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What is the most likely diagnosis? 123
Generalised anxiety disorder 123
Generalised anxiety disorder
Social anxiety disorder, performance-only type
Specific phobia
Avoidant personality disorder
Which neurobiological mechanism best explains the escalation of his anxiety after noticing palpitations and tremors?
Reduced dopaminergic activity in the mesolimbic pathway
Increased interoceptive threat processing by the anterior insula
Dysfunction of the primary visual cortex
Reduced activity of the basal ganglia motor circuit
Increased hippocampal neurogenesis
Which developmental factor is most likely to have contributed to the persistence of his symptoms?
A single embarrassing presentation alone
Childhood behavioural inhibition followed by repeated avoidance
Excessive exposure to public-speaking situations
Lack of intellectual ability
Adult-onset occupational stress without previous vulnerability
The patient receives an adequate trial of sertraline but shows no meaningful response or cannot tolerate it. What is the most appropriate next pharmacological step?
Add an antipsychotic immediately
Switch to another SSRI or venlafaxine
Add a benzodiazepine indefinitely
Start lithium
Replace sertraline with propranolol as daily monotherapy
