Psychiatric Pharmacotherapy – Obsessive-Compulsive Disorder (OCD) and Anxiety Disorders

Psychiatric Pharmacotherapy –
Obsessive-Compulsive Disorder (OCD)
and Anxiety Disorders
Question 1
Which class of medications is considered the cornerstone of first-line
pharmacological treatment for both OCD and most anxiety disorders?
A) Tricyclic antidepressants (TCAs)
B) Selective serotonin reuptake inhibitors (SSRIs)
C) Benzodiazepines
D) Atypical antipsychotics
Answer: B
Rationale: SSRIs constitute the cornerstone of first-line pharmacological
treatment for both OCD and most anxiety disorders, supported by robust
evidence from randomized controlled trials and international consensus
guidelines.


Question 2
Which of the following is also recommended as a first-line option specifically for
generalized anxiety disorder (GAD)?
A) Buspirone
B) Pregabalin
C) Clomipramine
D) Quetiapine
Answer: B
Rationale: Pregabalin, a calcium channel modulator, is established as a first-line

,treatment specifically for generalized anxiety disorder, in addition to SSRIs and
SNRIs.


Question 3
Which SSRIs have FDA approval for the treatment of OCD?
A) Fluoxetine, fluvoxamine, paroxetine, and sertraline
B) Escitalopram and citalopram only
C) Fluoxetine and sertraline only
D) Paroxetine and venlafaxine only
Answer: A
Rationale: Fluoxetine, fluvoxamine, paroxetine, and sertraline all have FDA
approval and strong evidence for OCD treatment.


Question 4
What is the preferred combined approach for optimal outcomes in OCD and
anxiety disorders?
A) Pharmacotherapy alone
B) Psychotherapy alone
C) Pharmacotherapy combined with cognitive behavioral therapy (CBT) or
exposure therapy
D) Electroconvulsive therapy
Answer: C
Rationale: A combined approach incorporating pharmacotherapy with CBT or
exposure therapy is recognized as the preferred clinical strategy for optimal
outcomes.


Question 5

,Which tricyclic antidepressant is considered a second-line agent for OCD?
A) Amitriptyline
B) Imipramine
C) Clomipramine
D) Nortriptyline
Answer: C
Rationale: Clomipramine is a second-line agent for OCD with established efficacy,
though it is generally less well-tolerated than SSRIs due to its anticholinergic and
other side effect profiles.


Question 6
Why is clomipramine generally used as a second-line rather than first-line agent
for OCD?
A) It is less effective than SSRIs
B) It has a slower onset of action
C) It is less well-tolerated due to anticholinergic and other side effects
D) It is more expensive than SSRIs
Answer: C
Rationale: While equally effective to SSRIs in some comparisons, clomipramine is
generally less well-tolerated due to its anticholinergic and other side effect
profiles.


Question 7
Which augmentation strategy is recognized for treatment-resistant OCD?
A) Adding a benzodiazepine
B) Adding an atypical antipsychotic (e.g., risperidone, aripiprazole)
C) Adding a mood stabilizer
D) Adding a stimulant

, Answer: B
Rationale: For treatment-resistant OCD, augmentation of SSRI treatment with
atypical antipsychotics such as risperidone and aripiprazole is a recognized
strategy.


Question 8
What is the FDA black box warning associated with all antidepressants?
A) Risk of hepatotoxicity
B) Risk of increased suicidal ideation and behavior in children, adolescents, and
young adults up to age 24
C) Risk of severe weight gain
D) Risk of cardiac arrhythmias
Answer: B
Rationale: All antidepressants carry an FDA black box warning regarding an
increased risk of suicidal ideation and behavior in children, adolescents, and
young adults up to age 24.


Question 9
Which of the following is NOT a first-line SSRI for OCD?
A) Fluvoxamine
B) Sertraline
C) Escitalopram
D) Paroxetine
Answer: C
Rationale: Escitalopram, while effective for anxiety disorders, is not among the
SSRIs with specific FDA approval for OCD. The approved SSRIs for OCD include
fluoxetine, fluvoxamine, paroxetine, and sertraline.