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[Chronic anxiety and phobic disorders with persistent agoraphobia: clinical and follow-up study]
Abstract:
There were studied 2 groups of the patients with a diagnosis of agoraphobia (according to ICD = 10). The first group included 34 patients which didn't use a specialized psychiatric service; the second one included 25 patients which needed an active therapy under conditions of psychiatric hospital. Dynamics of a disease was investigated by the method of retrospective (3 years) and following prospective (3 years) evaluation. The first group was characterized by relatively favourable outcome of chronic anxious-phobic disorders (APD) with the phenomena of a stable agoraphobia (5.8% of patients with a decrease of social adaptation): a limited agoraphobic avoidance (2 cases in the average), a rare and only psychogenic exacerbation (23 cases). Comorbid disorders were presented as minor depression (53%), somatophormic disorders (single isolated cardialgias and the conversive disorders--28%), personal disorders of hyperthimic (53%) and hysteric (35.5%) type. The second group was characterised by relatively worse outcome of chronic APD with the phenomena of a stable agoraphobia (32.0% of the patients with a decrease of social adaptation), that was associated with more generalized avoidance behaviour (more than 2 cases), with a gradual increase of both the severity of panic attacks and agoraphobia in limits of either periodic long-term aggravations (46%) or a continuous progredient course (29%). As compared with the 1-st group the second group was also characterised by significantly higher average number in a month of the panic attacks (4.9 + 1.1 vs 2.4 + 0.4; p < 0.01) and hospitalization (2.5 + 0.6 vs 0.2 + 0.2 + 0.1; p < 0.05) during all period of prospective observation. More severe comorbid disorders were revealed: slow-progredient schizophrenia (20% vs 0% in the first group; p < 0.01), a major depressive disorder (28% vs 3%; p < 0.01), dysthymic disorder (32% vs 3%; p < 0.05); personal disorders were presented mostly by the deviations of schizoid type (59%).