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Social Anxiety Partial Response — MRCPsych Paper B MCQ

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ModerateAnxiety & Stress-Related DisordersSocial Anxiety Partial ResponseMRCPsych Paper B

A 34-year-old adult with social anxiety disorder has taken sertraline for 12 weeks. The dose was gradually increased to 200 mg daily, adherence is confirmed, and adverse effects are tolerable. There has been a clinically meaningful but incomplete improvement, with continuing avoidance and occupational impairment. They have not previously received cognitive behavioural therapy and are willing to engage in it. What is the most appropriate next step?

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Correct answer: A — Add individual CBT while continuing sertraline

The correct answer is A. NICE recommends adding individual CBT specifically developed for social anxiety disorder when symptoms have only partially responded to escitalopram or sertraline after 10–12 weeks. Sertraline should be continued because there has been meaningful benefit and it is tolerated. Switching to another SSRI or venlafaxine is recommended for non-response or intolerable adverse effects, rather than partial response. Continuing medication alone does not implement the recommended next treatment step. Benzodiazepines are not routinely recommended because of dependence, withdrawal and limited long-term benefit. Propranolol may reduce peripheral autonomic symptoms in circumscribed performance situations but is not an evidence-based replacement treatment for generalised social anxiety disorder with continuing functional impairment.

Reference: National Institute for Health and Care Excellence. Social anxiety disorder: recognition, assessment and treatment (CG159), recommendations 1.3.9–1.3.10, 2013. https://www.nice.org.uk/guidance/cg159/chapter/recommendations