Makindo Medical Notes

💡 About

• Phobias are a subset of anxiety disorders, defined as intense, irrational, and disproportionate fears of objects, situations, or phenomena.
• They cause significant avoidance behaviour and distress, impacting daily life and functioning.

📖 Definition

• Triggered by an object 🕷️ (e.g., spiders)
• Triggered by a situation ✈️ (e.g., flying, crowded places)
• Triggered by a phenomenon 🌩️ (e.g., thunder, lightning)

🔎 Types of Phobias

• Simple (Specific) Phobia: Fear of a specific object/situation (e.g., animals, heights, injections). Often underreported, usually limited to one trigger.
• Social Phobia (Social Anxiety Disorder): Fear of being judged or negatively evaluated by others. 👉 Symptoms: blushing, trembling, sweating, stammering. 👉 Some use alcohol for "Dutch courage." 👉 Equal prevalence in men and women. 👉 Treatment: CBT, graded exposure, SSRIs; MAOIs may help in resistant cases.
• Agoraphobia: Fear of leaving a "safe space" → avoidance of public places, often housebound. 👉 May trigger panic attacks. 👉 More common in women. 👉 Often chronic and disabling. 👉 Treatment: relaxation, antidepressants, structured graded exposure programs.

🧬 Aetiology

• Genetic predisposition (family clustering).
• Learned behaviours (classical conditioning, observation of others).
• Overactive amygdala and sympathetic nervous system response.

🩺 Clinical Features

• Severe anxiety upon thinking about/encountering the trigger.
• Somatic symptoms of anxiety: palpitations, sweating, tremor, dyspnoea.
• Panic attacks in severe cases.
• Avoidance behaviour to reduce distress (can be very disabling).

🔬 Investigations

• Usually clinical diagnosis – no formal tests required.
• Screen for co-morbidities (depression, other anxiety disorders, substance misuse).

💊 Management

• CBT (Gold Standard): Corrects maladaptive thoughts & behaviours, combined with graded exposure therapy.
• Exposure Therapy (Systematic Desensitisation): Stepwise exposure to trigger → from imagery to real-life situations.
• Relaxation & Mindfulness: Breathing control, progressive muscle relaxation.
• Medication (adjunct only):
  • SSRIs (esp. in social anxiety disorder, agoraphobia).
  • Benzodiazepines – short-term use in unavoidable acute settings (e.g., fear of flying).
  • Beta-blockers (e.g., propranolol) – reduce somatic symptoms like palpitations.

📋 Exam Tips

✅ Phobias are common in OSCE psychiatry stations – always ask about avoidance, functional impairment, and coping mechanisms.
✅ Management = CBT + exposure first line.
✅ Drugs are adjuncts, not curative.
✅ Social phobia often confused with shyness → key differentiator is functional impairment.