A middle-aged person repoed to Psychiatric OPD with complaints of fear of leaving home, fear of travelling alone and fear of being in a crowd. He develops marked anxiety with palpitations and swelling if he is in these situations. He often avoids public transpo to go to his place of work. The most likely diagnosis is
D i.e. AgoraphobiaAgoraphobiaPatients with agoraphobia rigidly, avoid situations in which it would be difficult to escape or obtain help. They prefer to be accompanied by a friend or family member in busy streets, crowded stores, closed in places (eg. tunnels, bridges, and elevators), closed in vehicles (eg subways, buses, & airplanes).Patients may insist that they are accompanied every time they leave the house. A severely affected patient may refuse to leave the house. The behaviour may result in marital discord.The situations are avoided (eg. travel is restricted) or else are endured with marked distress or anxiety about having a panic attack or panic-like symptoms.The anxiety or phobic avoidance is not better accounted for by another mental disorder, such as social phobia (eg. avoidance limited to social situations because of fear of embarrassment), specific phobias (eg. avoidance limited to single situation like elevators), OCD (eg avoidance of di in someone with an obsession about contamination), post-traumatic stress disorder (eg avoidance of stimuli associated with severe stressor), or separation anxiety disorder (eg avoidance of leaving home or relatives), Agoraphobia is usually associated with panic disorder. Agoraphobia without a h/o panic disorder is often incapacitating & chronic, and alcohol dependence often complicates its curse. Treatment is staed with SSRIs (paroxetine, seraline, or fluvoxamine). Benzodiazepines have the most rapid onset of action against panic, within the first week. BDZs can reasonably be used as the first agent while an SSRI is being slowly titrated to a therapeutic dose (after 4 -12 weeks it can be tapered).
Generalised anxiety disorder
Schizophrenia
Personality disorder
Agoraphobia