A 28-year-old woman presents with recurrent episodes of sudden-onset palpitations, chest tightness, paresthesias, derealization, and fear of dying, lasting 10–15 minutes. She has begun avoiding shopping malls and public transport. The first-line pharmacological treatment for her primary condition is:

• A Sertraline (SSRI) with cognitive-behavioural therapy including interoceptive exposure ✓
• B Alprazolam 0.5 mg three times daily for rapid symptom control
• C Propranolol 40 mg twice daily to block peripheral autonomic symptoms
• D Buspirone, given its proven efficacy in panic disorder

Explanation

Panic disorder with agoraphobia is best treated with SSRIs (sertraline, paroxetine, escitalopram) as first-line pharmacotherapy combined with CBT incorporating interoceptive exposure (deliberate induction of feared bodily sensations). Alprazolam provides rapid relief but carries dependence risk and is not recommended for long-term use or as monotherapy. Propranolol is useful for situational anxiety but does not address panic disorder pathophysiology. Buspirone is effective for GAD but has no proven efficacy for panic disorder.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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