Abolition of lifelong specific phobia: a novel therapeutic consequence of left mesial temporal lobectomy

Electroencephalographic Activity in Patients with Claustrophobia: A Pilot Study

Background

Exposure to small confined spaces evokes physiological responses such as increased heart rate in claustrophobic patients. However, little is known about electrocortical activity while these people are functionally exposed to such phobic situations. The aim of this study was to examine possible changes in electrocortical activity in this population.

Method

Two highly affected patients with claustrophobia and two healthy controls participated in this in vivo study during which electroencephalographic (EEG) activity was continuously recorded. Relative power spectral density (rPSD) was compared between two situations of being relaxed in a well-lit open area, and sitting in a relaxed chair in a small (90 cm × 180 cm × 155 cm) chamber with a dim light. This comparison of rPSDs in five frequency bands of EEG was intended to investigate possible patterns of change in electrical activity during fear-related situation. This possible change was also compared between claustrophobic patients and healthy controls in all cortical areas.

Results

Statistical models showed that there is a significant interaction between groups of participants and experimental situations in all frequency bands (P < 0.01). In other words, claustrophobic patients showed significantly different changes in electrical activity while going from rest to the test situation. Clear differences were observed in alpha and theta bands. In the theta band, while healthy controls showed an increase in rPSD, claustrophobic patients showed an opposite decrease in the power of electrical activity when entering the confined chamber. In alpha band, both groups showed an increase in rPSD, though this increase was significantly higher for claustrophobic patients.

Conclusion

The effect of in vivo exposure to confined environments on EEG activity is different in claustrophobic patients than in healthy controls. Most of this contrast is observed in central and parietal areas of the cortex, and in the alpha and theta bands.

Phobia of the Supernatural: A Distinct but Poorly Recognized Specific Phobia With an Adverse Impact on Daily Living

The psychological and psychiatric literature has seldom appreciated the clinical fact that fears of ghosts and kindred supernatural worries may be a cause of intense discomfort, poor sleep, and socio-occupational impairment. In the present article, this claim is illustrated by the clinical features of six patients who developed intense anxiety when they had to sleep alone at night. The fears were first noticed in childhood and persisted into adolescence and adulthood. At these times, they were overwhelmed by images of ghosts and haunted houses often experiencing a vivid impression that an immaterial being not perceivable by the ordinary senses was hovering around. Comorbidity with other phobias was the rule. Owing to shame and self-consciousness, the fears were seldom if ever discussed with healthcare professionals. The overall clinical and psychopathological picture was consistent with a diagnosis of a specific phobia. In a few cases, response to pharmacological treatment and cognitive-behavioral intervention has alleviated the symptoms. "Phobia of the supernatural" may be more common than usually thought. It must actively be sought for in patients complaining of poor sleep and daytime somnolence, and in patients with other types of phobia. The differential diagnosis of phobia of the supernatural includes nocturnal panic attacks, psychosis, other types of phobia that tend to occur during the night, dissociative states of sleep, dementia, and a few rare presentations of epilepsy. Systematic studies must be carried out to settle the neurobiological correlates of phobia of the supernatural as well as the possible benefit of different modalities of pharmacological and psychological treatment.

Arachnophobia alleviated by subthalamic nucleus stimulation for Parkinson's disease

We report on a Parkinson patient with motor fluctuations and dyskinesias in whom deep brain stimulation (DBS) of the subthalamic nucleus (STN) not only improved motor symptoms but also pre-existing arachnophobia. Arachnophobia had been unchanged by the course of Parkinson's disease but rapidly improved with STN-DBS. Both, motor effects and the improvement of arachnophobia were stable during 2 years follow-up. To our knowledge this is the first report on STN stimulation effects on a specific phobia.