Extreme anxiety/panic disorder.

Abstract

A 45 year old man is referred to a specialist psychiatric centre. For 3 years he has been experiencing worsening impending fear of death and anxiety which he describes as 'panic attacks'. During these episodes he often experiences palpitations and becomes sweaty. These episodes have not been relieved despite several courses of electroconvulsive therapy. On examination, the man is alert and orientated. He has a normal blood pressure of 125/75 mmHg and electrocardiogram reveals a pulse rate of 102 beats per minute. A psychiatrist orders a number of routine tests to rule out organic disease.