The PMHNP diagnoses a 25-year-old woman with generalized anxiety disorder with panic attacks. Terrified by the panic attacks, she requests medication, saying, “I need something to control them immediately.” The patient is otherwise fit and healthy and has no history of substance abuse or dependence. Which of the following strategies would be reasonable?
Start the patient on alprazolam and refer her to cognitive-behavioral therapy
Start the patient on a combination of an SSRI for the long term and low-dose clonazepam for the short term
Start the patient on any SSRI
Start the patient in individual psychotherapy
The Correct Answer is B
Choice A reason: Alprazolam is a short-acting benzodiazepine that carries high risk for dependence. Using it as monotherapy without long-term management is not recommended.
Choice B reason: This is the correct answer. SSRIs are first-line long-term treatment for generalized anxiety disorder, and low-dose benzodiazepines such as clonazepam can be used short-term for rapid symptom relief during initiation of SSRIs. This approach balances immediate relief with safe long-term management.
Choice C reason: While starting an SSRI alone is reasonable, it may not provide immediate symptom relief, which the patient is requesting. Short-term adjunctive therapy is often needed initially.
Choice D reason: Psychotherapy alone is effective but does not meet the patient’s request for rapid symptom control. Combining therapy with pharmacologic treatment is more appropriate in this scenario.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Temporary tic disorder involves motor or vocal tics lasting less than 12 months. This patient’s symptoms have persisted for 6 months and include both motor and vocal tics, making a simple temporary tic diagnosis less appropriate.
Choice B reason: This is the correct answer. Tourette's disorder requires both multiple motor tics and at least one vocal tic, present for more than 1 year, starting before age 18. The boy’s presentation of motor and vocal tics over a 6-month period suggests early diagnosis of Tourette’s disorder if symptoms continue beyond a year.
Choice C reason: Persistent (chronic) vocal tic disorder involves only vocal tics for more than 1 year, not combined motor and vocal tics.
Choice D reason: Provisional tic disorder is diagnosed when tics are present for less than 1 year. Since the boy has both motor and vocal tics and duration may approach 6–12 months, this may be considered but does not fully explain the combination of tics if they persist beyond a year.
Correct Answer is C
Explanation
Choice A reason: Norepinephrine reuptake inhibitors increase norepinephrine availability but guanfacine does not inhibit reuptake; its action is through receptor agonism, not reuptake inhibition.
Choice B reason: Dopamine reuptake inhibition is the mechanism for some stimulant medications, not for guanfacine, which has a different pharmacologic profile.
Choice C reason: Guanfacine is a centrally acting alpha-2A adrenergic receptor agonist. It modulates prefrontal cortex activity, improving attention, working memory, and impulse control. This mechanism also helps reduce tics and hyperactivity in ADHD and Tourette’s syndrome.
Choice D reason: Selective serotonin agonists target serotonergic pathways, which is unrelated to guanfacine’s effects on adrenergic receptors and ADHD symptom control.
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