Course and prognosis | Agoraphobia and claustrophobia

Course and prognosis

In the absence of treatment, anxiety disorders, especially agoraphobia, have a poor prognosis. The untreated course is characterized by avoidance behavior and constant social withdrawal. The anxiety states become chronic and the patient suffers increasingly severe mental agony. However, if a suitable therapy is found as early as possible, the chances for improvement are good. The majority of patients who are motivated to undergo therapy are rewarded with relief or even freedom from anxiety.

Claustrophobia in the MRI

On average, one out of ten patients who are to have an MRI examination develops claustrophobia. This refers to claustrophobia, the fear of confined spaces. Although an MRI machine is large, the space for the patient is very small: the tube of most machines measures only 60 to 70 centimeters.

Some patients manage to get over themselves and go through the quarter to half hour procedure without panicking. There are, however, ways and means of making it possible for the opposite group of patients to undergo the magnetic resonance imaging, which is usually extremely important for diagnosis. First of all, if a patient is already aware that he or she is suffering from claustrophobia or panic attacks, he or she should inform the investigators.

The team can then adjust to the situation and the duration of the patient’s exertion can be minimized. The body area to be examined determines the patient’s position during the tomography. If, for example, only the leg, foot, pelvis or lumbar spine needs to be imaged, it is possible that the patient’s head and upper body are positioned outside the tube.

Most patients already experience this as an extraordinary relief. However, if the examination takes place on the upper body or even the head, it is impossible to relieve the patient in this way. The next possibility is, in consultation with the patient, to use anxiety-relieving and calming medication.

Benzodiazepines are mainly used in this case. Lorazepam (trade name: Tavor®) is normally used. It relieves the patient’s tense mood and makes them slightly drowsy.The drug needs a moment before it takes full effect, so it must be taken about half an hour before the examination.

Benzodiazepines should not be given if the patient has myasthenia gravis or a known drug addiction. The drug remains in the blood for a relatively long time – half of the substance is broken down only after about 15 hours – and makes the patient unfit for traffic. Other accident-related activities or work must also be avoided.

The administration of the drug makes the majority of all problematic MRI examinations feasible. If this attempt to make the examination easier for the patient also fails, a short anaesthetic can be induced if the diagnosis is extremely urgent. In this procedure, which also has to be discussed with the patient, the patient is not aware of any of this.