Examkin

Question

Difficulty: EasyAnxiety, OCD, and Trauma-Related Disorders

A 28-year-old woman presents to the psychiatry clinic with a 4-month history of recurrent, unexpected episodes of intense fear. These episodes are accompanied by palpitations, sweating, shortness of breath, and a feeling of impending doom. She constantly worries about having another episode and has started avoiding public transportation as a result. Her past medical history is significant for bipolar I disorder, but she discontinued all her psychiatric medications 2 years ago against medical advice and currently takes no medications. The physician and patient are discussing treatment options for her current symptoms. Which of the following is the most appropriate next step in management?

  1. Initiate cognitive-behavioral therapyAnswer
  2. B
    Initiate paroxetine monotherapy
  3. C
    Initiate phenelzine and fluoxetine concurrently
  4. D
    Reassure the patient that her symptoms are a normal physiological response to stress
  5. E
    Diagnose schizophreniform disorder and initiate risperidone

Answer

Initiate cognitive-behavioral therapy
The correct answer identifies that cognitive-behavioral therapy (CBT) is a first-line treatment for panic disorder. In a patient with unmedicated bipolar I disorder, CBT is particularly appropriate because it avoids the pharmacological risks associated with antidepressants, specifically the risk of triggering a manic episode.

Step-by-Step Solution

1
Identify the primary diagnosis based on the clinical presentation.
Panic disorder with agoraphobia.
The patient has recurrent, unexpected panic attacks followed by persistent worry and avoidance behaviors.
2
Identify relevant past medical history that affects treatment.
Unmedicated bipolar I disorder.
The patient stopped her mood stabilizers 2 years ago, leaving her vulnerable to mood destabilization.
3
Determine the safest and most effective first-line treatment for the primary diagnosis given the comorbidities.
Cognitive-behavioral therapy (CBT).
CBT is a first-line treatment for panic disorder and carries no risk of inducing a manic episode, unlike antidepressant monotherapy.

Key Concept

First-line management of panic disorder in a patient with unmedicated bipolar disorder is psychotherapy (CBT) to avoid the risk of antidepressant-induced mania.
Estimated Time:1m 0s
Rate this question

Topics

Anxiety, OCD, and Trauma-Related Disorders

More questions from this topic