Common Mental Disorders — MCQs
On this page
A 46-year-old woman presents with a 4-month history of persistent worry about multiple aspects of her life including her children's safety, finances, and work performance. She reports feeling restless, experiencing muscle tension, having difficulty concentrating, and poor sleep. She finds it extremely difficult to control her worry. Her symptoms occur most days and significantly impair her social functioning. Physical examination and routine blood tests including thyroid function are normal. What is the most appropriate first-line treatment?
A 33-year-old woman with a first episode of moderate depression achieved remission after 8 months of treatment with sertraline 100mg daily. She has no previous psychiatric history and no family history of mood disorders. She has been symptom-free for 9 months and wishes to discontinue medication. What is the most appropriate approach to stopping her antidepressant?
A 38-year-old man with panic disorder presents to the emergency department during a panic attack. He reports intense chest pain, breathlessness, dizziness, paraesthesia in his fingers, and a feeling of impending doom. Examination reveals a respiratory rate of 32 breaths per minute. Arterial blood gas analysis shows: pH 7.51, PaCO2 3.2 kPa, PaO2 13.1 kPa, HCO3- 24 mmol/L. What is the most appropriate immediate management?
What is the neurobiological mechanism that explains why selective serotonin reuptake inhibitors (SSRIs) typically require 2-4 weeks to produce clinical improvement in depression despite achieving serotonin reuptake inhibition within hours?
A 41-year-old woman with moderate depression has been taking citalopram 40mg daily for 10 weeks with good response. Her PHQ-9 score has improved from 18 to 6. She now wishes to stop treatment as she feels completely well. What is the most appropriate management advice regarding continuation of antidepressant therapy?
A 25-year-old woman presents with a 5-month history of experiencing sudden episodes of intense fear that peak within minutes. During these episodes she experiences palpitations, trembling, and a sensation of choking. She has been to the emergency department four times convinced she was having a heart attack. All cardiac investigations including ECG, troponin, and echocardiography have been normal. She now avoids crowded places and public transport. What feature would most strongly differentiate panic disorder from generalised anxiety disorder in this patient?
A 67-year-old man with a 6-week history of severe depression presents with persistent low mood, early morning wakening at 3 AM with inability to return to sleep, psychomotor retardation, and marked anhedonia. He has lost 8 kg in weight and reports feeling worse in the mornings with slight improvement as the day progresses. His PHQ-9 score is 22. What is the most appropriate initial pharmacological treatment?
A 36-year-old woman with panic disorder has been taking escitalopram 10mg daily for 5 months with excellent response. She is now planning a pregnancy with her partner. She has had no panic attacks for 3 months and her GAD-7 score is 4. What is the most appropriate management of her escitalopram at this stage?
A 53-year-old woman with severe depression has been referred for electroconvulsive therapy (ECT) after failing multiple medication trials. She has significant psychomotor retardation, poor oral intake, and nihilistic delusions. Which medication should be discontinued before starting ECT due to the risk of prolonged seizures?
A 44-year-old man with depression and panic disorder presents with symptoms of both conditions. His depression is moderate in severity (PHQ-9 score 16) and panic attacks occur 2-3 times per week with associated avoidance behaviour. He has no other medical conditions. What is the most appropriate management approach?
Common Mental Disorders UK Medical PG Practice Questions and MCQs
Question 91: A 46-year-old woman presents with a 4-month history of persistent worry about multiple aspects of her life including her children's safety, finances, and work performance. She reports feeling restless, experiencing muscle tension, having difficulty concentrating, and poor sleep. She finds it extremely difficult to control her worry. Her symptoms occur most days and significantly impair her social functioning. Physical examination and routine blood tests including thyroid function are normal. What is the most appropriate first-line treatment?
