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Answer 4
  1. Propranolol. Adjustment disorders are highly responsive to most types of psychological or psychopharmacologic intervention. Generally, such disorders occur in patients who lack sufficient naturally occurring social support and who are distressed by the negative meanings that they attach to the stressor. Psychotherapy provides support and helps patients reinterpret their experience in more positive ways. Occasional use of benzodiazepines is often very effective and rarely leads to dependence or abuse in patients with no history of alcohol abuse.1 Buspirone may be effective and carries no risk for dependence or abuse, but it requires 3 weeks or more to be effective. Although propranolol may slow heart rate and reduce tremor in anxious patients, this drug seems to have little effect on the subjective distress that constitutes the core feature of adjustment disorder with anxiety and all anxiety disorders.

    1. Nesse RM, Zamorski MA: Anxiety disorders in primary care. In Primary Care Psychiatry. Knesper DJ, Riba MB, Schwenk TL, eds. Philadelphia: WB Saunders, l997:32-163.

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