peak in late years, persistent, irrational fear with compelled desire to avoid situation is which the individual may exposed. The fear may lead the individual to behave abnormally like shaking hand, shouting. People with social phobia usually have social skills but need to undergo relaxation training and a combination of cognitive therapy with exposure to a feared situation.

5. 3. Simple phobia Are common and the fear is irrational by the person experiencing them common phobia such as spider, mice, frog. Are common and the fear is irrational by the person experiencing them common phobia such as spider, mice, frog. 4. Obsessional phobia Pt. Frightened that some thing might happen, he is compelled to think about it although he realize it is silly. Pt. Frightened that some thing might happen, he is compelled to think about it although he realize it is silly. 5. School phobia School phobia is a persistance reluctant or refusal to go to school in order to stay at home the major figure. Is

6. Child not not at home (run away ) at school At home kept at home domestic reason psychological distubance in parent psychological distubance in parent School refusal School refusal Separate anxiety Fear of travel special fear of school Fear of travel special fear of school General social with drawal General social with drawal

7. At home – too protective parent prevent child from going to school - Disease of one of the parent - Problem betmean parent so child afraid from leave them alone Treatment of phobia The treatment rest on the careful assessment and formulation of the pt. condition, the treat are :- * Behaviour therapy : * Behaviour therapy : 1. Systematic desensitization by gradual with drawal of phobia stimuli, it carry a good response with more specific phobic. 2. Flooding (implosion) by exposure to feared stimuli many times. 3. Modelling – to observe the therapist (model) Some time combination ofmodelling with flooding and moderate dose of diazepam is effective for the treatment of Agoraphobia Some time combination ofmodelling with flooding and moderate dose of diazepam is effective for the treatment of Agoraphobia

8. Drug Therapy :- Drug Therapy :- Benzodiazepines is effective for the treatof phobia. Benzodiazepines is effective for the treatof phobia. MAOI----Phenelzine 15mg *3day helpful, tricyclic antidepressant like clomipramine.25mg *3 /day is effective treatment. MAOI----Phenelzine 15mg *3day helpful, tricyclic antidepressant like clomipramine.25mg *3 /day is effective treatment. Panic disorder الفزع The symptoms of panic attacks are that anxiety build up quickly, the attacks occur unexpectedly the symptoms are : Palpitation Palpitation Dyspnea Dyspnea Chest discomfort sweating sweatingDizzinessNausea Fear of impending death Depersonalization.

9. Panic attacks in women about twice that in men. The Aetiological theories 1. Genetic 2. Biochemical changes noradrenergic system is active in panic attack. 3. Cognitive theory – that sever attacks causes panic attacks may lead to heart attack. Treatment :- Benzodiazepines like alprazolam 6mg/day or antidepressant like impramine 25mg/tds. Or zotral 50-100mg/day. Benzodiazepines like alprazolam 6mg/day or antidepressant like impramine 25mg/tds. Or zotral 50-100mg/day. Congnitive therapy the aim is to reduce the fear of physical symptoms and to explain these symptoms like palpitation and palor to the pt.