POLYCYTHEMIA AND AGORAPHOBIA

Using single photon emission computerized tomography (SPECT), we demon strated that in patient A, a 20-year-old male with polycythaemia, the cerebral blood flow was decreased (presumably as a result of increased viscosity and or microemboli), probably leading to frightening visual distortions (dysmorphopsia) associated with scintillating specks of b right colors (Teichopsia). This had presumably precipitated agoraphobi a. After hospitalization, when the patient had not responded to effort s at systematic desensitization, he improved through a combination of multiple venesections and antiplatelet aggregation therapy (aspirin 75 mg o.d.) over 3 months combined with systematic desensitization. A su bsequent SPECT demonstrated an increase in cerebral blood flow to norm al levels, which coincided with improvement of agoraphobic symptoms an d disappearance of visual distortions on further follow-up. This paper depicts another yet undocumented example of an alarming physical symp tom probably leading to a cognitively-based panic sufficient to cause agoraphobia by classical conditioning. It also suggests that prior tre atment of such physical symptoms is likely to facilitate the process o f systematic desensitization. Copyright (C) 1996 Elsevier Science Ltd