This electronic poster presentation covers the psychiatric diagnosis of agoraphobia and the role of advanced practice nurses in minimizing morbidity and optimizing functionality among patients. Agoraphobia is an anxiety disorder characterized by the fear of certain environments that make the patient panic (Wittchen et al., 2010). The etiology of agoraphobia centers on difficulties with spatial orientation. People with agoraphobia depend on their visual system for orientation rather than a balance between the vestibular system and visual system. Reliance on the visual system causes disorientation in open places, closed places and crowded spaces where visual cues are sparse, limited and overwhelming respectively, causing fear of panic attack.
The clinical manifestation of agoraphobia includes the fear of open places, crowded places, and closed areas such as trains or elevators. Additionally, agoraphobic people often have the inability to leave home alone, have a sense of helplessness and are overdependence on others. The treatment of agoraphobia usually centers on cognitive behavioral treatment including exposure treatment, cognitive restructuring and relaxation techniques. Pharmacologic interventions used for agoraphobia include selective serotonin reuptake inhibitors, MAO inhibitors and benzodiazepines (Perna et al., 2011). These classes of drugs mainly act as antidepressants and are usually used in conjunction with cognitive behavior therapy and self-help strategies such as support groups.
Research areas on the pathogenesis of agoraphobia include the impact of the vestibular system, dependence on tactile signals and proprioceptive sense in determining spatial orientation for agoraphobic patients (Graeff, 2012). Na et al., (2013) evaluated the relationship between the volumes of gray matter to agoraphobia. Research on substance-induced agoraphobia is currently ongoing, while research on treatment centers on the development of better conceptual models and eye movement desensitization and reprogramming. Advanced Practice Nurses can minimize morbidity and optimize functionality among agoraphobic patients through a patient-centric assessment focusing on functionality, psychiatric medication, psychosocial interventions, and promoting spiritual interventions.
References
Graeff, F. G. (2012). New perspective on the pathophysiology of panic: merging serotonin and
opioids in the periaqueductal gray. Brazilian Journal of Medical and Biological Research, 45(4), 366-375.
Na, K. S., Ham, B. J., Lee, M. S., Kim, L., Kim, Y. K., Lee, H. J., & Yoon, H. K. (2013).
Decreased gray matter volume of the medial orbitofrontal cortex in panic disorder with agoraphobia: A preliminary study. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 45, 195-200.
Perna, G., Daccò, S., Menotti, R., & Caldirola, D. (2011). Antianxiety medications for the
treatment of complex agoraphobia: pharmacological interventions for a behavioral condition. Neuropsychiatric disease and treatment, 7, 621.
Wittchen, H. U., Gloster, A. T., Beesdo‐Baum, K., Fava, G. A., & Craske, M. G. (2010).
Agoraphobia: a review of the diagnostic classificatory position and criteria. Depression and anxiety, 27(2), 113-133.
