Agoraphobia

Q: 22 year old male admitted to ICU with suicidal ideation is now ready to get discharged to home with his family. Patient suddenly develops chills, sweating, tachycardia, shortness of breath, chest pain, and dizziness. Psych service was present in the ICU while writing his discharge orders. Patient gets diagnosed with Agoraphobia. What is Agoraphobia?

Answer: Agoraphobia is a fear, anxiety, or avoidance of situations where escape might be difficult in the event of developing panic-like or other embarrassing symptoms. It is important to note that Agoraphobia is classified as a separate disorder in the DSM-5-TR and is diagnosed independently of panic disorder. 

The two objectives attempted in the above questions are:

1. Patients who develop frequent and high levels of such attacks and agoraphobia should be watched closely for suicidal attempts.

2. Chills (used as a distractor in this question) can occur in panic attacks, as high muscular and metabolic demands may cause the sensation of heat and chills.

#psychiatry

References:

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, American Psychiatric Association, Washington, D.C. 2022.

2. Kessler RC, Chiu WT, Jin R, et al. The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2006; 63:415.

3. Wittchen HU, Gloster AT, Beesdo-Baum K, et al. Agoraphobia: a review of the diagnostic classificatory position and criteria. Depress Anxiety 2010; 27:113.