I have a patient with high vagal tone and anxiety who does not respond to CBT(Cognitive Behavioral Treatment) so well. What is the best medical intervention?
Kazuo,
Is your patient experiencing syncope as one of the symptoms? If so, a cardiology consultation should be performed. https://dx.doi.org/10.3389%2Ffpsyt.2014.00080
If the "high vagal tone" is a symptom of the anxiety (and not the vagal symptoms causing the anxiety) A trial of benzodiazepine bridge (two weeks) and SSRI would be a good start. The benzodiazepine is indicated if the patient is unable to break their anxiety attack, not as a continuous therapy. (Bystritsky, A., Khalsa, S. S., Cameron, M. E., & Schiffman, J. (2013). Current diagnosis and treatment of anxiety disorders. PT, 38(1), 30-57.)
Please rule out a cardiac origin!
Hope you find this helpful,
Regards,
Christopher
Have you tried a programme of graded aerobic exercise, such as running?
@Richard; Thank you for your advice.
My patient may be not used to aerobic exercise, so I should advice " Why not try speedy walking or running, checking your symptom worsen or not?" after 24 hour ECG checked.
He works for mega industry as SE(System Engineer) since last April. Feels vocal tension most in the day saying "Good morning!" arriving at his company. Can present his degree of progress to his colleague and boss without symptom. He had had symptom since he entered collage, among classmates with grade A's , he enjoys one of amateur band member, without bad feeling at his vocal cord. After 5, he enjoys to drink with colleagues at same age. He begins to feel the symptom when they rise in chat.
So as you say, I should rule out he has organic disorder rather than mental, although being introduced to our clinic by psychiatrist.
Best Regards;
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