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Self-Assessment Questions

Psychiatry

Panic Disorders: Review Questions

William R. Marchand, MD

Dr. Marchand is acting associate director, Department of Veterans Affairs VISN 19 MIRECC, and assistant professor of psychiatry, University of Utah, Salt Lake City, UT.
This work was supported by the Veterans Administration VISN 19 MIRECC.




Choose the single best answer for each question.

1. A 23-year-old woman presents to her primary care physician with a 6-month history of anxiety symptoms that started after she was promoted to a job requiring public speaking. Her new job requires her to give presentations to colleagues and customers on a regular basis. She states that when she begins a presentation, she “has a panic attack.” She describes symptoms of rapid heart rate, shortness of breath, sweating, and tremor and reports being afraid of doing something “stupid” that will cause embarrassment. She states the discomfort is so intense that she is unable to speak articulately during presentations and that her job performance is significantly hampered by these attacks. When preparing for a presentation, worry keeps her awake at night and interferes with her concentration during the day. The patient reports that she does not worry excessively about anything other than the presentations. She does not have unexpected attacks of anxiety, fear of open spaces, or a history of exposure to any traumatic stressor. What is this patient’s most likely diagnosis?
  1. Acute stress disorder
  2. Generalized anxiety disorder (GAD)
  3. Panic disorder without agoraphobia
  4. Social phobia
Click here to compare your answer.


2. A 25-year-old man presents to a psychiatrist complaining of having severe panic attacks 3 to 4 times per week, each lasting 10 to 15 minutes. He meets criteria for a diagnosis of panic disorder with agoraphobia. Symptoms started about 6 months ago with 1 or 2 mild attacks per month, but the severity and frequency of the attacks have increased over the past 6 weeks. The patient reports severe anxiety over being in situations where he cannot escape or obtain assistance if he has a panic attack. He is particularly fearful of driving and riding the bus. Because of this anxiety, the patient often is unable to go to work and is afraid he will lose his job. He asks for something to control his symptoms quickly. The patient denies any history of substance abuse or other psychiatric conditions. What is the most appropriate initial treatment for this patient?

  1. Psychotherapy only
  2. Selective serotonin reuptake inhibitor (SSRI)
  3. SSRI and a benzodiazepine
  4. Tricyclic antidepressant and a benzodiazepine
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3. Five days after starting fluoxetine 20 mg/day for newly diagnosed panic disorder, a 44-year-old woman calls her primary care physician complaining that her anxiety symptoms seem to be worsening. In particular, she notes anxiety, sweating, and tremor even when she is not having a panic attack. What is the most appropriate management of this patient’s increased symptoms?

  1. Continue fluoxetine and add clonazepam 1 mg 3 times/day
  2. Discontinue fluoxetine immediately
  3. Increase fluoxetine to 40 mg/day
  4. Reassurance and decrease fluoxetine to 10 mg/day
Click here to compare your answer.


4. A 32-year-old woman is evaluated by an internist and is found to meet diagnostic criteria for panic disorder. She reports that although her symptoms are bothersome, they only minimally interfere with her life. She states she would rather not take psychiatric medication and wonders if there are other treatment options available. Which of the following is the most appropriate recommendation?

  1. Recommend no treatment since symptoms are not severe
  2. Refer for cognitive behavioral therapy
  3. Refer to a psychiatrist for a second opinion
  4. Strongly encourage psychopharmacotherapy
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5. A 21-year-old man presents to the psychiatrist for a follow-up appointment. He was diagnosed with panic disorder and has taken citalopram 40 mg/day for 6 months. He reports that he has been symptom-free for approximately 3 months and has no side effects from the medication. The patient asks if he can stop taking citalopram since his symptoms have resolved. Which of the following is the most appropriate recommendation?
  1. Encourage continuation of citalopram for at least another 6 months
  2. Explain that a minimum of 5 years of treatment will be necessary
  3. Explain that lifelong treatment will be necessary
  4. Taper and discontinue citalopram
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6. After 5 years of treatment with paroxetine 40 mg/day for panic disorder, a 40-year-old woman calls her primary care physician stating that she has forgotten to refill her prescription. She has not taken paroxetine for several days and is experiencing nervousness, insomnia, and dizziness but denies other symptoms. The patient reports that increased stress is the reason she did not notice that her prescription had run out.Which of the following is the most likely explanation of this patient’s symptoms?

  1. Onset of GAD
  2. Onset of major depression
  3. Relapse of panic disorder
  4. SSRI discontinuation syndrome
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7. A 36-year-old woman tells her family physician that she has been experiencing anxiety for approximately 4 weeks. She states that the anxiety is episodic and seems to occur as “attacks.” During these attacks, the patient experiences increased nervousness and feels shaky. She describes frequent worry as well as daily insomnia, trouble concentrating, loss of appetite, and feelings of worthlessness. She also reports loss of interest in her job and friends. The patient occasionally drinks alcohol but denies alcohol or drug abuse. She states that about 5 years ago she was diagnosed with panic disorder; however, the symptoms resolved after treatment with an antidepressant. She denies agoraphobia. Which of the following is this patient’s most likely diagnosis?

  1. Dysthymic disorder
  2. GAD
  3. Major depression
  4. Panic disorder without agoraphobia
Click here to compare your answer.


8. Which of the following is the most appropriate initial treatment for a patient with new-onset panic disorder with no comorbid psychiatric, substance abuse, or medical disorders?

  1. Bupropion 300 mg/day
  2. Citalopram 5 mg/day
  3. Clonazepam 2 mg 3 times/day
  4. Haloperidol 5 mg/day
Click here to compare your answer.


 

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