- A. Low-intensity psychological intervention such as guided self-help based on CBT principles
- B. High-intensity psychological intervention such as individual CBT (Correct Answer)
- C. Sertraline 50mg once daily
- D. Diazepam 5mg three times daily
- E. Propranolol 40mg twice daily
Explanation: ***High-intensity psychological intervention such as individual CBT*** - For patients with **Generalized Anxiety Disorder (GAD)** causing significant functional impairment, NICE guidelines recommend **high-intensity psychological interventions** (CBT or applied relaxation) as a first-line option. - Individual **Cognitive Behavioral Therapy (CBT)** specifically targets the cognitive processes of excessive worry and the somatic symptoms of restlessness and muscle tension. *Low-intensity psychological intervention such as guided self-help based on CBT principles* - These interventions are typically the first step in a **stepped-care model** for milder cases of GAD with less functional impairment. - Since this patient presents with symptoms that **significantly impair social functioning**, high-intensity therapy is more appropriate to address the severity of the case. *Sertraline 50mg once daily* - Selective Serotonin Reuptake Inhibitors (**SSRIs**) like sertraline are effective for GAD, but psychological interventions are generally preferred as the initial offering if accessible. - Pharmacological treatment is usually reserved for those who **decline psychological therapy**, fail to respond to it, or have a strong preference for medication. *Diazepam 5mg three times daily* - **Benzodiazepines** are not recommended for long-term management of GAD due to the high risk of **dependence**, tolerance, and cognitive side effects. - They should only be used as a **short-term measure** (max 2-4 weeks) during an acute crisis to manage severe symptoms. *Propranolol 40mg twice daily* - **Beta-blockers** like propranolol may alleviate **autonomic symptoms** of anxiety, such as palpitations or tremors, but they do not treat the psychological core of worry. - Propranolol is not considered a first-line treatment for GAD and has no significant effect on the long-term resolution of the disorder.
Question 92: A 33-year-old woman with a first episode of moderate depression achieved remission after 8 months of treatment with sertraline 100mg daily. She has no previous psychiatric history and no family history of mood disorders. She has been symptom-free for 9 months and wishes to discontinue medication. What is the most appropriate approach to stopping her antidepressant?
- A. Reduce sertraline by 50mg every week until discontinued
- B. Switch to fluoxetine 20mg for 2 weeks then stop due to its longer half-life
- C. Stop sertraline immediately as she has been well for 9 months
- D. Reduce sertraline by 25mg every 1-2 weeks while monitoring for symptoms (Correct Answer)
- E. Continue indefinitely as relapse risk remains elevated
Explanation: ***Reduce sertraline by 25mg every 1-2 weeks while monitoring for symptoms*** - A **gradual taper** is essential to minimize the risk of **discontinuation syndrome** and allows the clinician to monitor for the return of depressive symptoms. - For a first episode of depression with a 9-month symptom-free period, this **incremental reduction** (25% of dose) follows clinical guidelines for safe cessation. *Reduce sertraline by 50mg every week until discontinued* - This approach is considered **too rapid**, as reducing the dose by 50% weekly significantly increases the likelihood of withdrawal effects like **dizziness** and **paresthesia**. - Faster tapers are generally reserved for situations involving **severe adverse reactions** or when switching to another agent within the same class. *Switch to fluoxetine 20mg for 2 weeks then stop due to its longer half-life* - A **fluoxetine bridge** is typically reserved for antidepressants with very short half-lives, such as **paroxetine** or **venlafaxine**, to mitigate severe withdrawal. - Sertraline has an intermediate half-life, making a direct taper clinically appropriate without the added complexity of **switching medications**. *Stop sertraline immediately as she has been well for 9 months* - **Abrupt discontinuation** of SSRIs is contraindicated due to the high risk of **SSRI discontinuation syndrome**, even if the patient feels completely recovered. - Sudden cessation prevents the brain from adapting to the reappearance of normal **serotonin reuptake** levels, leading to physical and psychological distress. *Continue indefinitely as relapse risk remains elevated* - **Indefinite treatment** is usually only indicated for patients with a **recurrent history** (3 or more episodes) or significant risk factors for relapse. - For a **first episode** with no family history and successful maintenance, guidelines suggest stopping after 6-9 months of stable remission.
Question 93: A 38-year-old man with panic disorder presents to the emergency department during a panic attack. He reports intense chest pain, breathlessness, dizziness, paraesthesia in his fingers, and a feeling of impending doom. Examination reveals a respiratory rate of 32 breaths per minute. Arterial blood gas analysis shows: pH 7.51, PaCO2 3.2 kPa, PaO2 13.1 kPa, HCO3- 24 mmol/L. What is the most appropriate immediate management?
