Neuro Case 3

A 22-year-old woman presents to the emergency department in an agitated state, certain that she is "about to die."Fifteen minutes ago, she developed heart palpitations and severe "viselike" tightness in her chest and her medical history in unremarkable. Her father has a history of heart disease and her mother has diabetes mellitus. She takes no medications. Vital signs are: temperature 37ºC (98.6ºF), blood pressure 132/74 mmHg, pulse 118min, and respiratory rate 30/min. She is sweatin profusely. EKG reveals sinus tachycardia. The most appropriate next step is administration of which of the following? why?*

a. Alprazolam
b. Aspirin
c. Buspirone
d. Fluoxetine
e. Imipramine
f. Nitroglycerine

Panic disorder occurs most commonly in women between 20-40 years old. The condition is characterized by a sudden-onset of episodes in which the patient experiences extreme anxiety, a sense of "impending doom," and somatic complaits such as chest pain, palpitations, nausea, shortness of breath, numbness in extremities and diaphoresis. The diagnosis is typically made base on the clinical presentation, but drug screening and EKG should be performed to rule out more serious conditions. Acute treatment of panic disorder includes the administration of benzodiazepines (e.g. alprazolam) for rapid relief of symptoms. A selective serotonine reuptake inhibitor should also be started for long-term symptom relief, but this won't take effect for few weeks. Once symptoms are controlled, the benzodiazepines should be tapered off due to risks of dependence. Cognitive/behavioral therapy may also be of benefit.