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
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 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::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:: 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::