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Anorexia
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Borderline personality disorder
Major depressive disorder
Post-traumatic stress disorder
Schizotypal personality disorder
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This patient is having recurrent panic attacks with no clearly associated stimulus for a period greater than 1 month, which is consistent with a diagnosis of panic disorder. This condition is associated with the development of major depressive disorder.Panic attacks are characterized by palpitations, chest pain, abdominal pain, paresthesias, fear of death, and choking among others. Sometimes, these symptoms may be clinically difficult to distinguish from an organic cause. Agoraphobia is associated with panic disorder and can take place in several settings, including auditoriums, trains, bridges, and even traffic. Panic disorder is also associated with major depression, anxiety, schizophrenia, obsessive-compulsive disorder, substance use disorders, phobias, and cluster C personality disorders such as avoidant, dependent, and obsessive-compulsive personality disorders. Treatment is cognitive behavioral therapy and selective serotonin reuptake inhibitors. Acute episodes of panic can be treated with benzodiazepines; however, this is not an appropriate chronic therapy, as this will lead to dependence.Kunas et al. studied the effect of depressive comorbidities on patients with panic disorder. They found that cognitive-behavioral therapy is effective in improving depressive symptoms in patients with panic disorder as well. They recommend using cognitive-behavioral therapy to improve outcomes in patients with mental health disorders.Figure/Illustration A is an ECG that demonstrates normal sinus rhythm without abnormalities (red circle). Patients with panic disorder will not have cardiac changes when they are at rest.Incorrect Answers:Answer 1: Anorexia is an eating disorder characterized by extreme weight loss (with a BMI < 17.5) and aversion to eating. It is associated with major depressive disorder, suicidality, obsessive-compulsive disorder, and other eating disorders. Patients often suffer from major electrolyte derangements.Answer 2: Borderline personality disorder is a cluster B personality disorder characterized by splitting and unstable interpersonal relationships. It is associated with major depressive disorder, bipolar disorder, and substance use disorder.Answer 4: Post-traumatic stress disorder is caused by a traumatic event and presents with flashbacks, nightmares, and anxiety. Unlike panic disorder, patients have specific previous events that trigger episodes. It is associated with other mood disorders such as major depressive disorder and bipolar disorder.Answer 5: Schizotypal personality disorder is a cluster A personality disorder characterized by strange or magical thinking that is not frankly psychotic. Patients have stable but strange beliefs, such as healing crystals. It is associated with schizophrenia.Bullet Summary:Panic disorder is associated with major depressive disorder, agoraphobia, substance abuse, and bipolar disorder.
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