- A. Administer high-flow oxygen via non-rebreather mask
- B. Administer intravenous lorazepam 2mg stat
- C. Encourage breathing into a paper bag
- D. Provide reassurance and coach slow, controlled breathing techniques (Correct Answer)
- E. Arrange urgent cardiology review for acute coronary syndrome
Explanation: ***Provide reassurance and coach slow, controlled breathing techniques*** - This patient is experiencing **hyperventilation** secondary to a panic attack, leading to **respiratory alkalosis** (pH 7.51, low PaCO2); initial management should always be non-pharmacological. - Coaching the patient to perform **slow, controlled breathing** (6-10 breaths per minute) is the most effective way to normalize PaCO2 levels and reduce physical symptoms like **paraesthesia**. *Administer high-flow oxygen via non-rebreather mask* - High-flow oxygen is contraindicated because the patient already has an **elevated PaO2** (13.1 kPa) and is successfully blowing off carbon dioxide. - Increasing oxygen delivery would not address the **respiratory alkalosis** and is unnecessary in the absence of hypoxia. *Administer intravenous lorazepam 2mg stat* - **Benzodiazepines** are generally reserved as second-line therapy for severe cases that do not respond to psychological interventions or breathing exercises. - Reassurance and breathing techniques are preferred first-line interventions to avoid potential **sedation** and dependence issues associated with pharmacological therapy. *Encourage breathing into a paper bag* - This historical practice is **no longer recommended** as it carries risks of inducing **hypoxia** and hypercapnia if the diagnosis is incorrect (e.g., myocardial infarction or asthma). - Current clinical guidelines and evidence-based practice favor **controlled breathing techniques** over the use of paper bags to manage hyperventilation. *Arrange urgent cardiology review for acute coronary syndrome* - While chest pain is present, the clear history of **panic disorder** and ABG evidence of **respiratory alkalosis** strongly point toward a psychiatric cause. - Although organic pathology must be ruled out in a first presentation, this patient's known diagnosis and **hyperventilation symptoms** prioritize immediate behavioral stabilization.
Question 94: What is the neurobiological mechanism that explains why selective serotonin reuptake inhibitors (SSRIs) typically require 2-4 weeks to produce clinical improvement in depression despite achieving serotonin reuptake inhibition within hours?
- A. Time required for the drug to reach therapeutic plasma concentrations
- B. Gradual downregulation of presynaptic 5-HT1A autoreceptors increasing serotonergic neurotransmission (Correct Answer)
- C. Slow accumulation of serotonin in the synaptic cleft over several weeks
- D. Time needed for hepatic enzyme induction to produce active metabolites
- E. Progressive increase in serotonin synthesis by tryptophan hydroxylase
Explanation: ***Gradual downregulation of presynaptic 5-HT1A autoreceptors increasing serotonergic neurotransmission*** - Initial use of SSRIs causes an acute increase in serotonin which activates **presynaptic 5-HT1A autoreceptors**, leading to a negative feedback loop that temporarily reduces serotonin release. - Sustained treatment over 2-4 weeks leads to the **desensitization and downregulation** of these autoreceptors, allowing for increased serotonergic neuron firing and subsequent greater release of serotonin into the synaptic cleft, which ultimately produces the clinical antidepressant effect. *Time required for the drug to reach therapeutic plasma concentrations* - This is incorrect because most SSRIs achieve **steady-state plasma concentrations** within a few days of consistent dosing. - The delayed clinical effect is due to **neuroadaptive changes** in the brain, not simply the time it takes for the drug to accumulate in the bloodstream. *Slow accumulation of serotonin in the synaptic cleft over several weeks* - SSRIs inhibit the **serotonin reuptake transporter (SERT)** quite rapidly, leading to an increase in extracellular serotonin concentrations in the somatodendritic region within hours. - The delay is not in the accumulation of serotonin itself, but in the **adaptive changes** of the receptors to this altered serotonin level. *Time needed for hepatic enzyme induction to produce active metabolites* - Most SSRIs are pharmacologically active in their **parent form** and do not require hepatic enzyme induction to become active. - While some SSRIs have **active metabolites** (e.g., fluoxetine to norfluoxetine), their formation does not explain the consistent 2-4 week delay observed across the entire class. *Progressive increase in serotonin synthesis by tryptophan hydroxylase* - SSRIs primarily exert their action by blocking the **reuptake of serotonin**, thereby increasing its availability in the synaptic cleft, rather than by directly stimulating its synthesis. - There is no significant evidence that SSRIs cause a **progressive increase in serotonin synthesis** via tryptophan hydroxylase that would account for the clinical delay.
Question 95: A 41-year-old woman with moderate depression has been taking citalopram 40mg daily for 10 weeks with good response. Her PHQ-9 score has improved from 18 to 6. She now wishes to stop treatment as she feels completely well. What is the most appropriate management advice regarding continuation of antidepressant therapy?
