Evaluation of Shorty Rheinbold

Evaluation of Shorty Rheinbold

Evaluation of Shorty Rheinbold

Shorty’s panic attack was typical: It began suddenly, developed rapidly, and included a generous helping of the required symptoms. His shortness of breath (criterion A4) and heart palpitations (A1) are classical panic attack symptoms; he also had chest pain (A6), lightheadedness (A8), and numbness in his fingers (A10). Shorty’s fear that he would die (A13) is typical of the fears that patients have during an attack. The sensation of watching himself (depersonalization—A11) is a less common symptom of panic. He needed only four of these symptoms to substantiate the fact of panic attack.

Shorty’s panic attack was uncued, which means that it seemed to happen spontaneously, without provocation. He was unaware of any event, object, or thought that triggered it. Uncued attacks are typical of panic disorder, which can also include cued (or situationally bound) attacks. The panic attacks that develop in social anxiety disorder and specific phobia are cued to the stimuli that repeatedly and predictably pull the trigger.

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Panic attacks can occur in several medical conditions. One of these is acute myocardial infarction, the very condition many panic patients fear the most. Of course, when indicated patients with symptoms like Shorty’s should be evaluated for myocardial infarction and other medical disorders. These include low blood sugar, irregular heartbeat, mitral valve prolapse, temporal lobe epilepsy, and a rare adrenal gland tumor called a pheochromocytoma. Panic attacks also occur during intoxication with several psychoactive substances, including amphetamines, marijuana, and caffeine. (Note that in addition, some patients misuse alcohol or sedative drugs in an effort to reduce the severity of their panic attacks.)

There is no code number associated with panic attack. I’ll give Shorty’s complete diagnosis below.