HuBio 564: Principles of Pharmacology II
Case Study 2
A 20 year old junior Biology major consults you at the student health center, complaining of anxiety. He is embarrassed to tell you that, for the past year, he has had increasing worries about catching germs, at first from the equipment in his Biology labs, but now from shaking hands with people, doorknobs, touching things that other people have touched. He fears he will spread disease to his friends and family. He washes his hands repeatedly throughout the day, so that his hands are red and chapped. He uses a handkerchief to touch things and refuses to shake hands. If he cannot wash his hands right after touching something, he has a sudden, intense attack of anxiety, with palpitations, sweating, shaking, dizziness, and fears of dying or infecting someone else. He has started avoiding seeing friends or family, because of his fears of infecting them. He realizes logically that his fears and habits make no sense, but feels he cannot resist them. He is medically healthy.
1. What is the most likely diagnosis? Explain why you think this is the most appropriate choice and why you think the other anxiety disorders are less plausible.
2. What class of medication would you recommend, and name 3 possible drugs that you would consider for this patient?
3. At the next visit, he tells you that he is unable to go to class and is having trouble leaving his apartment. You decide to add another adjunctive medication to improve his functioning as rapidly as possible. What class of medication would you choose? Name a specific choice, and justify your selection. What side effects would you warn him about?
4. Two months later, he is much improved and is no longer taking any adjunctive medication. However, his father is hospitalized for a serious illness and your patient has new onset of trouble falling asleep at night, taking 1-2 hours to fall asleep. Once he falls asleep, he can sleep through the night. You decide to give him a short-term medication to help him sleep during this stressful period. It is very important to him not to be tired and "hungover" during the daytime. What would you choose and why?
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