- A. Continue treatment for at least 6 months from the point of remission then consider gradual withdrawal (Correct Answer)
- B. Stop citalopram immediately as she has achieved remission
- C. Switch to psychological therapy and discontinue citalopram over 2 weeks
- D. Continue treatment for a further 4 weeks then stop abruptly
- E. Reduce citalopram to 20mg daily and continue indefinitely
Explanation: ***Continue treatment for at least 6 months from the point of remission then consider gradual withdrawal***- According to **NICE guidelines**, for a first episode of depression, patients who respond well to antidepressants should continue therapy for **at least 6 months** after achieving remission to significantly reduce the **risk of relapse**.- Maintaining the antidepressant at the **full effective dose** that led to remission during this continuation phase is crucial for ensuring stability and preventing symptom recurrence.*Stop citalopram immediately as she has achieved remission*- Stopping antidepressant medication immediately after achieving symptomatic remission carries a **very high relapse risk**, as the brain's neurochemical balance requires more time to stabilize.- **Abrupt cessation** can also lead to **antidepressant discontinuation syndrome**, characterized by symptoms such as dizziness, nausea, headaches, and flu-like symptoms.*Switch to psychological therapy and discontinue citalopram over 2 weeks*- While **psychological therapy** is an excellent adjunctive treatment for depression, it does not replace the critical **continuation phase** of pharmacotherapy necessary for preventing relapse after a first episode.- A **2-week taper** is generally too rapid for discontinuing an antidepressant like citalopram after 10 weeks of effective treatment, increasing the risk of both relapse and withdrawal symptoms.*Continue treatment for a further 4 weeks then stop abruptly*- Continuing treatment for only **4 weeks** after remission is insufficient; the high risk of **recurrent depressive symptoms** persists if medication is stopped prematurely.- **Abruptly stopping** antidepressant therapy after such a short continuation phase is strongly discouraged due to the increased risk of **relapse** and severe **discontinuation symptoms**.*Reduce citalopram to 20mg daily and continue indefinitely*- **Indefinite continuation** of antidepressant therapy is typically reserved for patients with a history of **recurrent depressive episodes** (e.g., two or more episodes) or chronic severe depression, not usually a first episode.- Reducing the dose during the **continuation phase** is generally not recommended as the **remission-inducing dose** should be maintained to provide adequate protection against relapse.
Question 96: A 25-year-old woman presents with a 5-month history of experiencing sudden episodes of intense fear that peak within minutes. During these episodes she experiences palpitations, trembling, and a sensation of choking. She has been to the emergency department four times convinced she was having a heart attack. All cardiac investigations including ECG, troponin, and echocardiography have been normal. She now avoids crowded places and public transport. What feature would most strongly differentiate panic disorder from generalised anxiety disorder in this patient?
- A. The presence of autonomic symptoms during episodes
- B. The discrete, time-limited nature of the anxiety episodes (Correct Answer)
- C. The development of avoidance behaviours
- D. The duration of symptoms exceeding 3 months
- E. The presence of excessive worry about physical health
Explanation: ***The discrete, time-limited nature of the anxiety episodes***- **Panic disorder** is uniquely characterized by **paroxysmal episodes** that have a sudden onset, peak rapidly (usually within 10 minutes), and are self-limiting.- In contrast, **generalized anxiety disorder (GAD)** involves a a **persistent, chronic** state of tension and worry that lacks these discrete, high-intensity spikes.*The presence of autonomic symptoms during episodes*- Autonomic symptoms such as **palpitations**, trembling, and sweating are common to both **panic attacks** and the somatic manifestations of **GAD**.- Because these symptoms overlap across many anxiety disorders, they cannot be used to reliably differentiate the two conditions.*The development of avoidance behaviours*- While avoidance is typical of **panic disorder with agoraphobia**, it can also occur in **GAD** as a way to avoid triggers of worry or stress.- Avoidance is a secondary behavioral response rather than a defining characteristic of the **core anxiety pattern** itself.*The duration of symptoms exceeding 3 months*- Both conditions are chronic; **panic disorder** requires 1 month of worry about attacks, while **GAD** requires persistent symptoms for at least **6 months**.- Duration does not distinguish the clinical manifestation as effectively as the **temporal pattern** of the anxiety (episodic vs. continuous).*The presence of excessive worry about physical health*- Excessive worry about health is a central feature of **GAD** (generalized worry) but also occurs in panic disorder as **catastrophic misinterpretation** of physical symptoms.- In **GAD**, this worry is usually wide-ranging and covers multiple life domains, whereas in panic disorder, it is specifically focused on the **imminent danger** of the attack.
