I am referring this patient to you for assessment. He is suffering from attacks of palpitations and breathlessness.
The patient is a student. He has suffered from anxiety since he was thirteen. He told me that when he was a child, he was very afraid that his parents would die.
He came to see me six month ago. He expressed fears about having heart disease. These fears are based on the fact that both his brothers and his father have heart conditions.
When things are going badly,he eats too much. Consequentiy he is overweight with a BMI of 32, which partly explains his breathlessness. Urine analysis indicates the onset of type 2 diabetes. He said that he had gained weight recently as a result of the shock of losing his part-time job. It brought on severe palpitations, hyperventilation, and panic attacks and he had to be sedated.
He believes he was’stupid’ to become engaged to his girlfriend because she has emotional and personality problems. He regrets this relationship and they have frequent rows which make his symptoms worse.
In the past the patient has been treated with the antidepressant Lofepramine even though there are no clear symptoms of depression. It is possible that weight gain and tiredness are side effects of the antidepressants so I have advised him to stop taking them.
Other physical symtoms include joint pains, muscle pains, and dizziness. He told me that he has morbid thoughts, but I do not think he has suicidal intentions.
He is receiving Diazepam 2 mg t.d.s. for anxiety. Because he has a history of asthma, I have not tried beta blockers.