The University of Texas System
Resources

CPAN Case of the Month – January 2023

Each month, PCPs call CPAN with a wide variety of mental health questions. Find out how CPAN helped a pediatrician with their 6-year-old patient with ADHD.

Patient: The adolescent had been diagnosed with anxiety and was seeing a therapist to address anxiety symptoms. More recently, the individual was diagnosed with Obsessive-Compulsive Disorder. The individual presented to the PCP with complaints of worsening panic attacks. PCP notes that the individual has experienced multiple traumas in a short period of the past year.

Reason for CPAN consultation: The PCP started Hydroxyzine 25 mg daily for the patient, but is contacting CPAN for guidance on if a SSRI is more appropriate and, if so, which SSRI to start, especially for the new diagnosis of OCD. The individual presented to the PCP with complaints of worsening panic attacks. PCP notes that the individual has experienced multiple traumas in a short period of the past year, including running from an active shooter and witnessing a murder suicide outside the home.

While discussing the case, the CPAN psychiatrist discussed first-line medication used to address OCD. Prozac and Zoloft are two SSRIs that are FDA approved for OCD in adolescents. The CPAN psychiatrist advised starting with the lowest dose of either medication first to ensure tolerability and to follow up within 3-4 weeks. Usually, higher doses of SSRI may be needed to address OCD symptoms.

The PCP further inquired if Hydroxyzine can still be used and if it should be further increased, to which the CPAN psychiatrist advised that it is safe to continue, but keep at the current dosage as it may be sedating for the individual.

The CPAN psychiatrist also mentioned that the panic attacks could also be part of a possible diagnosis of Post-Traumatic Stress Disorder or Acute Stress Disorder. Both OCD and Post Traumatic Stress Disorder will require more involved therapy for the individual. The CPAN psychiatrist further provided information that Zoloft is FDA approved for PTSD in adults, and it could be a good choice to address OCD and PTSD.

Take home point:
When panic attacks are involved, it is advisable to explore triggers to clarify the diagnosis. CPAN can help with assessment and starting first-line medications when cases are not as straight-forward. We always welcome follow up calls to help at the patient’s subsequent visits. We are at your side when you need us to help the families in your care.