Panic Attack Management in Cancer Patient — SCE Palliative Medicine MCQ

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EasyPsychological & PsychiatricPanic Attack Management in Cancer PatientSCE Palliative Medicine

A 65‑year‑old woman with advanced cancer develops an acute severe anxiety episode—hyperventilation, tachycardia, fear of dying—but her observations are stable and she is not at risk of cardiorespiratory compromise. What is the most appropriate immediate management?

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Correct answer: E — Reassurance, breathing coaching and low-dose SL lorazepam

Option E is correct. In UK palliative care practice, acute panic or anxiety with stable observations is managed first with calm reassurance and slow‑breathing coaching, and if needed, rapid‑acting sublingual lorazepam (0.5–1 mg) for immediate anxiolysis. The GMMMG guideline recommends lorazepam sublingually for anxiety/panic PRN with faster symptomatic relief; the RUH Handbook similarly designates lorazepam SL for panic crises. IV morphine and increasing opioids address pain or dyspnoea rather than acute anxiety and risk sedation or respiratory depression. Haloperidol is inappropriate for panic and may cause extrapyramidal or sedative effects. Calling the arrest team is unnecessary with stable observations. Thus, only option E is both appropriate and UK‑aligned.

Reference: GMMMG Palliative Care Pain & Symptom Control Guidelines (2020); RUH Palliative Care Handbook (recent): https://bnf.nice.org.uk/