GP CCE Cases · mental-health
Panic attacks and GAD — CCE clinical encounter
CCE-style clinical encounter: a 34-year-old with recurrent panic attacks, daily worry and five coffees a day wants 'something for the nerves'. The candidate must screen and stage with GAD-7, exclude mimics, deliver stepped-care choices, counsel SSRI activation, and set measurement-based review.
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Target exams
RACGP CCEFRACGP oralsCFPC SOOs
Prompt
A 34-year-old graphic designer attends saying she 'can't control the worry any more'. Three months of racing thoughts about work, muscle tension, broken sleep. Two sudden attacks last month — heart pounding, couldn't breathe, certain she was dying — both while sitting at her desk. She now avoids the train. She drinks six coffees daily to function. GAD-7 today: 14.
Objectives
- Stage severity and diagnosis with GAD-14 (GAD-7 plus PHQ-9) while explaining what negative screens do not exclude. [3]
- Exclude medical mimics — thyroid, cardiac, caffeine, substances — before fixing the label. [16]
- Deliver NICE stepped care: education and active monitoring versus low-intensity versus high-intensity options matched to severity. [1]
- Counsel sertraline initiation honestly: slow onset in anxiety, activation risk, start-low-go-slow titration, twelve-month continuation after response. [5] [1]
- Address panic-specific management: interoceptive exposure within CBT; no long-term benzodiazepines. [10]
References6ShowHide
- [2]Spitzer RL, Kroenke K, Williams JB et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of internal medicine, 2006.PMID 16717171
- [3]Aktürk Z, Hapfelmeier A, Fomenko A et al. Generalized Anxiety Disorder 7-item (GAD-7) and 2-item (GAD-2) scales for detecting anxiety disorders in adults. The Cochrane database of systematic reviews, 2025.PMID 40130828
- [5]Lewis G, Duffy L, Ades A et al. The clinical effectiveness of sertraline in primary care and the role of depression severity and duration (PANDA). The lancet. Psychiatry, 2019.PMID 31543474
- [10]Farris SG, Derby L, Kibbey MM Getting comfortable with physical discomfort: A scoping review of interoceptive exposure in physical and mental health conditions. Psychological bulletin, 2025.PMID 40014537
- [16]Nascimento AOD, Silva CECD, Silva MLD et al. The Effects of Caffeine on Anxiety Behavior in Healthy Individuals: A Systematic Review of the Literature. Stress and health, 2026.PMID 41549915
- [1]Bandelow B, Allgulander C, Baldwin DS et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders - Version 3. Part I: Anxiety disorders. The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry, 2023.PMID 35900161