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Original Question

A 33-year-old woman presents with recurrent episodes of palpitations, chest pain, shortness of breath, and feeling like she is “outside of her own body.” The symptoms resolve within minutes, and she cannot relate the episodes to a specific trigger, noting they are non-exertional. Upon further questioning, she says, “I feel like I am going to die” during the episodes. She is otherwise in good health with no prior psychiatric diagnosis. She has no concerning family history, and she denies smoking tobacco, drinking alcohol, or using illicit drugs. The physical exam demonstrates a regular heart rate and rhythm with no concerning lung sounds, and an electrocardiogram reveals normal sinus rhythm. She expresses interest in treatment because she is developing a persistent worry about where and when the next episode will occur. Given the likely diagnosis, what is the most appropriate patient education for this condition? A. Cognitive-behavioral therapy has no adverse effects. B. Tricyclic antidepressants are considered the first-line treatment. C. Cognitive-behavioral therapy is typically conducted once every 2 to 3 months on an ongoing basis. D. Cognitive-behavioral therapy is typically conducted every week for approximately 8 weeks.

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