A 50-year-old white male with mildly symptomatic benign prostatic hyperplasia has been diagnosed with panic disorder. Of the following, which one would be most appropriate as pharmacotherapy for this individual?
Correct Answer C:
SSRIs have been shown to be very effective in the treatment of panic attacks. For a number of years, imipramine was used to treat panic attacks. However, a patient with prostatic hyperplasia is likely to become more symptomatic if given a tricyclic antidepressant. Haloperidol is not indicated for this problem. Lithium and carbamazepine have not been shown to be effective in the treatment of panic disorder.
Which one of the following is true regarding panic disorder?
Correct Answer A:
Ninety percent of patients with panic disorder will have at least one other psychiatric disorder during their lifetime. Conditions commonly reported include major depression, generalized anxiety disorder, agoraphobia, post-traumatic stress disorder, bipolar disorder, and alcohol abuse. The risk of suicidal behavior is likely to be increased among patients with panic disorder and coexisting major depression.
Panic disorder is more common in women than in men. Anti-epileptic drugs are not indicated for panic disorder. Relapse occurs within 2 years in at least one-third of patients with the disorder. The most effective medications for panic disorder include SSRIs, SNRIs, and tricyclic antidepressants, as well as benzodiazepines.
A 30-year-old female presents to your office after being evaluated in the ED for chest pain. She reports that her medical workup for heart disease was negative, but that she continues to have episodes of chest pain and fears she is going to have a heart attack. On further evaluation, you identify her episodes as lasting usually 10 minutes and associated with shortness of breath, sweating, lightheadedness, tingling in her extremities, and an intense feeling of doom. After educating the patient about the symptoms of panic disorder, you suggest medication treatment.
All of the following medications may be useful in treating her symptoms, except:
Bupropion has not been shown to be effective in treatment of panic disorder and does not appear to have antipanic properties. Tricyclic antidepressants, particularly imipramine, and benzodiazepines such as alprazolam have been shown to be effective in treating panic disorder. Selective serotonin reuptake inhibitors, such as sertraline, have valuable antipanic properties and are useful to treat panic disorders. MAOIs such as phenelzine are also very effective in treatment of panic disorder.
Which of the following types of psychotherapy is most efficacious for treating panic disorder?
Correct Answer B:
Cognitive-behavioral therapy (CBT) can be very helpful in treating panic disorders. Some studies found an equal efficacy to pharmacologic interventions. CBT is based on the premise that panic is a learned response. Cognitive misinterpretations of environmental and internal cues result in a conditioned response, which can be unlearned. Insight oriented therapies based on underlying unconscious conflicts of unresolved relationship issues tend not to alleviate the specific symptoms of a panic disorder.
A 23-year-old, otherwise healthy, single woman presents to the emergency center complaining of an episode of lightheadedness, chest discomfort, shortness of breath, and trembling, which occurred earlier that morning and lasted nearly 10 minutes. This is the first episode of these symptoms, but she is very fearful that it will happen again.
Each of the following psychiatric conditions are commonly associated with her symptoms, except:
Correct Answer E:
Mania. Comorbid psychiatric conditions exist in the majority of patients with panic disorders. The most frequent is agoraphobia. Depression may precede or follow the onset of a panic disorder, but mania and bipolar disorder has no particular association. A variety of “cluster C” personality disorders, including avoidant, dependent, and obsessive compulsive personality, are associated with panic disorder. A variety of drugs, including stimulants, can precipitate a panic episode.
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