A 32-year-old married woman describes experiencing panic attacks every time she goes to the local store. These have been getting more frequent and she is finding it increasingly difficult to leave her home.
Which one of the following should form part of her treatment?
Correct Answer E:
A panic attack is the sudden onset of a discrete, brief period of intense discomfort, anxiety, or fear accompanied by somatic or cognitive symptoms. Panic disorder is occurrence of repeated panic attacks typically accompanied by fears about future attacks or changes in behavior to avoid situations that might predispose to attacks.
Diagnosis is clinical. Isolated panic attacks may not require treatment. Panic disorder is treated with drug therapy, psychotherapy (eg, exposure therapy, cognitive-behavioral therapy), or both.
Cognitive-behavioral therapy involves teaching patients to recognize and control their distorted thinking and false beliefs and to modify their behavior so that it is more adaptive. For example, if patients describe acceleration of their heart rate or shortness of breath in certain situations or places and fear that they are having a heart attack, they are taught the following: not to avoid those situations, to understand that their worries are unfounded and to respond instead with slow, controlled breathing or other methods that promote relaxation.
Which of the following treatment interventions should you consider avoiding when treating panic symptoms?
Correct Answer D:
SSRIs are generally used as first-line pharmacologic agents in panic disorder, followed remotely by tricyclics. Paroxetine and amitriptyline are both serotonergic agents very helpful in preventing panic episodes, as is the potent benzodiazepine alprazolam. Mirtazapine has a much more sedating effect, generally reducing its potential to aggravate initial anxiety.
Consider avoiding bupropion due to stimulating effects.
A 25-year-old white female presents to your office with the following complaints: sudden onset of intense apprehension, fear, terror associated with impending doom, dyspnea, palpitations, and a feeling of loss of control.
Which one of the following is the most likely diagnosis?
Correct Answer B:
Panic attacks generally begin between the ages of 17 and 30, and 80% of those affected are women. Panic attacks manifest as the sudden onset of intense apprehension, fear, or terror, often associated with thoughts of impending doom and at least four of the following somatic symptoms:
Hypochondriasis is a condition where the patient is preoccupied with health and absorbed in his/her own physical ailments. Major depressive episodes/depression are characterized by marked, sustained changes of mood. In major depression the prevailing mood is low, being described as “blue”, “down in the dumps” or apathetic. Part of the low mood consists of a decreased ability to enjoy activities that usually are a source of pleasure.
Which one of the following agents would be best when rapid relief of symptoms is required in a severely distressed patient with panic disorder?
All the agents listed are effective in the management of panic disorder. However, only alprazolam has an onset of action measured in hours instead of weeks, making it the most appropriate choice for managing acutely distressed patients. Because of the difficulty in discontinuing benzodiazepines, their most common use is to stabilize severe initial symptoms until another treatment becomes effective.
The most appropriate initial pharmacologic treatment of panic disorder is:
Correct Answer A:
An SSRI is the treatment of choice for patients who have never had pharmacotherapy for panic disorder.
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