Social Anxiety — MRCPsych Paper B MCQ

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ModerateAnxiety & Stress-Related DisordersSocial AnxietyMRCPsych Paper B

A 20-year-old man with social anxiety disorder has completed 14 sessions of 90-minute individual CBT based on the Clark and Wells model. His anxiety has reduced slightly, but he continues to have marked avoidance of social situations. According to NICE CG159, which pharmacological treatment should be considered in combination with continued individual CBT?

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Correct answer: E — Escitalopram or sertraline

The correct answer is E. He has had an adequate course of disorder-specific individual CBT with only a partial response. NICE CG159 recommends considering a pharmacological intervention in combination with individual CBT in this situation; the recommended initial SSRIs are escitalopram or sertraline. Phenelzine or moclobemide are later-line monoamine oxidase inhibitors, offered only after non-response to an initial SSRI and then an alternative SSRI or venlafaxine. Pregabalin and gabapentin are anticonvulsants, and diazepam and lorazepam are benzodiazepines; NICE advises that these drug classes should not routinely be offered for social anxiety disorder. Beta-blockers may reduce peripheral autonomic symptoms in limited performance situations but are not the recommended treatment for generalised social anxiety disorder following partial CBT response.

Reference: National Institute for Health and Care Excellence. Social anxiety disorder: recognition, assessment and treatment (CG159), recommendations 1.3.6 and 1.3.8. 2013; last reviewed 21 May 2024. https://www.nice.org.uk/guidance/cg159/chapter/recommendations