Mrs. E. is a 49-year-old married female and Civil servant who presented in the outpatient psychiatric clinic of the University of Calabar Teaching Hospital accompanied by her daughter with chief complaints of Fear of enclosed spaces of 12 years duration. About 12 years before the onset of symptoms and presentation she reported to be involved in an unstable relationship with her male partner where she became pregnant which was not planned and undesired.
However, she insisted on keeping the pregnancy to the displeasure of the partner, though not married, but co-habiting with him for the past seven (7) years, he constantly pressured her to have an induced abortion done, which she refused. Consequently, on several occasions, she had been neglected, assaulted, and abused (physically, verbally, and emotionally) by her partner for refusing to terminate the pregnancy.
During and following this incident, she subsequently developed an intense fear of enclosed spaces, especially places where she had no possession of the Keys. Other occasions and examples include occasions when she visits the bank, where she will persistently insist the bank securities does not allow the electronic door to the banking hall to be closed in order for her to be comfortable and relaxed, otherwise, she will become restless, agitated and will occasionally scream.
She also couldn’t travel in a plane, as she would start panicking as well as becoming breathless.
She only feels comfortable when she owns the keys to any enclosed space, she finds herself in.
Other reported difficulties encountered include poor interaction with other people; very rare visits to places of family relatives and friends, especially outside the confines of her home.
She reported no history of persistent feelings of sadness, low energy, suicidal Ideations or self-harm to suggest a depressive condition. No history of elated or irritable mood, increased energy, or inflated self-worth. There is no history of any hallucinatory experiences or experience of control by an external agent/force.
There was no reported history of care (medical, traditional, etc.) received by the patient since the onset of her illness
She has no previous history of mental illness nor family history suggestive of symptoms of mental illness. There is a medical history of Hypertension diagnosed about 2 years prior to presentation and currently on prescribed oral antihypertensive with good drug adherence. No significant surgical history, nor known allergies. There is also no history of use of alcohol or any form of psychoactive substances before the onset of symptoms.
Her childhood history revealed no childhood emotional problems or abuse; Her sexual orientation is heterosexual, and her past relationship history is not contributory.
Currently, she is married and maintains a cordial relationship with her partner, however distant as her partner is based in another city, and not close to the patient. They have two children together, a 12-year-old female and a 6-year-old male both living with the patient.
Pre-morbidly she describes herself as cheerful, her predominant mood is happy, enjoys singing as an interest of leisure.
Her Mental state Examination findings at presentation revealed a well-groomed and kempt woman; Psychomotor agitation and restlessness; no abnormality in her Speech; mood was anxious; Affect congruous with the mood and reactive; Attention and concentration (tested with serial 7’s) was arousable and sustained; and had full insight to her condition.
A diagnosis of Agoraphobia (with comorbid panic disorder) using the ICD-11 diagnostic criteria was made. She was psycho-educated on the nature of the illness, treatment modalities available to ameliorate the symptoms, and self-help strategies that could be employed to relieve symptoms and distress,
She was started on Fluoxetine 20mg daily (mane), in addition, offered behavioral therapies such as Relaxation therapy/technique; Music therapy, and Cognitive therapy for a weekly session for the next few four (4) months. CBT was helpful and effective as it helped the patient become less afraid with fewer attacks.
Followed up for a duration of six months, she showed marked improvement within one (1) month of commencement of treatment with reported significant improvement in her mood, behavior, and somatic symptoms with a reduction of anxiety to feared situations. She has sustained her follow-up visit afterward and has returned to her premorbid state of functioning.
She has returned to her premorbid state of functioning with improvement in her social interactions and occupational functioning two years later.