Aquaphobia: A Case Report on the Unique Presentation of a Specific Phobia

Aquaphobia is an irrational fear of water that is classified as a specific phobia. Specific phobias are a type of anxiety disorder that cause persistent and unrealistic fear triggered by an object, person, animal, activity, or situation. The National Institute of Mental Health states that approximately 19.2 million American adults suffer from some form of a specific phobia. They often present early in life but it is important to recognize that the geriatric population may develop phobias too, especially as they experience the negative effects of medical conditions. Previous studies report up to a 10% phobia prevalence rate in people 65 or older, with specific phobias accounting for 2.1% of this group. Adult phobias often last many years and will not subside unless treated appropriately. Those who suffer from specific phobias tend to avoid the trigger and, in certain situations, this can have a major detriment to quality of life. Here, we present the case of a 69-year-old male who developed aquaphobia while undergoing treatment for non-small cell lung cancer. The patient was seen and treated by the psychiatry team through multiple telehealth evaluations over a four-month period. Case: JY is a 69-year-old male with the diagnosis of non-small cell lung cancer, 80 pack-year smoking history, COPD, chronic kidney disease, and no past psychiatric history. He was diagnosed in 2019 after a CT chest scan showed left upper lobe and right lower lobe lung nodules. He underwent a complex surgical procedure followed by chemotherapy and radiotherapy. In June 2020, he experienced coughing spells and distressing shortness of breath and underwent thoracentesis, which confirmed malignant pleural effusion. Shortly after thoracentesis, JY presented for initial psychiatry telehealth evaluation accompanied by his wife. Following this procedure, he had been experiencing persistent and irrational fear of water. He reported episodes of intense anxiety and shortness of breath associated with any activity that involved water, including looking at a glass of water, drinking water, shaving, washing dishes, or showering. The sight of water elicited an immediate anxious reaction where he started to gasp for air and felt that he was going to die. As a result, he began to avoid situations that required contact with water. He stopped showering and shaving and he avoided drinking water to the point of frequently experiencing thirst and dehydration. He recognized that his fear was irrational and believed his condition severely interfered with his life. He was diagnosed with aquaphobia based on history and DSM-5 Criteria. He was started on sertraline 25mg daily which was titrated up to 200mg daily. Quetiapine was added as an adjuvant with a dose of 12.5mg PO QAM, noon, and 50mg bedtime. The patient was referred to psychotherapy but was unable to attend sessions. However, during telehealth sessions the psychiatrist was able to provide psychoeducation about the patient's condition and guided breathing exercises; the patient found this to be helpful. After four months of treatment, the patient reported significant improvement in symptoms and was to resume activities that involved exposure to water. Anxiety disorders in older adults reduce quality of life yet these disorders have received little attention in the literature. In this poster, we will discuss the unique presentation of aquaphobia in an elderly patient and the potential causes and treatment options. This case highlights that specific phobias can develop in the geriatric population particularly as they experience the long-term sequelae of medical conditions. In the case of JY, it is hypothesized that his feeling of choking while drinking water, in the setting of shortness of breath due to malignant pleural effusions, triggered an irrational fear of water. The development of this condition severely decreased the patient's quality of life and had negative effects on his overall health. Effective therapeutics to aquaphobia include a pharmacological approach as well as Cognitive Behavioral Therapy (CBT) or exposure therapy. These treatments allow patients to regain control of reactions to stress and stimulus in the presence of water. In the case of JY, a pharmacological approach was found to be successful. Phobias can severely affect quality of life in the elderly and it is therefore important to promptly recognize the diagnosis to quickly enact treatment modalities. No funding was provided for this case report

Preparing the Next Generation of Scholars in Migrant Health

This chapter discusses the state of the science in teaching about migration and population health to illustrate the best way to contribute to the creation of the next generation of scholars in the field. It looks at the process of creating migrant health coursework to ask and answer several framing questions to outline the structure of a potential course. The field of migration and population health is sufficiently compelling in breadth and complexity that a talented instructor can assemble a course quickly, deliver the course, and likely receive high ratings. The chapter emphasizes how migration and health cannot be taught well with learners in spectator mode as they must be personally involved. Learners' experiences are important for “norming” the migrant experience and are emissaries themselves from a world on the move

