A 18-year-old female develops breathlessness with perioral tingling, similar 2 episodes in the past; what is your diagnosis?
Correct Answer: Panic disorder
Description: Ans. c. Panic disorderIt is characterized by recurrent, unexpected panic attacks.Two to three times more common in women than in men.Agoraphobia is present in 30-50% of cases.The average age of onset is 25, but may occur at any age.HISTORY/PE:Panic attacks are defined as discrete periods of intense fear or discomfort in which at least four of the following symptoms develop abruptly and peak within 10 minutes: tachypnea, chest pain, palpitations, diaphoresis, nausea, trembling, dizziness, fear of dying or "going crazy," depersonalization, or hot ashes.Perioral and/or acral paresthesias, when present, are fairly specific to panic attacks, which produce hyperventilation and low O2 saturation.Patients present with 1 or more months of concern about having additional attacks or significant behavior change as a result of the attacks--e.g., avoiding situations that may precipitate attacks.Determine whether a patient has panic disorder with or without agoraphobia so that agoraphobia can also be addressed in the treatment plan.TREATMENTShort-term therapy: Benzodiazepines (e.g., clonazepam) may be used for immediate relief, but long-term use should be avoided in light of the potential for addiction and tolerance.Taper benzodiazepines as soon as long-term treatment is initiated (eg, SSRIs).Long-term therapy:CBTMedications: SSRIs (First-line therapy), TCAs.
Category:
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