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    How to deal with fear of commitment phobia?

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Posted on Wed, 1 Jun 2016 in Mental Health
Question: What kind of treatment can people fearing new situations undergo, such as fear of interacting with new people, fear of a job change?

In addition, Suppose the fear of marriage is such that it looks as though the brain will explode?
doctor
Answered by Dr. Seikhoo Bishnoi 27 minutes later
Brief Answer:
This occurs due to anxiety.

Detailed Answer:
Hello thanks for asking from HCM for your health related queries

I can understand your concern. Fear of interacting people, fear of job change etc occur due to some underlying anxiety disorder possibly social anxiety. Fear to get married and feeling that brain would explode could also be the part of that only. In anxiety proper evaluation is required before starting the treatment.

In my clinic I usually prefer to advise non pharmacological treatment for mild to moderate anxiety situations. Relaxation exercises, yoga, breathing exercises, Behaviour therapy etc are common modalities of treatment. These have great efficacy and result in improvement in most cases.

For more severe conditions or in persons whose work, social or personal life get hampered due to anxiety, medicines are needed. SSRIs are mainstay of treatment for such individuals. Fluoxetine, Paroxetine, Sertraline etc are commonly used drugs for anxiety. These medicines are prescription drugs and are advised to be taken regularly to get proper relief. Medicines are advised for about 3-6 months and then tapered gradually. In addition to this exercises, yoga etc further supplement the effects of the drugs.

Thanks, Take care. Hope this helps, if you have more doubts please ask again.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Seikhoo Bishnoi 18 minutes later
Thanks doctor....that was very helpful......what about obsessions with male figures without the desire for marriage.....i am also very restless and struggle to concentrate 99 percent of the time which in turn makes it hard to remember things without writing....what kind of treatment would help for this....
doctor
Answered by Dr. Seikhoo Bishnoi 3 hours later
Brief Answer:
Please explore in detail.

Detailed Answer:
Hello again and thanks for asking a follow up question.

Obsessions are also type of anxiety symptoms. OCD is a type of anxiety disorder. Obsessions with male figures without desire to get married should be evaluated. Please explore in detail about this in follow up.

Please mention what kind of obsessions you have for male figures?

Are these obsessions distressing?

Why does you have no desire for marriage?

Any sexual feeling related to these complaints?

Any other obsessive thoughts you have?

Repeated obsessive thoughts could result in heaviness in head and thus result in loss of focus. Lack of focus in turn results in poor concentration, difficulty in day to day tasks, anxiety, restlessness etc symptoms.

Thanks, Take care. Please provide details in free follow up question.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Seikhoo Bishnoi 17 minutes later
The obsession is usually with people who give me attention, it can be a friend, relative, father figure or crush! Yes, the obsessions are distressing because they may sit in my head for a whole day and I may not be able to think of or do anything else.....

I have a fear or rather hatred for physical relations....

I cannot manage my own responsibilities properly and cannot adjust well with people, also fear intimacy hence marriage seems frightening, terribly frightening......also fear that the prospective husband may tie me down or be too demanding.....my parents' own failed marriage could be another reason......Matters don't stop here....may father has obsessive-compulsive disorder and my mother is obsessed with me so there is no chance of her wanting to see me married.....

My lack of concentration is not always due to obsessive thoughts perhaps it is a general lack of peace of mind and uncertainty about the future....

Can you suggest what kind of psychiatrist I should consult as I am based in XXXXXXX XXXXXXX ...Any names or people I can consult online/by phone?







doctor
Answered by Dr. Seikhoo Bishnoi 11 hours later
Brief Answer:
OCD can be treated with SSRIs

Detailed Answer:
Hello thanks for asking again

You have family history of OCD and failed marriage of your parents. Both these are independent risk factors for your problems. Discord in parents results in continuous stress and thus results in development of anxiety and psychiatric disorders. This also increases the risk of development of psychiatrist.

The fear of close relationship, fear of prospective husband is due to the problems you faced because of parent's failed marriage. This would improve with time. Obsessions of male figures and which cause distress needs treatment. As I have mentioned earlier also that SSRIs are the mainstay of treatment. Fluoxetine is commonly used for similar complaints. Fluoxetine in high doses results in control of unwanted obsessions. For the problems you have with falling in close relation or due to marriage you should consult a psychologist. Psychological counselling would help to reveal the unconscious conflict and you will feel better after that.

Just keep one thing in mind that if your parents have failed marriage then that doesn't mean that you also will have failed marriage. Try to accept this and reassure yourself again and again. When you will start accepting this then the problem will start reducing gradually.

For psychiatrist based in XXXXXXX you can visit XXXXXXX XXXXXXX Institute and there you can find good psychiatrists. Better to visit there because phone consultation would not help much.

Thanks, Take care. Still have doubts please ask again.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Seikhoo Bishnoi 1 hour later
Hello doctor,

Thank you so much for your advice.

I made a mistake in my last email as I was typing in a hurry...My father actually has bipolar disorder and I suspect, also an untreated anxiety disorder. Being with him all the time, only serves to increase anxiety levels. So do you think, psychiatric counseling/treatment/intervention for the whole family would be beneficial?

My father was already on Depakote -250 mg (three times a day)
Risnia MD - 1 mg (twice a day)
Ativan - 1 mg (at night)
Pacitane - 2 mg (once a day)

When we met a psychiatrist last week, he told us if my father's anxiety is way beyond normal which is the case, we can give him Sertraline twice a day. I'm wondering whether this will be too much medicine for my father. He is 78 and frail, with retinitis pigmentosa and poor balance.

Last month my sister was started on Fluoxetine. Looks like our whole family is in trouble.