Question 97: A 67-year-old man with a 6-week history of severe depression presents with persistent low mood, early morning wakening at 3 AM with inability to return to sleep, psychomotor retardation, and marked anhedonia. He has lost 8 kg in weight and reports feeling worse in the mornings with slight improvement as the day progresses. His PHQ-9 score is 22. What is the most appropriate initial pharmacological treatment?
- A. Fluoxetine 20mg once daily
- B. Mirtazapine 15mg once nightly (Correct Answer)
- C. Sertraline 50mg once daily
- D. Venlafaxine 37.5mg twice daily
- E. Trazodone 50mg once nightly
Explanation: ***Mirtazapine 15mg once nightly*** - **Mirtazapine** is a noradrenergic and specific serotonergic antidepressant (NaSSA) that is ideal for patients with **melancholic features**, specifically addressing **insomnia** and **weight loss** through its sedative and appetite-stimulating effects. - Its pharmacological profile makes it a preferred option for elderly patients who present with **psychomotor retardation** and **poor nutrition** associated with severe depression. *Fluoxetine 20mg once daily* - As an SSRI with a **long half-life** and activating properties, it may initially worsen **insomnia** and **early morning wakening**. - It is frequently associated with **decreased appetite**, which would be detrimental to a patient who has already lost **8 kg**. *Sertraline 50mg once daily* - While often a first-line SSRI, it lacks the specific **sedative properties** needed to immediately address this patient's severe **sleep disturbance**. - Like other SSRIs, it carries a risk of **gastrointestinal side effects** that could complicate the patient's existing weight loss and nutritional status. *Venlafaxine 37.5mg twice daily* - This SNRI is generally reserved for **treatment-resistant depression** or cases where SSRIs have failed, rather than as the first-line choice for insomnia-predominant cases. - It can cause **increased blood pressure** and significant withdrawal symptoms, making it less suitable as an initial choice in a 67-year-old before trying more targeted options. *Trazodone 50mg once nightly* - **Trazodone** is primarily utilized in low doses as an adjunct for **insomnia** rather than as a primary monotherapy for **severe depression** with a PHQ-9 score of 22. - At therapeutic antidepressant doses, it is often poorly tolerated due to excessive **orthostatic hypotension** and sedation.
Question 98: A 36-year-old woman with panic disorder has been taking escitalopram 10mg daily for 5 months with excellent response. She is now planning a pregnancy with her partner. She has had no panic attacks for 3 months and her GAD-7 score is 4. What is the most appropriate management of her escitalopram at this stage?
- A. Continue escitalopram 10mg daily throughout pregnancy planning and pregnancy
- B. Stop escitalopram immediately and monitor for relapse
- C. Gradually reduce and stop escitalopram before attempting conception (Correct Answer)
- D. Switch to sertraline before conception as it is safer in pregnancy
- E. Reduce escitalopram to 5mg daily before attempting conception
Explanation: ***Gradually reduce and stop escitalopram before attempting conception***- For patients with **panic disorder** who have been asymptomatic for several months (remission), NICE guidelines suggest a trial of medication discontinuation prior to conception if the patient is stable.- This patient has been **symptom-free for 3 months** and has a low **GAD-7 score**, making her a good candidate for a gradual taper to minimize neonatal exposure and withdrawal.*Continue escitalopram 10mg daily throughout pregnancy planning and pregnancy*- While some medications are continued for high-risk **recurrent depression**, panic disorder in full remission offers an opportunity to minimize **fetal exposure**.- Continuing therapy is reserved for patients at **high risk of relapse** or those who have failed previous attempts to stop medication.*Stop escitalopram immediately and monitor for relapse*- Abrupt cessation of SSRIs can trigger **discontinuation syndrome**, characterized by dizziness, nausea, and irritability.- A **gradual reduction** over several weeks is necessary to distinguish withdrawal symptoms from a true **relapse** of panic disorder.*Switch to sertraline before conception as it is safer in pregnancy*- While **sertraline** is often preferred in pregnancy, there is no clinical benefit to switching a patient who is already stable on **escitalopram** if the goal is to stop treatment.- Switching introduces a risk of **instability** and new side effects during a critical planning period for pregnancy.*Reduce escitalopram to 5mg daily before attempting conception*- Maintaining a **sub-therapeutic dose** provides neither full protection against relapse nor the benefit of being medication-free for the fetus.- Current clinical practice favors either maintaining the **effective dose** or aiming for complete **discontinuation** when the patient is in remission.
