WBR0554

Author	[[PageAuthor::Ayokunle Olubaniyi, M.B,B.S [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Behavioral Science/Psychiatry
Sub Category
Prompt	[[Prompt::A 17-year-old college student is brought to the ED because of shortness of breath and palpitation. The symptoms came on suddenly about one hour after she got back from the airport where she had arrived from a 6-hour flight visiting her parents. She tells you, "I can't get my breath and I'm having pains in my chest. My face is numb. I think I'm dying. Do something!" The past medical history is unremarkable, except for the oral contraceptive pills that she takes occasionally. Physical examination is normal except for tachypnea and tachycardia. Electrocardiogram shows sinus tachycardia but is otherwise normal. Arterial blood gas values while breathing room air show: PO2 – 98 mm Hg PCO2 - 31 mm Hg pH - 7.45 Which of the following is the most appropriate long-term pharmacotherapy?]]
Answer A	AnswerA::Buspirone
Answer A Explanation	AnswerAExp::This stimulates serotonin 1A receptors. It is used for generalized anxiety disorders
Answer B	AnswerB::Olanzepine
Answer B Explanation	AnswerBExp::This is an atypical antipsychotic. Olanzepine is also used for the treatment of OCD, anxiety disorders, depression, mania, and tourette syndrome.
Answer C	AnswerC::Lorazepam
Answer C Explanation	AnswerCExp::Benzodiazepines may be considered during the acute phase of panic disorders but it is generally considered for refractory cases of panic disorders. It is also discouraged due to its ability to cause both physiologic and psychologic dependence
Answer D	AnswerD::Metoprolol
Answer D Explanation	AnswerDExp::Beta-blockers are usually not employed in the management of panic disorders.
Answer E	AnswerE::Paroxetine
Answer E Explanation	AnswerEExp::SSRIs are the first line agents for the treatment of panic disorders.
Right Answer	RightAnswer::E
Explanation	[[Explanation::The patient in this vignette is experiencing symptoms of panic disorder. Panic disorder is defined as the experience of spontaneous and unpredictable panic attacks. Panic attacks are periods of intense fear with the presence of 4 out of 13 defined symptoms appearing suddenly and reaching a peak within 10 minutes from the onset of the symptoms. The symptoms are: Palpitations, pounding heart, or accelerated heart rate Sweating Trembling or shaking Sense of shortness of breath or smothering Feeling of choking Chest pain or discomfort Nausea or abdominal distress Feeling dizzy, unsteady, lightheaded, or faint De-realization or depersonalization (feeling detached from oneself) Fear of losing control or going crazy Fear of dying Numbness or tingling sensations Chills or hot flashes There have been a few reported cases suggesting a casual association between panic attacks and intake of oral contraceptive pills. Initial management should be tapered around supportive measures – oxygen therapy, monitor oxygen saturation, lay in the supine position, analgesia , antiemetics. Acute attacks may require intravenous beta blockers or intravenous benzodiazepine consideration. The long term therapy of panic disorder involves referral to a psychiatrist, cognitive behavioral therapy (CBT) and with the use of SSRIs e.g., paroxetine. Educational Objective: Panic attacks occur suddenly or triggered by some factors. There has been a reported cases of panic attacks following OCP use. The first line pharmacotherapy is SSRIs. Other drugs used in the management include tricyclic antidepressants (TCAs) and benzodiazepines. Long term therapies include SSRIs and cognitive behavioral therapy. All patients with panic disorders should get a psychiatry referral. References: A case of panic disorder induced by oral contraceptive. http://www.ncbi.nlm.nih.gov/pubmed/1315108]]
Approved	Approved::No
Keyword	WBRKeyword::Panic disorder, WBRKeyword::panic attack, WBRKeyword::selective serotonin reuptake inhibitors
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::