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Panic disorder — MCCQE Part 1 MCQ

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ModerateAnxietyPanic disorderMCCQE Part 1

27-year-old man presents with recurrent sudden episodes of palpitations and fear of dying. ECG and thyroid testing are normal and he avoids buses due to fear of attacks. Which of the following is the most appropriate next step?

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Correct answer: D — Offer CBT and/or SSRI after explaining panic disorder

Offer CBT and/or SSRI after explaining panic disorder is best because recurrent unexpected panic attacks with avoidance suggest panic disorder. Provide reassurance only and arrange no follow-up is suboptimal because mental health risk often requires structured follow-up or urgent escalation; Use long-term benzodiazepine monotherapy as default treatment is suboptimal because benzodiazepine monotherapy is rarely an appropriate long-term strategy; Avoid direct risk assessment to preserve rapport is suboptimal because direct assessment of suicide, violence, capacity and substance use is clinically appropriate; Attribute symptoms to personality or culture without assessing illness is suboptimal because diagnostic overshadowing risks missing treatable mental illness. Benzodiazepines are not preferred long-term first-line therapy.

Reference: Canadian anxiety guidelines