A 22-Year-Old Man Comes to the Office for Follow-Up Regarding

question 149

Multiple Choice

A 22-year-old man comes to the office for follow-up regarding anxiety.  The patient was referred for treatment by the student health service due to severe anxiety accompanied by sweaty palms and shaky voice, as well as blushing when meeting new people and giving oral presentations.  He was diagnosed with social anxiety disorder and started on fluoxetine 2 weeks ago.  Today, the patient reports that his anxiety in social situations has not improved and that he has started to feel uncharacteristically tense and jittery, "like I've had too much coffee."  He says, "If anything, my anxiety is worse than before, and I feel anxious most of the time."  The patient now has difficulty falling asleep.  He has no significant medical history.  The patient does not use illicit drugs.  Vital signs are stable, and physical examination is unchanged from the initial presentation.  Which of the following is the most appropriate next step in management of this patient?

• A)Add buspirone
• B)Add zolpidem
• C)Decrease dose of fluoxetine
• D)Discontinue fluoxetine and start bupropion
• E)Discontinue fluoxetine and start clonazepam
• F)Increase dose of fluoxetine

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