GAD — MRCPsych Paper B MCQ

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ModerateAnxiety & Stress-Related DisordersGADMRCPsych Paper B

A 28-year-old woman with generalised anxiety disorder has completed an adequate course of individual guided self-help, but her symptoms remain functionally impairing. She has not received pharmacological treatment and is not experiencing a crisis. According to NICE CG113, which treatment choice should now be offered?

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Correct answer: A — An SSRI or an individual high-intensity psychological intervention

The correct answer is A. An inadequate response to guided self-help, a step 2 intervention, moves treatment to step 3. NICE recommends offering a choice between an individual high-intensity psychological intervention—CBT or applied relaxation—and drug treatment, with the decision based on the patient’s preference because neither mode is established as superior. If medication is chosen, an SSRI should be offered; NICE advises considering sertraline first. An SNRI is generally considered after an ineffective initial SSRI, while pregabalin is considered when SSRIs and SNRIs cannot be tolerated. Benzodiazepines should not be used routinely for GAD and are reserved for short-term treatment during crises. Buspirone is not a NICE-recommended step 3 treatment.

Reference: National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management (CG113), recommendations 1.2.17–1.2.26. 2011, updated 2020 with amendment in 2022. https://www.nice.org.uk/guidance/cg113/chapter/Recommendations