Abstract
BackgroundIn this report, we describe a case of a patient with substance-induced anxiety disorder occurring after a single dose of 3,4-methylenedioxymethamphetamine. Furthermore, we describe the use and efficacy of the Primary Care Behavioral Health model, a collaborative approach to integrative primary mental health care, in evaluating and treating this rare mental health disorder.Case presentationThree days following ingestion of one dose of 3,4-methylenedioxymethamphetamine, a 35-year-old Hispanic man with no significant prior mental health history and no history of prior 3,4-methylenedioxymethamphetamine use presented to our hospital with severe, acute anxiety and panic symptoms. He was initially treated with a combination of behavioral therapy and the serotonin agonist buspirone. Buspirone ultimately proved ineffective, so it was discontinued in favor of the selective serotonin reuptake inhibitor sertraline. While awaiting the pharmacological onset of sertraline, the patient worked with a behavioral health consultant, who provided psychoeducation on the experience of panic, building relaxation skills, and modifying maladaptive thought patterns. Enhanced communication between the primary care provider and behavioral health consultant facilitated the planning and enactment of the patient’s care plan. Approximately 2.5 months after his initial ingestion of 3,4-methylenedioxymethamphetamine, the patient’s symptoms subsided. This improvement was attributed to the combination of the behavioral health intervention and sertraline at a dose of 50 mg daily. Six months after 3,4-methylenedioxymethamphetamine ingestion, the patient began to gradually taper sertraline and has had no resurgence of anxiety symptoms to date.ConclusionsOur patient’s case not only demonstrates a rare presentation of 3,4-methylenedioxymethamphetamine-induced anxiety disorder but also provides support for the use of the Primary Care Behavioral Health model to deliver individualized, timely mental health care in a primary care setting.
Highlights
In this report, we describe a case of a patient with substance-induced anxiety disorder occurring after a single dose of 3,4-methylenedioxymethamphetamine
50–70% of people experiencing psychological or behavioral conditions receive their treatment in primary care settings from primary care providers (PCPs) [11, 12], and 80% of individuals with a mental health disorder report that they will visit their PCP at least one time within a calendar year [13]
We describe a patient who took a single dose of MDMA that triggered substance-induced anxiety disorder which lasted for several months
Summary
The patient’s symptoms were severe and were addressed with a combination of behavioral health and psychopharmacological therapies His symptoms stabilized and improved only after several months of behavioral health counseling and medical treatment with the SSRI sertraline. We posit that his care was augmented by the direct integration of his medical treatment with his behavioral health treatment according to the PCBH model. This integration allowed for timely communication between the patient’s behavioral health provider and PCP and facilitated the assessment and treatment of his unique mental health disorder. Author details 1Swedish First Hill Family Medicine Residency, Swedish Medical Center, 1401 Madison Street, Suite 100, Seattle, WA 98104, USA. 2Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA
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