WBR0554

Author	[[PageAuthor::Ayokunle Olubaniyi, M.B,B.S [1] (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Behavioral Science/Psychiatry
Sub Category	SubCategory::General Principles
Prompt	[[Prompt::A 19-year-old female college student presents to the physician's clinic for an episode of palpitations and shortness of breath. She states that her symptoms occurred suddenly, lasted for a few minutes, and then resolved spontaneously without medications. She is worried because these episodes have been occurring more often lately, and she is afraid that they will recur. The patient states that during these episodes, she also experiences "rapid breathing, numbness of the fingers, and fear of impending doom". Her first episode occurred 3 months ago; at the time, she thought she was experiencing a heart attack and visited a nearby emergency department. Her test results were reassuring and she was immediately discharged. Her past medical history is unremarkable, except for regular use of oral contraceptive pills. She has no history of smoking, alcohol intake, or illicit drug use. In the clinic, her temperature is 37.2 °C (98.96 °F), blood pressure is 122/84 mmHg, heart rate is 72/min, and respiratory rate is 14/min. Physical examination is unremarkable. What is the most appropriate long-term pharmacological therapy to treat this patient's condition?]]
Answer A	AnswerA::Buspirone
Answer A Explanation	AnswerAExp::Buspirone is a serotonin 1A receptor partial agonist. It is indicated for generalized anxiety disorders. Of note, buspirone does not interact with alcohol and is not associated with sedation, addiction, or tolerance.
Answer B	AnswerB::Olanzapine
Answer B Explanation	AnswerBExp::Olanzapine is an atypical antipsychotic agent. Olanzepine is indicated for schizophrenia, obsessive-compulsive disorder (OCD), anxiety disorders, depression, mania, and Tourette syndrome.
Answer C	AnswerC::Lorazepam
Answer C Explanation	AnswerCExp::Administration of benzodiazepines may be considered during the acute phase of panic disorders. Benzodiazepines are associated with drug dependence and are discouraged in the long-term use.
Answer D	AnswerD::Metoprolol
Answer D Explanation	AnswerDExp::Beta-blockers are indicated for performance anxiety, but not panic disorder.
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::Panic disorder is an anxiety disorder characterized by episodes or attacks of fear that are associated with other somatic and cognitive symptoms. Panic disorder features a sudden unexpected onset and spontaneous resolution. It commonly affects young women before the age of 25 years. Patients may be otherwise healthy with no past medical history or risk factors, and they tend to have an unremarkable physical examination in the physician's clinic while not experiencing an attack. Common manifestations of panic attacks include symptoms of multiple organ systems and anatomic locations, such as chest pain, palpitations, dyspnea, bolus sensation and choking sensation, abdominal pains, feeling of unreality and impending doom, numbness of the extremities, diaphoresis, hot flashes, chills, and shaking. During an attack, physical examination may only be remarkable for tachycardia and tachypnea. Panic disorder may significantly affect a patient' quality of life; and patients are often too afraid of experiencing future attacks. The diagnosis of panic disorder necessitates that the patient experiences symptoms for more than 1 month. Acutely, patients may be administered benzodiazepines to relieve the anxiety. However, benzodiazepines are not adequate long-term therapeutic options due to the risk of dependence. Thus, the mainstay of long-term pharmacological therapy for patients with panic disorder is selective serotonin reuptake inhibitors (SSRI), such as paroxetine. Although SSRI may require a few weeks to demonstrate efficacy, the majority of patients eventually report significant improvement with SSRI administration. Other non-pharmacological approaches include regular exercise, sufficient sleep, and avoidance of stimulants, alcohol, and caffeine intake. Educational Objective: Panic disorder is an anxiety disorder characterized by episodes or attacks of fear that are associated with other somatic and cognitive symptoms. For the diagnosis to be made, the symptoms should persist for at least 1 month. The mainstay of long-term pharmacological therapy for patients with panic disorder is selective serotonin reuptake inhibitors (SSRI) References: Kircanski K, Craske MG, Epstein AM, et al. Subtypes of panic attacks: a critical review of the empirical literature. Depress Anxiety. 2009;26(10):878-87. First Aid 2014 page 508]]
Approved	Approved::No
Keyword	WBRKeyword::Panic disorder, WBRKeyword::Panic attack, WBRKeyword::Anxiety disorder, WBRKeyword::SSRI, WBRKeyword::Selective serotonin reuptake inhibitor, WBRKeyword::Paroxetine
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