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harmful
2. Enviromental
Negative events in childhood and other stressful events such as
seen as dangerous
3. Genetic and Physiological
Heritability is 61%. Of the various phobias, it is the strongest and most
spesific association with genetic factors
B. Epidemiology
1. Prevalence
The prevalence ranges from 30% in community to more than 50% in clinic
2. Age
Mean age at onset is 17 years. But, it also can be 25 29 years, before age
35 years, or after age 40 years
3. Course
Typically persistent and chronic, complete remission is rare
In United States, it always develops as complication of panic disorder
C. Gejala Klinis
Menghindari situasi dimana sulit mendapatkan bantuan
Lebih suka ditemani saat pergi ke tempat tertentu misalnya jalan yang ramai,
toko yang padat, ruangan tertutup seperti lift, kendaraan tertutup seperti bus
Meminta untuk ditemani saat keluar rumah, bahkan jika parah maka hanya
c.
d.
e.
f.
g.
h.
i.
D. Therapy
1. Pharmacologic Therapy
Benzodiazepine has the most rapid onset of action. Alprazolam and
used
Tricyclic and tetracyclic drugs such as clomipramine and imipramine
2. Psychotherapy
Supportive psychotherapy involve the use of psychodynamic concepts and
PHOBIA SOSIAL
A. Etiology and Pathogenesis
1. Psychologic Factors
Trait of behavioral inhibiton and fear of negative evaluation
Childhood maltreatment and adversity
The parents were less caring, more rejecting, and more overprotective
2. Genetic Factors
The genetic influence is subject to gene-environment influences
First-degree relatives are about three times more likely to be affected
3. Biology Factors
Release norepinephrine or epinephrine both centrally and peripherally
Decreased dopamine activity and low levels of homovanillic acid
B. Epidemiology
1. Prevalence
Lifetime prevalence ranging from 3 13%
2. Age and Sex
Mean age at onset between 8 15 years, the peak is in the teens
May follow stressful or humiliating experience such as being bullied,
new job promotion and marrying someone from different social class
3. Course
Typically persistent and chronic, complete remission is rare
C. Clinical Features
Irrational fear of performing activities in the presence of other people
Thought that they will be judged as anxious, weak, crazy, stupid, boring,
people
Being observed : Eating or drinking
Performing in front of others : Giving public speech
In children, the anxiety must occur in peer settings and not just
during interaction with adults
b. The individual fears that he or she will act in way or show anxiety
symptoms that will be negatively evaluated (humiliating,
embarrasing, rejection, offend others)
c. The social situations almost always provoke fear or anxiety
In children, the fear or anxiety may be expressed by crying,
d.
e.
f.
g.
h.
i.
j.
D. Therapy
1. Pharmacologic Therapy
SSRI is considered the first-line treatment. Others are benzodiazepine,
venlafaxine, buspirone
MAO-I for severe cases such as phenelzine, moclobemide
Beta blockers shortly before exposure. The most widely used are atenolol
a. Classical Conditioning
Anxiety is provoked by naturally frightening stimulus that occurs in
when there is large spider in the bath The child may develop
arachnophobia
3. Environmental Factors
Parental overprotectiveness, parental loss and separation
Physical and sexual abuse
Negative or traumatic encounters with feared object or situation
4. Genetic Factors
Certain category of spesific phobia tends to run in families
First-degree relatives of individual with animals phobia is more likely to
have the same spesific animal phobia than any category of phobia
Individual with blood-injection-injury phobia show unique propensity to
years
3. Sex
Women is affected two times higher than men
4. Kinds of Phobia
Arachnophobia (spider) > Astraphobia (lightning) > Acrophobia (height) >
Nosophobia (illness) > Traumatophobia (injury) > Necrophobia (death)
C. Clinical Features
Arousal of anxiety when the persons are exposed to spesific objects or
situations
Try to avoid the phobic stimulus Persistent avoidance behavior
The fear is out of proportion to danger perceived, patient recognises the fear
a.
b.
c.
d.
e.
f.
g.
phobic stimuli
Teach various techniques to deal with anxiety including relaxation, breathing
GANGGUAN PANIK
A. Etiology and Pathogenesis
1. Biologic Factors
Exaggerated postsynaptic receptor response to serotonin
Decreased inhibitory GABA receptor sensitivity with resultant excitatory
effect
Increased local norepinephrine discharge with hypersensitivity of
presynaptic alpha-2-receptors
Increased sympathetic tone which adapt slowly to repeated stimuli and
Mediated by fear network in the brain that involves the amygdala, the
affected
Increased risk for panic disorder among relatives of parents with anxiety,
gangguan jantung
Pernapasan terasa cepat dan pendek, tetapi tidak terdapat bukti
hiperventilasi
Merasa sangat takut, ancaman kematian, bingung, sulit konsentrasi
depersonalisasi
Nocturnal panic attack : Serangan panik pada malam hari yang
consequences
Significant maladaptive change in behavior related to the attacks
Chronic, feeling anxious and nervous all of their lives, wash and wane
day
2. Motoric Symptoms
Trembling, twitching, feeling shaky, muscles aches or soreness
3. Autonomic Hypereactivity
Accelerated heart rate, shortness of breath, dizziness, chronic diarrhea,
sweating
4. Exaggerated startle response
F41.1 Diagnostic Criteria for Generalized Anxiety Disorder (DSM-V)
a. Excessive anxiety and worry (apprehensive expectation), occuring
more days than not for at least 6 months, about number of events
or activities such as work or school performance
b. The individual finds it difficult to control the worry
c. The anxiety and worry are associated with three or more of
following symptoms with at least some symptoms having been
present for more days than not for the past 6 months :
Restlessness or feeling keyed up or on edge
Being easily fatigued
Difficulty concentrating or mind going blank
Irritability
Muscle tension
Sleep disturbance : Difficulty falling asleep, or restless,
unsatisfying sleep
d. The anxiety, worry, or physical symptoms cause clinically significant
distress or impairment in social, occipational, or other important
areas of functioning
e. The disturbance is not attributable to the physiological effects of
substance or another medical condition
f. The disturbance is not better explained by another mental disorder
D. Terapi
1. Terapi Farmakologi
inhibition in childhood
Physical and sexual abuse in childhood, other stressful or traumatic events
Regression from oediphal phase to the anal phase Feel threatened by
affected
Higher concordance rate for monozygotic twins than for dizygotic twins
Contohnya adalah makan berjam jam atau mencukur kumis dan janggut
D. Terapi
SSRI atau klomipramine
Terapi perilaku