Stage fright

A 23-year-old medical student has to make a presentation before his classmates. He is very anxious about this presentation and reports that on one previous occasion the sweating and palpitations that accompany his stage fright were so intense that he was unable to complete his presentation. Pretreatment with which of the following drugs... 

D. As a 3-adrenoceptor blocker, propranolol can relieve many of the symptoms of stage fright. For this use it can be taken once a few hours before the performance. Chronic dosing is usually not necessary. The other agents produce sedation. 

Brantigan CO, Brantigan TA, Joseph N Effect of beta-blockade and beta-stimulation on stage fright. Am J Med 72 88-94, 1982... 

Neftel, K.A, Adler, R H, Kaeppeli, L., et ah Stage fright in musicians a model illustrating the effect of beta blockers. Psychosom. Med. 44, 461-469, 1982. 

Propranolol reduces the frequency and intensity of migraine headache. Other 13-receptor antagonists with preventive efficacy include metoprolol and probably also atenolol, timolol, and nadolol. The mechanism is not known. Since sympathetic activity may enhance skeletal muscle tremor, it is not surprising that 13 antagonists have been found to reduce certain tremors (see Chapter 28). The somatic manifestations of anxiety may respond dramatically to low doses of propranolol, particularly when taken prophylactically. For example, benefit has been found in musicians with performance anxiety ("stage fright"). Propranolol may contribute to the symptomatic treatment of alcohol withdrawal in some patients. 

May be useful as an as needed medication for stage fright or other predictable socially phobic situations... 

Marshall, J. R. (1994). Social phobia From stage fright to shyness. New York Basic Books. 

Discrete performance anxiety (stage fright) most common phobia, treat with atenolol or propranolol (beta blocker) or paroxetine (SSR1)... 

Propranolol has been shown to be effective in the management of angina pectoris, myocardial infarction, ventric-nlar and supraventricular arrhythmias, hypertension, aortic dissection, hypertrophic cardiomyopathy, mitral valve prolapse, thyrotoxicosis, migraine, tremor, and performance anxiety (stage fright). 

Familial tremor, other types of tremor, stage fright Propranolol Reduced Pj alteration of neuromuscular transmission possible CNS effects... 

Steptoe, A. (1989). Stress, coping and stage fright in professional musicians. Psychology of Music 17 3-11. 

Stage fright or nervousness is natural. Comedian Johnny Carson said he was nervous prior to every monologue. Johnny was nervous over 4000 times (Koegel 2002). Maybe instead of calling it stage fright, we should refer to it, in a more positive way, as speech excitement (Laskowski 2001). 

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