Question 99: A 53-year-old woman with severe depression has been referred for electroconvulsive therapy (ECT) after failing multiple medication trials. She has significant psychomotor retardation, poor oral intake, and nihilistic delusions. Which medication should be discontinued before starting ECT due to the risk of prolonged seizures?
- A. Lithium (Correct Answer)
- B. Venlafaxine
- C. Olanzapine
- D. Lorazepam
- E. Fluoxetine
Explanation: ***Lithium*** - **Lithium** is known to increase the risk of **prolonged seizures** and **postictal delirium** when combined with ECT. - Discontinuation, typically 24-48 hours before treatment, is recommended to prevent increased **neurotoxicity** and significant cognitive side effects. *Venlafaxine* - **Venlafaxine**, an **SNRI**, is generally safe to continue during ECT and may even **enhance the clinical response**. - It does not significantly lower the **seizure threshold** or contribute to prolonged seizure activity during ECT. *Olanzapine* - **Olanzapine**, an **atypical antipsychotic**, is often continued, especially in cases of **psychotic depression** or **nihilistic delusions**. - It does not cause **prolonged seizures** or typically interfere with the safety or efficacy of electrical stimulation. *Lorazepam* - **Lorazepam**, a **benzodiazepine**, is an **anticonvulsant** that would raise the **seizure threshold**, potentially making ECT ineffective. - It is usually held or tapered before ECT to ensure a **therapeutic seizure**, rather than causing prolonged seizures. *Fluoxetine* - **Fluoxetine**, an **SSRI**, is generally safe to continue during ECT and does not have a documented association with **prolonged seizure duration**. - While it can theoretically lower the seizure threshold slightly, it does not carry the high risk of **delirium** and neurotoxicity seen with lithium.
Question 100: A 44-year-old man with depression and panic disorder presents with symptoms of both conditions. His depression is moderate in severity (PHQ-9 score 16) and panic attacks occur 2-3 times per week with associated avoidance behaviour. He has no other medical conditions. What is the most appropriate management approach?
- A. Treat the depression first with an SSRI, then address panic disorder separately once depression improves
- B. Start an SSRI which will treat both conditions simultaneously (Correct Answer)
- C. Offer CBT for panic disorder first, then review depression symptoms
- D. Start an SSRI for depression and a benzodiazepine for panic attacks
- E. Refer to specialist mental health services for dual diagnosis management
Explanation: ***Start an SSRI which will treat both conditions simultaneously*** - **Selective Serotonin Reuptake Inhibitors (SSRIs)** are the first-line pharmacotherapy for both **major depressive disorder** and **panic disorder**, allowing for streamlined management of comorbidities. - NICE guidelines suggest that when depression and anxiety disorders coexist, clinicians should prioritize treating the most disabling condition or treat both **simultaneously** using an agent effective for both. *Treat the depression first with an SSRI, then address panic disorder separately once depression improves* - Sequential treatment is unnecessary and inefficient since **SSRIs** provide therapeutic benefit for the symptoms of both conditions at the same time. - Delaying treatment for **panic disorder** may lead to persistent avoidance behavior and reduced quality of life despite improvements in mood. *Offer CBT for panic disorder first, then review depression symptoms* - While **Cognitive Behavioral Therapy (CBT)** is effective, moderate depression (PHQ-9 of 16) often requires immediate intervention to improve the patient's capacity to engage in psychological therapy. - Treating the **panic symptoms** in isolation fails to address the neurochemical and functional impact of the comorbid **moderate depression**. *Start an SSRI for depression and a benzodiazepine for panic attacks* - **Benzodiazepines** are generally avoided in long-term management due to the significant risk of **dependence**, tolerance, and withdrawal symptoms. - Routine use of benzodiazepines for **panic disorder** is not recommended by guidelines because they do not address the underlying pathology as effectively as **SSRIs**. *Refer to specialist mental health services for dual diagnosis management* - Primary care clinicians are typically equipped to manage **uncomplicated comorbid depression and panic disorder** without an immediate specialist referral. - **Dual diagnosis** usually refers to the co-occurrence of mental illness and **substance misuse**, which is not indicated in this patient's clinical presentation.
Practice by Chapter
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free