임장공포증에 대한 임상적 연구

A Clinical Study on Agoraphobic Patients

This study was done to evaluate some clinical characteristics of thirteen cases of agoraphobia, who had been treated at the Department of Neuro psychiatry of Korea University Hospital from June, 1980 to June, 1982. 1. The female to male ratio was 1.3 to 1 (female 7, male 6) and the age of onset ranged from 16 to 49 years, with the mean age of 32.3 years. 2. The interval between the time of onset and first visit was long (mean duration; 41.8 months). 3. In marital status, eleven were married and two were single. The majority of the subjects were college and high school graduates with mean educational period of 10.4 years. 4. The occupation of subjects was various. Among these, house wife was most common for the female subjects and over the half of male were engaged in commercial job. 5. In premorbid personality, obsessive and histrionic traits were predominant. Four of the subjects had the family history for psychiatric disorders such as affective disorder, alcoholism, etc. 6. Six subjects had the experiences of parental loss before 13 years old and one of the subjects had separation anxiety in childhood. 7. In clinical features, anticipatory anxieties were noted in all. Ten subjects had experienced panic attack, so they received additional diagnosis of panic attack. 8. All of the subjects showed a variety of avoidance behaviors, but two of them were severely restricted in their daily life. The correlation between the degree of avoidance behavior and the duration of illness was identified. 9. The fear objects could be divided into two groups. The first group had multiple fear objects and the second had single fear object such as bus, airplane, crowded place, crowded street, subway, crossing road, and elevator. The associated features most frequently seen were anxiety, depressive symptoms and minor compulsive behaviors in their order of frequency. 10. The eight of the subjects had major depression and five had drug abuse as complication. Interestingly, complication of alcohol abuse with heavy smoking and episodes of bulimia were seen in two of the cases. The four of the subjects had been hospitalized because of complicated major depression, panic attacks, and severe restriction of daily life. 11. The effect of imipramine for ten of the subject who had associated panic attacks was significant. With the combination of drug therapy, behavior therapy, and supportive psychotherapy, anticipatory anxiety and phobic behavioral pattern improved markedly within 8 weeks. Three subjects without associated panic attacks showed only mild improvement in their anticipatory anxiety and phobic behavioral pattern.