GAD Augmentation — MRCPsych Paper B MCQ

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ModerateAnxiety & Stress-Related DisordersGAD AugmentationMRCPsych Paper B

A 32-year-old woman with generalised anxiety disorder has adhered to sertraline 200 mg daily for 8 weeks. She tolerates it and has experienced a partial response, but clinically significant anxiety persists. She has not previously received a high-intensity psychological intervention. According to NICE CG113, which intervention should now be considered in addition to sertraline?

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Correct answer: C — Sertraline plus high-intensity individual CBT

The correct answer is C. NICE CG113 recommends considering a high-intensity psychological intervention, such as individual CBT, in addition to medication when GAD has partially responded to drug treatment. Pregabalin is not recommended as routine augmentation of a tolerated SSRI producing an incomplete response; NICE positions it as an alternative when SSRIs and SNRIs cannot be tolerated. Benzodiazepines should be reserved for short-term use during crises. Propranolol is not recommended for treating the core syndrome of GAD. Quetiapine augmentation is not routine step-3 management; complex drug combinations at step 4 have limited supporting evidence and should be undertaken only by clinicians with expertise in treatment-refractory anxiety disorders.

Reference: National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management (CG113), recommendations 1.2.18, 1.2.25–1.2.27, 1.2.36 and 1.2.41–1.2.42. 2011; last updated 2020, with minor changes through 2026. https://www.nice.org.uk/guidance/cg113/chapter/Recommendations