Clinical Case Database / Category: Patient Management
Panic and agoraphobia
Publication details
Sohail Tariq, Lynne M Drummond MBChB (Glasgow), MRCP (UK), FRCPsych
Foundation Years Journal, volume 3, issue 7, p.52 (123Doc Education, London, September 2009)
Abstract
One evening in A&E you are asked to see a 19-year-old Caucasian woman, Lorraine, who presents with palpitation, breathlessness and numbness in her fingers. It is impossible to obtain any history from her as she is extremely distressed and agitated. On examination, her BP is 140/95 with a pulse rate of 102. Her respiratory rate is 28/minute and she is apyrexial with a temperature of 36.2. Her chest is clear on auscultation, she has a normal peak flow and capillary oxygen saturation and her heart sounds are normal. Examination of her nervous system reveals no abnormality. There is no palpable thyroid and no bruit. You suspect that this may be psychogenic in origin but first ask the casualty officer for her opinion. She confirms your findings and asks you to obtain a blood sugar reading but if this is normal to try and calm her down and obtain a history of the presenting complaint.
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Authors
Sohail Tariq
MBBS
ST–2
South West London and St George's NHS Trust
London
SW17 7DJ
Lynne M Drummond MBChB (Glasgow), MRCP (UK), FRCPsych
Consultant Psychiatrist and Senior Lecturer
South West London and St George's NHS Trust
London SW17 7DJ
lynnemd@sgul.ac.uk
References
1. World Health Organization ICD-10. The ICD-10 Classification Of Mental And Behaviour And Diagnostic Guidelines Geneva: WHO, 1991.
2. American Psychiatric Association. Diagnostic And Statistical Manual Of Mental Disorders DSM IV, Washington D.C: American Psychiatric Association, 1994.
3. Clark DM., A cognitive approach to panic. Behav Res Ther, 1986, 24(4):46–70.
4. Stern RS, Drummond LM. The Practice of Behavioural and Cognitive Psychotherapy, Cambridge University Press 1991.
5. Burke M, Drummond LM, Johnson DW. Treatment choice for agoraphobic women: Exposure or cognitive-behaviour therapy? British Jl of Clin Psychology, 1997, 36:409–420.
6. Drummond LM, Fineberg NA. Phobic Disorders. In College Seminars in Adult Psychiatry. (ed. G. Stein) London: Gaskell, 2007, Chapter 14:258–269.
7. Ballenger JC. Current Treatments of Anxiety Disorders in Adults. Biol Psychiatry, December 1999, 1;46(11):1579–1594.
8. National Institute for Health and Clinical Excellence. National Clinical Practice Guideline Number 22: Anxiety: management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care. British Psychological Society and Royal College of Psychiatrists, 2004.
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About the Clinical Cases Database
The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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