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Old 07-04-2012
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Psyche Overwhelmingly anxious 35-year-old man

A 35-year-old man visits a psychiatrist because he is overwhelmingly anxious about a speech he has to make. The man states that he was recently promoted to a position within his company that requires him to speak in front of an audience of approximately 100 people. He says that the first such speech is coming up in 2 weeks and that worrying about it keeps him from sleeping. He knows that his fear is out of proportion, but he is unable to control it. He explains that he has always had trouble with public speaking because he fears that he might “do something stupid” or otherwise embarrass himself. He has avoided public speaking in the past as much as possible or has spoken in public only before an audience of fewer than 10. Because he knows that he must make the presentation coming up in 2 weeks or he will not be able to keep his new job, he has visited the psychiatrist hoping to find a solution to the problem.

➤ What is the most likely diagnosis?

A. Social phobia
B. Generalized anxiety disorder
c. Panic disorder with agoraphobia
D. Agoraphobia without panic attacks


➤ What are the treatment options open to this patient?
A. Benzodiazepines
B. Cognitive-behavioral therapy
C. Beta-blockers
D. Buspirone
E. Escitalopram
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  #2  
Old 07-04-2012
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A & C?

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Old 07-05-2012
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should be a and c.
this man has stage fright and beta blocker prior to stage performance is recommended.

though CBT [systemic desensitization] can be done in long run to end his stage fright completely.[hope i m correct here]
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Old 07-05-2012
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Answers are A and D.....
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Old 07-05-2012
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➤ Most likely diagnosis: Social phobia.
➤ Treatment : Behavioral or cognitive-behavioral therapy is the treat-
ment of choice.
A typical treatment regimen involves relaxation training
followed by progressive desensitization.
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Old 07-06-2012
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A and B
Cognitive behavior therapy since he is still 2 weeks away from presentation. Beta blockers would have immediate effect for symptoms. Should be given 30 mins before presentation. If behavior cognitive therapy fails start SSRI...
Is the last line true?/
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Old 07-06-2012
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Psychotherapy is helpful in treating social phobia and usually involves a combination of behavioral and cognitive therapy using desensitization to the feared situation, rehearsal during sessions, and homework assignments in which patients are asked to place themselves in public situations in a graded fashion.
In some cases, psychopharmacotherapy for severe social phobia has succeeded with the use of selective serotonin uptake inhibitors (SSRIs), benzodiazepines, venlafaxine, and buspirone. Buspirone has been shown to augment the treatment of this disorder when used adjunctively with SSRIs.
Treating the anxiety associated with performance situations involves the use of beta-adrenergic receptor antagonists just before the feared situation.
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