Overcoming Agoraphobia and Extreme Anxiety Disorders
Couples and family therapists have developed specialized interventions for a wide variety of psychiatric disorders, including depression, alcohol, and a variety of anxiety disorders. Outcome studies have generally found that intervening with couples and families (rather than individuals) leads to lower drop-out rates and higher treatment success rates. Behavioral and cognitive couples treatments for depression have been found to reduce depression and increase satisfaction when the depressed person is in a distressed relationship. Behavioral Couples Therapy has also been shown to reduce alcoholism and to improve couples' satisfaction. Finally, spousal involvement has been shown to increase the effectiveness of behavioral treatments for agoraphobia.
At even more extreme moments, persons with the borderline personality disorder may engage in self-mutilation (usually cutting themselves). They also occasionally suffer psychotic withdrawals from reality in which they lose all sense of time and place. Because of the extremes to which 'borderline' cases swing, they also tend to be diagnosed with other disorders such as depression, generalised anxiety, agoraphobia, and so on. Whereas the anti-social personality disorder is more common in men, the borderline disorder is more common in women.
Labels that are instrumental (they point to effective interventions) are helpful. For example, the understanding of anxiety disorders has advanced requiring the differential diagnosis among different categories (simple phobia, generalized anxiety, panic attacks and agoraphobia). Failure to use labels that are indeed informative may prevent clients from receiving appropriate intervention. Labels can normalize client concerns. Parents who have been struggling to understand why their child is developmentally slow may view themselves as failures. Recognition that their child has a specific kind of developmental disability that accounts for this can be a relief.
Is essential that the physician be able to recognize and correct for targeting errors (Figures 4-14A to 4-14C). Certain patient characteristics will interfere with the success of a stereo-tactic breast biopsy. Patients with neurologic or musculoskeletal conditions may not tolerate positioning on the stereotactic table. Patients that are coughing because of an acute or chronic respiratory condition will increase breast motion and lesion movement, which may interfere with accurate targeting. Patients with a high level of anxiety, especially those suffering from claustrophobia or agoraphobia, may require sedation. As any biopsy has the potential for bleeding complications, those patients with a history of bleeding abnormalities or who are taking anticoagulants will require correction prior to biopsy. The small or ptotic breast creates one of the most common difficulties in stereotactic breast biopsy. A breast that flattens to a marginal thickness in compression may lead to stroke margin...
Psychopharmacologic treatment of anxiety disorders began with the use of sedative-hypnotics (e.g., bromide salts, alcohol, chlorol hydrate) at the turn of the twentieth century. Barbiturates (e.g., phenobarbital, pentobarbital) were introduced early in the twentieth century but their adverse side effects, including addiction liability and toxic overdose, limited the use of these agents. The development of the benzodiazepines (e.g., chlordiazepoxide, diazepam) in the 1960s as general anxiolytics (separate from the muscle relaxant properties) was a major breakthrough because of the wide effective dose range and the limited adverse side effects. Subsequently, beta-adrenergic receptor antagonists (e.g., propranolol), antihistamines (e.g., hydroxyzine), and anticholinergic agents were used to treat specific cases of anxiety disorders (e.g., speech anxiety, posttraumatic stress disorder PTSD ). More recently, azapirones (e.g., buspirone) that act via serotonergic antagonism and some...
Jointly produced not only by a person and a situation, but each of these factors also responds to the other over time to create a dialectical whole, such as a relationship. When a relationship contextualizes a behavior, as is always true even in diagnosis, the meanings of any behavior must take into account the dialectical determinants. The complex of avoidant actions identified by the label agoraphobia, for example, does not exist inside the person. The actions are ways of coping with situations that have developed over time. Nontraditional approaches that depart from the disease model begin with the individual's history of trying various ways to cope with his or her environment. Traditional diagnosis underplays the agential character of human behavior because diseases are ordinarily understood to be happenings that take place inside the person.