A 21-year-old woman comes to the emergency depament with complaints of 'constricting pain in chest' and difficulty in breathing. The patient is sure that 'she is having a hea attack' . She has three similar episodes in the past one month. The past medical history is unremarkable, there is family history of myocardial infarction in father who died of it at the age of 47. The ECG shows sinus tachycardia, the cardiac enzymes and urine drug screen came out to be normal. What is the next best step in the management of this patient?
The presence of recurrent episodes of chest pain and breathing difficulty in an otherwise healthy young adult with negative cardiac enzymes is suggestive of panic disorder. Currently the patient is experiencing a panic attack. The drug of choice for a panic attack is a benzodiazepine, which provides immediate relief from the symptoms, but due to possibility of dependence , benzodiazepines are avoided in long term treatment. SSRIs like escitalopram and cognitive behavioural therapy are preferred treatment modalities in the long term treatment of panic disorder. Reassurance must be given to patient that its not a hea attack, however reassurance by itselfewill not terminate the attack. Hence benzodiazepines must be used.
Reassurance
Alprazolam
Escitalopram
Cognitive behavioural therapy
Neurotic, Stress Related and Somatoform Disorders