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a bad husband

DAM - الأربعاء, 2007-08-08 09:39 |

الوصف الكامل Background: 

A 28-year-old attorney presents complaining of a six-month history of extreme nervousness, irritability, and restlessness. He is "plagued" by recurrent thoughts of not being able to properly carry out his responsibilities at the office. He dreads the possibility of not being offered a position as partner in the law firm. As a result, he finds himself unable to concentrate well or perform his duties efficiently. He is also engaged to be married, and spends sleepless nights thinking about the responsibilities of married life. He worries that he will not be a good husband or father. He denies any history of alcohol intake, but has recently begun drinking two bottles of beer every night for the past month as a means of escaping from his distressing thoughts. Which of the following is the treatment of choice for this patient?

A. Propanolol before a distressing situation
B. Alprazolam
C. Treatment for alcohol dependence
D. Ziprasidone
E. Buspirone

الشكوى الرئيسية CC: 

القصة المرضية HPI: 

الأجهزة الأخرى ROS: 

السوابق المرضية الشخصية PMH: 

السوابق المرضية العائلية FMH: 

الوضع الصحي والاجتماعي SH: 

الفحص السريري Clinical Exam: 

التشخيص التفريقي DD: 

الاستقصاءات Investigations: 

التدبير Managment: 

كتابة حرة وطرح موضوع النقاش!: 

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Dr_Ayyad - الأربعاء, 2007-08-08 10:14

GAD is the dx
E.buspirone is the answer

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DAM - الخميس, 2007-08-09 21:41

as usual ayyad, correct

Given this patient's presentation, the most likely diagnosis is generalized anxiety disorder (GAD). According to the DSM-IV, GAD is characterized by excessive anxiety and concern regarding multiple events or activities for a minimum of six months. Three or more of the following symptoms must also be present: sleep impairment, easy fatigability, restlessness, muscle tension, poor concentration, or irritability. These symptoms cause the patient significant distress, and can be treated with buspirone, benzodiazepines (eg, alprazolam), or antidepressants (eg, venlafaxine, escitalopram). All of these medications are highly effective in combination with cognitive-behavioral psychotherapy. Because buspirone does not cause the physical dependence and withdrawal symptoms associated with benzodiazepines, it is considered a first-line drug in the treatment of GAD.
(Choice A) Prophylactic propanolol is effective in the treatment of performance-related anxiety, but is not used in the treatment of generalized anxiety disorder.
(Choice B) Benzodiazepines like alprazolam have a fast onset of action and are used to treat GAD. However, the patient in this case mentions recent onset alcohol abuse. Given the addiction potential of alprazolam, buspirone would be a safer option in this patient. Buspirone also does not cause the cognitive impairment observed with use of benzodiazepines.
(Choice C) If this patient's symptoms were secondary to his alcohol abuse, it would be appropriate to treat that first. However, this patient's alcohol use is due to his anxiety.
(Choice D) Ziprasidone is an atypical antipsychotic and plays no role in the management of GAD.

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