she has to give a public talk. This also happens to her before interviews, exams and after arguments. What is the best management strategy for this pt?
a. Diazepam
b. Rebreathe in a paper bag
c. Desensitization
d. Buspirone
e. Propranolol
Answer: B
This happens with public speaking, interviews, exams, arguments (not a specific situation). Desensitization is not therefore an appropriate choice (which is more of a treatment for specific phobias e.g. phobia to cats).
Hyperventilation Syndrome:
Management
Anxiety can cause hyperventilation, producing symptoms that are interpreted as indicating serious physical illness. This causes more hyperventilation, worse symptoms and a vicious circle. Careful explanation of the nature of the condition is needed. Patients may find it difficult to accept the aetiology. Reproducing symptoms with voluntary hyperventilation may be useful.- Rebreathing into a paper bag can be used to help build up the pCO2 but this should only be used where the diagnosis is certain, as it may be dangerous if there is physical disease.
- Relaxation techniques may be helpful.
- Breathing exercises are frequently used to treat dysfunctional breathing and hyperventilation syndrome. However, there is currently no strong evidence of benefit either in children or adults.
- Treating asthmatics with dysfunctional breathing, using a brief physiotherapy intervention (teaching breathing retraining exercises), improves quality of life but this is only maintained in a quarter of patients six months on.
Pharmacological
The basis of treatment should be behavioural therapy rather than medication but there may be a place for drugs.- Benzodiazepines can be used in the acute situation if severe. Use only occasionally, as there is the potential for sedation and dependence.
- Propranolol may be of value if asthma has been excluded.
- Tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) may also be of value.
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