Psychiatric Interviews for Teaching: Anxiety

Summary

Julie Thomas consults with Dr. Vehdi, a new GP at her clinic, about recurring heart palpitations and chest pain. She describes episodes of rapid heartbeat, shortness of breath, and fear of heart attacks, which started six months ago during a stressful period at work. Despite a normal ECG, Julie remains anxious and avoids activities like going out and exercising. Dr. Vehdi explains that her symptoms may stem from anxiety and suggests further discussion of treatment options at a follow-up appointment. Julie agrees to return next week for further consultation.

Takeaways

• 🙂 The patient, Julie, is seeing Dr. Vehdi due to heart-related symptoms and anxiety.
• 💓 Julie describes experiencing episodes where her heart races, causing chest pain, shortness of breath, and fear of a heart attack.
• 🕰️ These symptoms have been happening for about six months, starting during a stressful time at work and a specific event in town.
• 🏠 Julie has started avoiding certain activities, like going to town or exercising, fearing that they might trigger her symptoms.
• 🤔 Despite being reassured by Dr. Jones after an ECG test that her heart is healthy, Julie still worries that something is wrong.
• 👫 The situation is affecting her relationship with her husband, who is frustrated with her avoiding social activities like going to the pub.
• 🚶‍♀️ Julie avoids walking or going out alone and is also abstaining from sex, fearing it might strain her heart.
• 🧠 Dr. Vehdi suggests that Julie's symptoms may be caused by anxiety and panic attacks rather than a heart issue.
• 💭 Julie admits that she has started monitoring her heart, which seems to make her symptoms worse due to heightened anxiety.
• 📆 Dr. Vehdi proposes a follow-up appointment next week to explore treatment options, including medication or therapy, to address the anxiety.

Q & A

What symptoms does Julie describe during her visits to the GP?

Julie describes her heart racing, chest pains, shortness of breath, and feeling anxious. She worries she might be having a heart attack.

How long has Julie been experiencing these symptoms?

Julie has been experiencing these symptoms for about six months.

What does Julie believe triggers her symptoms?

Julie believes her symptoms were triggered by stress at work, particularly after a new manager was introduced and a new computer system was put in place. Her first panic attack happened during a hot day in town.

What impact have these symptoms had on Julie's daily life?

Julie has been avoiding activities such as going to town alone, socializing, exercising, and even having sex, out of fear that they might trigger another episode. This avoidance is affecting her relationship with her husband.

What medical tests has Julie undergone, and what were the results?

Julie had an ECG (electrocardiogram) arranged by her regular GP, Dr. Jones. The results came back normal, indicating no issues with her heart.

What is Julie's main concern despite the ECG results?

Despite the normal ECG results, Julie remains convinced that something is wrong with her heart, especially given her family history of heart disease (her father died of a heart attack at 72).

What explanation does Dr. Vehdi offer for Julie’s symptoms?

Dr. Vehdi suggests that Julie’s symptoms might be related to anxiety and panic attacks rather than a heart condition. He explains how anxiety can trigger the release of adrenaline, leading to symptoms like a racing heart and shortness of breath.

How does Dr. Vehdi describe the fight-or-flight response?

Dr. Vehdi explains that adrenaline is released in stressful situations, preparing the body for 'fight or flight.' This increases heart rate, breathing, and other physical reactions that Julie experiences during her episodes.

What is hypervigilance, according to the doctor, and how is it relevant to Julie's case?

Hypervigilance is when someone constantly monitors their body for signs of danger, such as monitoring heart rate. Julie's focus on her heart might cause anxiety, leading to the release of more adrenaline, which worsens her symptoms.

What treatment options does Dr. Vehdi suggest for Julie's anxiety?

Dr. Vehdi suggests that they explore treatment options for anxiety, which could include medications or talking therapies. He recommends discussing these further in a follow-up appointment.