Psychiatry/Behavioral Medicine

Question 1

Panic Attack
Path:
Pt:
Tx:

Answer 1

Path: Brief episode of intense fear accompanied by somatic or cognitive symptoms

Pt: Sudden onset of palpitations, chest pain, choking sensation, dizziness, feelings of unreality (depersonalization or derealization), secondary fear of dying, losing control or going mad

Tx: 
1st line: 
SSRI (citalopram)
benzodiazepine (diazepam, lorazepam)-> avoid in patients with substance abuse disorders 
Others: TCA (imipramine)

Question 2

Major depressive disorder
Path:
Pt:
Dx:

Answer 2

Path: Hx of 1 or more major depressive episodes and no hx of mania or hypomania

Pt:
Multiple somatic complaints-> physical symptoms that are distressing to the pt and have no discernible organic cause

Dx: must report at least 5 symptoms, including either dysphoria or anhedonia, that occur almost every day for at least 2 consecutive weeks
SIG E CAPS
-Sleep- hypersomnia/insomnia
-Interest- loss of interest or pleasure in activities (anhedonia)
-Guilt- feeling of worthlessness or inappropriate guilt
-Energy- low
-Concentration- poor
-Appetite- decreased or increased
-Psychomotor agitation or retardation
-Suicidal ideation

Question 3

Generalized anxiety disorder
Pt:
Dx:
Tx:

Answer 3

Pt: Excessive worry
Persistent symptoms
Difficult to control feelings

Dx:
Generalized, persistent and excessive anxiety and combination of various psychological and somatic complaints
Symptoms last >6m

Tx: CBT, SSRI (sertraline)