Master the board step 3

Master the Boards: USMLE Step 3
Treatment
Exposure therapy (involves increasing exposure to stimulus in order to induce
habituation and decreased anxiety). Benzodiazepines and beta-blockers are
helpful when given prior to exposure.
Basic Science Correlate
Benzodiazepines work by increasing GABA through increased frequency
of chloride ions across neuronal cell membranes, resulting in decreased
excitability of neurons.
Barbiturates work by increasing GABA through increased duration of
chloride ions across the neuronal cell membranes, resulting in decreased
excitability of neurons.
A 19-year-old ballet dancer presents because of extreme anxiety on stage. She
reports that she fell 3 months ago at a national ballet competition and since then
suffers extreme anxiety, trembling, diaphoresis, and breathlessness when she has
to go on stage. She denies any problems with ballet practice and has no other
medical problems. Which of the following is the most likely diagnosis?
a. Acute stress disorder
b. Adjustment disorder with anxious mood
c. Panic disorder
d. Social phobia
Answer: C. Panic disorder presents with a clear precipitating event which subsequently
results in anxiety in similar circumstances. Panic disorder is differentiated from social
phobia, which has no clear precipitating cause.
Generalized Anxiety Disorder (GAD)
Excessive, poorly controlled anxiety that occurs daily for more than 6 months.
No single event or focus is related to the anxiety. It often coexists with major
depression, specific phobia, social phobia, and panic disorder.
Treatment
Treatment consists of supportive psychotherapy, including relaxation training
and biofeedback. Medications include SSRIs, venlafaxine, buspirone, and
benzodiazepines.
Distinguish GAD from panic attack or social phobia by what is causing the
anxiety. If the question describes persistent worry of a panic attack or social
encounter, then GAD is not the answer. In GAD, multiple life circumstances,
not just one, are causing the anxiety.
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