A 24-year-old medical student reports experiencing episodes of intense fear lasting 10–15 minutes, associated with palpitations, chest tightness, shortness of breath, dizziness, and a fear of dying. These episodes occur without warning and have happened 4 times in the past month. Between episodes she persistently worries about having another attack and has started avoiding crowded public transport. Cardiac and thyroid workup is normal. What is the most appropriate first-line treatment?

• A Propranolol as needed
• B Cognitive behavioral therapy and/or an SSRI ✓
• C Lorazepam as needed for attacks
• D Buspirone scheduled

Explanation

Panic disorder is defined by recurrent unexpected panic attacks with at least 1 month of anticipatory anxiety or avoidance behavior. First-line treatment is cognitive behavioral therapy (particularly panic control therapy with interoceptive exposure) and/or SSRIs/SNRIs. SSRIs are the pharmacological treatment of choice for long-term management. Benzodiazepines may provide rapid relief but are not recommended for regular use due to dependence and interference with exposure-based learning. Propranolol addresses somatic symptoms but does not treat the disorder.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.