So doctor, do you think I should consult both a psychologist and psychiatrist? Can i recover without medication? How long will it take before I can be ready for marriage? I also doubt that any boy would like to marry into our family with a history of mental illness...





doctor
Answered by Dr. Seikhoo Bishnoi 3 hours later
Brief Answer:
Visit a psychologist first

Detailed Answer:
Hello again

First of all I'd like to tell you that mental illnesses are not considered as stigma now a days. So there should not be any fear that a boy will not marry in a family with history of mental disorders. Mental illnesses doesn't follow clear mandelian inheritance pattern.

In my opinion adding Sertraline to your fathers prescription would increase risk of manic switch. The drug should be used with caution in him.

Your problem will reduce with proper psychological intervention. The symptoms should improve in 4 weeks. If symptoms persist then visit a psychiatrist.

Thanks
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Seikhoo Bishnoi 18 hours later
Hello again, doctor....

As I mentioned earlier, the following are the medicines my father is taking but his anxiety is really way beyond normal. Can you suggest any slight/moderate medication alterations that would help curb the problem?

Depakote -250 mg (three times a day)
Risnia MD - 1 mg (twice a day)
Ativan - 1 mg (at night)
Pacitane - 2 mg (once a day)
doctor
Answered by Dr. Seikhoo Bishnoi 8 minutes later
Brief Answer:
Minor dose alterations can help in anxiety.

Detailed Answer:
Hello thanks for asking again

Yes we can make slight alterations in doses to get good effects. As you've mentioned that he is suffering from bipolar disorder then in such case the dose of Depakote can be increased to 1000 mg per day if he is having average weight. This would cause better mood stabilisation and anxiety will reduce. Other option is to give 250 one tablet in morning and two in evening instead of three times a day.

The dose of Risinia is fine and no need to change that. I'd advise you to give him 2 mg in evening instead of 1 mg twice a day. Day time dose is known to cause sedation and drowsiness and can increase anxiety also.

Ativan is fine and if his doctor agrees then half of it can be taken in day time in events of severe anxiety on SOS basis. This would help in better control of symptoms.

Pacitane is to prevent side effects of Risinia and there is no need to change its doses.

Thanks. I hope this helps you. Just to sum up there is need to minor alteration in timings of the drugs and Ativan can be used on SOS basis for anxiety during day time.

Take care
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Seikhoo Bishnoi 1 hour later
You seem to be a very knowledgeable doctor......Thank you again....

My father (78 years of age) is underweight actually which brings me to another question.

My father had initially been on the following medication

Lithium Carbonate - 400 mg (twice a day)
Chlorpromazine - 100 mg (twice a day)

He had been following the above regimen for some 30-40 years without consulting a psychiatrist again.

Two years back, due to non-availability of a certain brand of chlorpromazine, we consulted the psychiatrist. He said the lithium should be stopped because my father was showing signs of toxicity. After that, we started the new medicine regimen which I shared with you.

Depakote -250 mg (three times a day)
Risnia MD - 1 mg (twice a day)
Ativan - 1 mg (at night)
Pacitane - 2 mg (once a day)

Ever since the medicine changeover, my father has been experiencing discharges from his anus, sometimes white and sometimes the color of stool. He is terribly upset because of this problem and for long, we have been suspecting that the medicine changeover could be responsible for this problem. What is your opinion? Or Could the discharges be stress/anxiety induced?




doctor
Answered by Dr. Seikhoo Bishnoi 13 hours later
Brief Answer:
Dose of Depakote should be increased to 1000 mg per day.

Detailed Answer:
Hello again and thanks for appreciation.

If his weight is normal then dose of Depakote is fine. Normally the dose should be about 1000 mg per day for a healthy male with weight of about 60-70 kg. Lower doses result in poor response.

Anus discharge is no a very known side effect of either of the drugs he is taking. I haven't seen any patient of mine with similar side effect. But this could be a sequel of persisting anxiety. In anxiety such complaint can be seen. SO yes this could be stress induced.

Thanks. Still have doubts please don't hesitate to ask again. Take care
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Seikhoo Bishnoi 9 hours later
My father used to be 60 kilos but he lost 10 kilos after the medicine changeover. He is 5 ft 4 inches. So do you think I can give him the 1000 mg dose? Will his anxiety come down then?

Here is a list of the other medications he is taking (not psychiatric)

1. Concor Cor 1.25 mg (morning)
2. IBSCIM (morn and night) - this is for the anal discharge but it is not working
3. I-site capsules - 1 on alternate days
4. Throcab - 2.5 mg (5 days a week)
5. Lumia 2K (afternoon)
6. Avas - 10 mg (night)
7. Ecospirin - 75 mg (night)

Second question, is it dangerous to take Ativan long term?

Third question, can taking Ativan in the morning cause daytime sleepiness?

Fourth question, how often should we check the liver and kidney to determine the levels of the medicine in the blood?

Thanks again


doctor
Answered by Dr. Seikhoo Bishnoi 13 hours later
Brief Answer:
Ativan in low doses help to reduce anxiety

Detailed Answer:
Hello again an thanks for asking again

Considering his weight its better to stay on 750 mg dose only. Another option is to get his serum sodium valproate levels done. If the levels are lower than therapeutic ranges then the dose can be increased otherwise better to stay on the existing dose only.

Ativan is safe drug and has no serious side effects but if taken regularly for long then the drug is known to cause tolerance and dependence. This is the reason the drug should not be taken regularly for long periods of the time.

Yes taking the dose in higher doses in day time can cause sedation. But in low doses the drug helps to control the day time anxiety.

The liver and renal function tests should be done every six months while on therapy.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Seikhoo Bishnoi

Psychiatrist

Practicing since :2007

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