Patient Demographics:
- Name: J.D. (initials used for confidentiality)
- Age: 20
- Gender: Male
- Education: Sophomore in college
- Living Situation: Lives in a dormitory with a roommate
- Medical History: No major medical illnesses. Family history significant for anxiety in his mother.
- Substance Use: Reports occasional alcohol use on weekends, denies drug use.
Chief Complaint:
“I feel like I’m going to die when it happens. My chest hurts and I can’t breathe.”
During the attacks, he experiences:
- Palpitations
- Shortness of breath
- Chest tightness
- Sweating
- Trembling
- Fear of losing control or dying
He notes that the first attack occurred in class, leading him to rush to the emergency department where cardiac workup was normal. Since then, he has had recurring attacks in various settings.
QUESTIONS:
1. Which of the following symptoms is most characteristic of panic attacks?
A. Chronic worry about daily events
B. Sudden onset of intense fear with physical symptoms
C. Fear of public speaking
D. Intrusive flashbacks of trauma
2. Which pharmacological treatment is considered first-line for panic disorder?
A. SSRI
B. Benzodiazepine as monotherapy long-term
C. Antipsychotics
D. Beta-blockers
3. Which of the following can worsen panic attacks and should be avoided?
A. Regular aerobic exercise
B. Mindfulness meditation
C. Sleep hygiene practices
D. Caffeine and stimulant use
Answers:
1. B - Panic attacks involve abrupt surges of intense fear and autonomic arousal (palpitations, chest tightness, sweating).
2. A - SSRIs are first-line due to efficacy and safety for long-term treatment.
3. D - Caffeine and stimulants can increase heart rate and anxiety, triggering panic symptoms