The patient in this vignette most likely suffers from performance anxiety, a form of social phobia. The pharmacologic treatment of choice is a beta blocker, typically propanolol, which can be taken several hours prior to her performance and combat symptoms by blocking beta-adrenergic receptors.
Performance anxiety is a subset of a larger class of social phobias, which involve an exaggerated sense of fear of embarrassment or shame in social situations. This fear interferes with normal function, and can result in difficulty ranging from public speaking to using public restrooms. The most common form is performance anxiety. Social phobias may coexist with avoidant personality disorder.
Bruce et al. outline specific treatments for general social phobia and specific performance anxiety. Cognitive behavioral therapy (CBT), with or without specific antidepressant therapy, is the evidence-based treatment of choice for most patients. Adjunctive use of benzodiazepines can facilitate the treatment response of patients who need initial symptom relief. The use of beta blockers as needed has been found to be helpful in the treatment of circumscribed social and performance phobias.
Rodebaugh et al. outline CBT as used to treat performance anxiety. The basic premise holds that a "client's thoughts and beliefs about situations maintain distressing feelings, such as anxiety." CBT works to change these beliefs through detection and disputation of anxiety-provoking thoughts. Further work involves testing these thoughts through exposure to feared situations.
Answer 2: This describes SSRIs, which can be used for general social phobia.
Answer 3: This describes TCAs, which can be used for obsessive compulsive disorder,
Answer 4: This describes donepezil, which can be used for Alzheimer's disease.
Answer 5: This describes benzodiazepines, which can be used for panic attacks.
None of these medications are the drug of choice for circumscribed performance-related anxiety.
Bruce TJ, Saeed SA. Social anxiety disorder: a common, underrecognized mental disorder. Am Fam Physician. 1999 Nov 15;60(8):2311-20, 2322.
PMID:10593322 (Link to Abstract)
Rodebaugh TL, Chambless DL. Cognitive therapy for performance anxiety. J Clin Psychol. 2004 Aug;60(8):809-20.
PMID:15241809 (Link to Abstract)