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Agoraphobia: Hope and Help for the Agoraphobic and Shut In.

Posted Jun 16 2011 2:10pm

Agoraphobia:Help and Hope for the Agoraphobic and Shut-In patient.

Yusuf Saleeby, MD

The advent of  telehealth, the use of modern telecommunication advances to direct health care delivery, has helped those who are shut in, unable to leave their homes, access to health care.

 The condition known as Agoraphobia, the fear or anxiety of being in public, leaving the house, being among strangers (even in your house), complicates the health care for those who suffer and live with this disorder.  Fact is that Agoraphobics get sick too.   Acute illness like urinary tract infections, ear aches, headaches occur.  Chronic conditions such as diabetes, hypertension, anemia also occur with regularity as in the non-agoraphobic population.  But lack of medical intervention due to the inability to contact a physician, make an office visit will cause these conditions to be ignored, ill-diagnosed or go untreated.  With the advent of Telehealth, shut ins and agoraphobics are able to get the health care they need in a timely, affordable manner.   They no longer have to ignore or put off contact with a medical doctor or psychologist for assistance with any condition that arises which is able to be diagnosed and treated via phone or video conference.  

Eventual kiosks which house hardware (and software) that can make in-house diagnosis easy and practical are under development.   Instruments that can be applied by the patient in their home, will allow doctors to monitor and evaluate vital signs, visualize body parts and even evaluate internal organs.

Agoraphobia Definition (Taken from the Mayo Clinic Web site):

Agoraphobia is a type of anxiety disorder in which you avoid situations that you're afraid might cause you to panic. You might avoid being alone, leaving your home or any situation where you could feel trapped, embarrassed or helpless if you do panic.

People with agoraphobia often have a hard time feeling safe in any public place, especially where crowds gather. The fears can be so overwhelming that you may be essentially trapped in your own home.

Agoraphobia treatment can be tough because it usually means confronting your fears. But with medications and psychotherapy, you can escape the trap of agoraphobia and live a more enjoyable life.

Agoraphobia is a type of phobia. A phobia is the excessive fear of a specific object, circumstance or situation. Agoraphobia is excessive worry about having a panic attack in a public place. Commonly feared places and situations are elevators, sporting events, bridges, public transportation, shopping malls, airplanes, crowds or lines of people.

Typical agoraphobia symptoms include:

·         Fear of being alone in any situation

·         Fear of being in crowded places

·         Fear of losing control in a public place

·         Fear of being in places where it may be hard to leave, such as an elevator or train

·         Inability to leave your house for long periods (housebound)

·         Sense of helplessness

·         Overdependence on others

·         A sense that your body is unreal

In addition, you may also have signs and symptoms similar to a panic attack, including:

·         Lightheadedness

·         Trouble breathing

·         Dizziness

·         Excessive sweating

·         Rapid heart rate

·         Flushing

·         Nausea

·         Upset stomach or diarrhea

·         Chest pain

·         Feeling a loss of control

·         Trouble swallowing

 

Symptoms:  Agoraphobia usually starts in your late teens or early 20s, but younger children and older adults also can develop agoraphobia. Women are diagnosed with agoraphobia more often than are men.

Possible agoraphobia risk factors include:

·         Having panic disorder

·         Experiencing stressful life events, including sexual or physical abuse during childhood

·         Having a tendency to be nervous or anxious

·         Having an alcohol or substance abuse disorder

·         Being female

 

Treatments:  Agoraphobia treatment usually includes both medication and psychotherapy. It may take some time, but treatments can help you get better.

Medications 
Antidepressant and anti-anxiety medications are often used to treat agoraphobia and panic symptoms. You may have to try several different medications before you find one that works best for you.

Your doctor is likely to prescribe one or both of the following:

·         A selective serotonin reuptake inhibitor (SSRI). Drugs in this category that are FDA-approved for the treatment of panic disorder with agoraphobia include paroxetine (Paxil, Paxil CR) and fluoxetine (Prozac, Prozac Weekly, Sarafem).

·         Another type of antidepressant, such as a tricyclic antidepressant or monoamine oxidase inhibitor. While these drugs may effectively treat agoraphobia, they're associated with more side effects than are SSRIs.

·         An anti-anxiety medication. Also called benzodiazepines, these drugs can help control symptoms of anxiety and panic attacks. However, these medications can cause dependence if taken in doses larger than prescribed or over a longer period of time than prescribed. Your doctor will weigh this risk against the potential benefit of this class of drugs. Drugs in this category that are FDA-approved for the treatment of panic disorder with agoraphobia include alprazolam (Xanax) and clonazepam (Klonopin).

Both starting and ending a course of antidepressants can cause side effects that seem just like a panic attack. For this reason, your doctor likely will gradually increase your dose at the beginning of your treatment, and slowly decrease your dose when he or she feels you're ready to stop taking medication — often over the course of a year or more after your agoraphobia symptoms are controlled. [AtroGene Telehealth physicians are able to prescribe SSRIs, SNSRIs, Benzos, & TCAs]

Psychotherapy
Several types of psychotherapy or counseling can help agoraphobia. One common therapy that's used is cognitive behavioral therapy.

Cognitive behavioral therapy has two parts. The cognitive part involves learning more about agoraphobia and panic attacks and how to control them. You learn what factors may trigger a panic attack or panic-like symptoms and what makes them worse. You also learn how to cope with these symptoms, such as using breathing and relaxation techniques.

The behavioral part of cognitive behavioral therapy involves changing unwanted or unhealthy behaviors through desensitization, sometimes called exposure therapy. This technique helps you safely face the places and situations that cause fear and anxiety. A therapist may join you on outings to help you stay safe and comfortable, such as trips to the mall or driving your car. The more you go to feared places and realize you're okay, the more your anxiety will lessen.

If you have trouble leaving your home, you may wonder how you can possibly go to a therapist's office. Therapists who treat agoraphobia will be well aware of this problem. They may offer to see you first in your home, or they may meet you in one of your safe zones. They may also offer some sessions over the phone or through email. Look for a therapist who can help you find alternatives to in-office appointments, at least in the early part of your treatment. You may also try taking a trusted relative or friend to your appointment who can offer comfort and help, if needed.   [AtroGene Telehealth has on staff psychologist that can help with psychotherapy via phone]

Source:  mayoclinic.com/health/agoraphobia

 

In conclusion, for the shut in or Agoraphobic, there is hope, the preverbial light at the end of the tunnel in respect to basic health care, resolution to acute minor illness.   That hope is realized within the realm of Telemedicine.   For more information visit www.AtroGene.com

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Yusuf M. Saleeby, MD  is Southeastern Regional Medical Director for AtroGene Telehealth and the DAT lab resource eStatLabs.com.   Dr. Saleeby may be reached at ymsaleeby@gmail.com

©2011

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