Treatment of nightmares with prazosin: a systematic review

Nightmares, frequently associated with posttraumatic stress disorder and clinically relevant in today's world of violence, are difficult to treat, with few pharmacologic options. We performed a systematic review to evaluate the evidence for the use of prazosin in the treatment of nightmares. A comprehensive search was performed using the databases EMBASE, Ovid MEDLINE, PubMed, Scopus, Web of Science, and Cochrane Database of Systematic Reviews, from their inception to March 9, 2012, using keywords prazosin and nightmares/PTSD or associated terms (see text). Two authors independently reviewed titles and abstracts and selected relevant studies. Descriptive data and outcomes of interest from eligible studies were extracted by 1 author, and checked by 2 others. The risk of bias of randomized controlled trials (RCTs) was assessed independently by 2 reviewers. Articles met criteria for inclusion if prazosin was used to treat nightmares, and outcome measures included nightmares or related symptoms of sleep disorders. Our search yielded 21 studies, consisting of 4 RCTs, 4 open-label studies, 4 retrospective chart reviews, and 9 single case reports. The prazosin dose ranged from 1 to 16 mg/d. Results were mixed for the 4 RCTs: 3 reported significant improvement in the number of nightmares, and 1 found no reduction in the number of nightmares. Reduced nightmare severity with use of prazosin was consistently reported in the open-label trials, retrospective chart reviews, and single case reports

Pembrolizumab Induced-Encephalitis in An Elderly Patient with Nasal Angiosarcoma: A Case Report

New immunotherapies are increasingly being used as treatment for different types of malignancies. Immunotherapeutic agents such as immune checkpoint inhibitors (ex. pembrolizumab) have been associated with various side effects, including encephalitis. Pembrolizumab, a monoclonal antibody which mechanism of action consists of activity against programmed cell death antigen (PD-1) has been associated with encephalitis. We present the case of a 76-year-old man with past medical history of angiosarcoma of the nose that was treated with radiation, chemotherapy with Taxol. Due to the patient's high tumor mutation burden, he began treatment with pembrolizumab. After six months of treatment with pembrolizumab, he presented to the emergency department with acute changes in mentation. The patient was confused and wanted to go to vote in the middle of the night. He was waking up every 30 minutes and exhibited disorganized thought process and visual hallucinations. Full delirium work-up was done without any major findings. The following tests were in the normal range or negative: thyroid function tests, prolactin, LH, cosytropin stimulation test, ACTH, UA, CBC and CMP. Brain MRI excluded evidence of acute intracranial findings, acute ischemia or brain metastases. Psychiatry was consulted. Pembrolizumab was stopped. Recommendation was made to start aripiprazole 5mg daily. Patient improved after implementing these measures. We postulate that the patient developed encephalitis triggered by pembrolizumab in the context of angiosarcoma of the nose. Autoimmune encephalitis is a rare adverse effect of immune checkpoint inhibitors but it may be severe and potentially lethal. The etiology is not known and diagnosis can be challenging. We postulate that the patient developed encephalitis triggered by pembrolizumab in the context of angiosarcoma of the nose. This case highlights the need of psychiatrists to understand the behavioral symptoms that could be attributed to immunotherapy agents in patient undergoing cancer treatment. Early identification and treatment of the behavioral symptoms are important in order to evaluate and manage appropriately, especially in the elderly population. It is important to consider autoimmune encephalitis secondary to immunotherapy as a differential for psychiatric disorders. No fundin

Interpersonal Counseling for Internally Displaced Women in Bogotá, Colombia

This chapter evaluates interpersonal counseling (IPC) for internally displaced women in Bogotá, Colombia. No other nation throughout the Americas has experienced internal displacement on a scale comparable to Colombia. Colombian internally displaced persons (IDPs) have a high prevalence of trauma exposure and correspondingly high rates of common mental disorders (CMDs), especially among women. The chapter then looks at a feasibility and acceptability pilot study to examine the potential efficacy of an evidence-based, stepped-care intervention adapted for depression, anxiety, and post-traumatic stress disorder (PTSD) for IDP women residing in Bogotá. The study was named OSITA (meaning “little teddy bear” in Spanish), an acronym for Outreach, Screening, and Intervention for TraumA. Feedback from IPC trainees and participants confirmed that the 4 therapeutic foci of IPC were highly relevant to the target population. Analyses of symptom changes in the sample of completers with baseline, last session, and follow-up data points revealed significant decreases over time in depression, anxiety, and PTSD symptom levels from baseline to last IPC session and further significant decreases in depression from last IPC session to follow-up