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Anxiety, OCD and PTSD flashcards

7 high-yield MRCP Part 1 cards from the Intellect Medicos Psychiatry course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.

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1. If drug treatment is chosen for generalised anxiety disorder, which drug is first line?

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   Sertraline.

   Why? NICE recommends sertraline first because it is effective and cost-effective. If it fails, try another SSRI or an SNRI (venlafaxine or duloxetine).

2. What is the first-line treatment for panic disorder?

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   CBT. If a drug is needed, an SSRI.

   Why? CBT gives lasting benefit. If an SSRI is unsuitable or there is no improvement after 12 weeks, NICE says imipramine or clomipramine may be considered.

3. What is the first-line treatment for post-traumatic stress disorder in adults?

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   Individual trauma-focused CBT. EMDR (eye movement desensitisation and reprocessing) is offered for non-combat trauma presenting more than 3 months after the event.

   Why? Psychological therapy is more effective than drugs. An SSRI (e.g. sertraline) or venlafaxine is considered if the person prefers drug treatment; risperidone may be added for disabling symptoms that have not responded to other treatment.

4. What is the first-line treatment for obsessive-compulsive disorder?

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   CBT including exposure and response prevention (ERP); add an SSRI if more severe.

   Why? ERP exposes the patient to the trigger while they resist the compulsion, so the anxiety fades without the ritual.

5. Generalised anxiety disorder requires excessive, hard-to-control worry lasting at least ______.

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   6 months

   Why? Symptoms include free-floating worry, restlessness, muscle tension, irritability and poor concentration. Severity is tracked with the GAD-7.

6. In generalised anxiety disorder, which drug does NICE suggest if SSRIs and SNRIs cannot be tolerated?

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   Pregabalin.

   Why? Usual sequence: sertraline, then another SSRI or an SNRI (venlafaxine or duloxetine), then pregabalin if both classes are not tolerated.

7. Acute stress disorder lasts from 3 days up to ______ after a traumatic event; persisting symptoms suggest PTSD.

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   1 month

   Why? Acute stress disorder starts immediately and has prominent dissociation (detachment, derealisation). PTSD may have delayed onset.