MENTAL DISORDERS CLINICAL OUTPATIENT VENEZUELA – 18 YEARS19 – 55 YEARS Mentally RetardedSchizophrenic Psychosis EpilepsyAffective Psychosis Attention Deficit Disorder / Hyperactivity Alcohol Abuse Emotional DisordersDepressive Disorder Pervasive Developmental Disorder Drug Abuse

 Many studies reported 10% of Children affected.  3,49% appears in different ways, including social phobia, separation anxiety disorder, overanxious anxiety disorder, panic disorder, obsessive-compulsive disorder and posttraumatic stress disorder.  The comorbidity of depression and other pathologies could reach levels near 60%.  50,59% could present risk of suicide, drug and alcohol abuse, and functional impairment.  Several somatic symptoms associated to these diagnostics, increase the cost of primary attention, due to an important number of clinical studies unnecessary practiced.

Children evince fear reactions to everyday stimuli. Fears vary in frequency, intensity and duration. Fears tend to be mild, age-specific and transitory. Fears reflect the children's emerging cognitive and representational abilities.

Are out of proportion to the demands of the normal situation Can not be explained or reasoned away Are beyond voluntary control Lead to avoidance of the feared situation Persist over and extended period of time Lead to considerable distress

Is defined: As a marked and persistent fear, of one or more social or performance situations in which the child is subject to possible scrutiny by others. Basically the child fears that he or she will act in a way that will be embarrassing or humiliating to her or him.

Marked and persistent fear that is excessive or unreasonable by the presence or anticipation of a specific object or situation. Exposure to the phobic stimulus provokes an immediate anxiety response. The individual recognizes that the fear is excessive or unreasonable. The phobic situation is avoided or else endured with intense anxiety or distress. The avoidance, anxious anticipation or distress in the feared situation, interfere with the child's normal routine, occupational, academic functioning or social activities. The duration is at least 6 months. (DSM-IV)

 Anderson et al,reported a 2.,4% rate / 11 year old / New Zeland  McGee et al, reported a 3.6% rate/ 15 years old / New Zeland  Bird et al, reported a 2.6% rate / 4-16 years old / Puerto Rico  Steinhausen et al, reported a 2.6% rate / 7-16 years old / Switzerland  Costello et al, reported a 3.6% rate/ years old / United States  Essau et al, reported a 3.5% rate/ years old / Germany Prevalence: Average about 3.5% across studies

Phobic disorders tend to be relatively “pure” in community samples, whereas other anxiety disorders tend to overlap and coexists with one another (e.g. depression, conduct disorder, attention- deficit / hyperactivity disorder.

Last et al., reported 64% of children and adolescent with a primary diagnosis of simple phobia presented with one or more additional diagnoses, including overanxious disorder, social phobia, obsessive- compulsive disorder, panic disorder. These findings have important implications for the assessment and treatment.

Not fully understood. May result from terrifying, or frightening experiences. Not all phobias are acquired through individual- specific learning histories and other causal factors need to be considered.

Genetic factors appear to be associated with a general state or propensity toward “fearfulness”. The environment plays a stronger role in making an individual afraid of. Along with genetic factors, constitutional (i.e. temperament) characteristics of the child may play a role in the onset and maintenance of phobias in children (“shyness vs. sociability”, “introversion vs. extroversion”, “Withdrawal vs. approach”)

Behavioural and cognitive behavioural procedures demonstrate considerable promise. No support was found for the use of other psychosocial treatment procedures (psychodynamic, non-directive and family systems perspectives)

Recent treatment trials for adults suggest use of selective serotonin reuptake inhibitors (SSRIs) as the medications of choice rather than benzodiazepines or tricyclic antidepressants for most anxiety disorders including phobias.

Clinical trials have examined the joint efficacy of psychosocial and pharmacological treatment. Given the independent promise of both treatment.