Review Question - QID 103341

This patient is likely experiencing a panic attack. The immediate treatment for an acute panic attack is benzodiazepines, reassurance, encouraging patient to slow breathing.

Panic attacks are due to sympathetic activation due to no particular stimulus leading to significant fear and discomfort. Symptoms typically peak approximately 10 minutes into the attack and include chest pain, palpitations, abdominal pain, nausea, diaphoresis, fear of dying, loss of reality, chocking, paresthesias, and chills. Panic attacks may mimic other serious conditions such and myocardial infarction and arrhythmia, which should be ruled out before diagnosing and treating a panic attack. Panic disorder occurs if a patient experiences 3 panic attacks in 3 weeks and associated fear of recurrent attacks.

Locke et al. discuss the diagnosis and management of panic disorder and generalized anxiety disorder. They state that these two conditions are frequently under-diagnosed and can significantly disrupt a patients quality of life. The authors recommend the use of the GAD-7 and the Severity Measure for Panic Disorder to aid in the diagnosis of these conditions. They states that treatment should be individualized to the patient and can include a combination of SSRI, cognitive behavioral therapy, and physical activity. The use of benzodiazepenes should be limited due to adverse effects and the risk for abuse.

Steenen et al. review the use of propranolol in the treatment of anxiety disorders, including panic attacks. Their meta analysis revealed no difference between propranolol and benzodiazepines on the frequency of anxiety and panic attacks.They call for further studies comparing the efficacy of propranolol and SSRIs as long term treatment modalities for panic attacks.

Incorrect answers:
Answer 1: This patient is unlikely to be experiencing an acute myocardial infarction, but rather a panic attack.
Answer 3: Although the patient has an increased respiratory rate and tachycardia, there is no other factors suggesting an asthma attack.
Answer 4: Although SSRI therapy is an appropriate long term treatment for panic attacks/panic disorder, it is not useful in an emergent setting.
Answer 5: Although cognitive behavioral therapy is an appropriate long term treatment for panic attacks/panic disorder, it is not useful in an emergent setting.