Anxiety Disorders Practice Questions

Q: What is the definitive treatment for all types of phobias?

Behavior therapy. **Explanation:** The definitive treatment for phobias is **Behavior Therapy**, specifically techniques involving **Exposure Therapy**. The underlying medical concept is based on the principle of **extinction** and **habituation**. By repeatedly exposing the patient to the feared stimulus (the phobic object or situation) in a controlled manner without the possibility of escape, the pathological fear response is gradually extinguished. * **Systematic Desensitization:** A type of behavior therapy where the patient is exposed to a hierarchy of fears while practicing relaxation techniques. * **Flooding:** Direct, intense exposure to the feared stimulus until the anxiety subsides. **Why other options are incorrect:** * **Social Therapy:** While supportive, it does not address the core behavioral avoidance pattern inherent in phobias. * **Avoidance:** This is a symptom of the disorder, not a treatment. Avoidance acts as a **negative reinforcer**, actually maintaining and worsening the phobia over time. * **Drug Therapy:** While Benzodiazepines or SSRIs may be used to manage acute anxiety or comorbid depression (especially in Social Anxiety Disorder), they are considered **adjunctive**. They do not "cure" the phobia and symptoms often return once the medication is stopped if behavior therapy was not performed. **High-Yield Clinical Pearls for NEET-PG:** * **Specific Phobia:** The most common psychiatric disorder in women and the second most common in men. * **Treatment of Choice (TOC):** Exposure therapy (Behavior therapy). * **Social Anxiety Disorder (Social Phobia):** The TOC is Cognitive Behavioral Therapy (CBT); however, **SSRIs** (like Paroxetine) are the first-line pharmacological treatment. * **Performance Anxiety:** A subtype of social phobia specifically treated with **Beta-blockers (Propranolol)** taken 30–60 minutes before the event.

Q: A 25-year-old female presents with chest pain, sweating, restlessness, dyspnea, and palpitations. Initial investigations including enzyme analysis and X-ray are normal. Her symptoms resolve with supportive measures. What is the most probable diagnosis?

Panic attack. ### Explanation **Correct Option: A. Panic attack** The clinical presentation describes a classic **Panic Attack**. It is characterized by a sudden onset of intense fear or discomfort reaching a peak within minutes, accompanied by at least four somatic or cognitive symptoms (e.g., palpitations, sweating, dyspnea, chest pain, and fear of dying). In this case, the patient is young (25 years), and the **normal investigations** (cardiac enzymes and X-ray) rule out acute organic causes like myocardial infarction. The spontaneous resolution with supportive measures is a hallmark of the self-limiting nature of panic episodes. **Why other options are incorrect:** * **B. Autonomic nervous system instability:** This is a broad, non-specific physiological state rather than a clinical diagnosis. While panic attacks involve autonomic arousal, "instability" does not define this specific episodic presentation. * **C. Angina pectoris:** While chest pain and dyspnea occur, angina is typically related to exertion and would not explain the rapid resolution with supportive measures in a 25-year-old with normal enzymes. * **D. Vasovagal attack:** This usually presents with bradycardia and hypotension leading to **syncope** (fainting). In contrast, panic attacks involve sympathetic overactivity (tachycardia and hypertension) without loss of consciousness. **NEET-PG High-Yield Pearls:** * **Diagnosis:** Panic Disorder requires recurrent, unexpected panic attacks followed by ≥1 month of persistent concern about future attacks or behavioral changes. * **Acute Management:** Benzodiazepines (e.g., Alprazolam or Lorazepam). * **Long-term Treatment (DOC):** Selective Serotonin Reuptake Inhibitors (SSRIs) + Cognitive Behavioral Therapy (CBT). * **Rule Out:** Always exclude hyperthyroidism, pheochromocytoma, and caffeine intoxication in such patients.

Q: Applied tension is characteristically used in which type of phobia?

Blood injection phobia. **Explanation:** **1. Why Blood-Injection-Injury (BII) Phobia is correct:** Most phobias are characterized by a **sympathetic nervous system** surge (tachycardia and hypertension). However, BII phobia is unique because it often involves a **biphasic response**. After an initial brief rise in heart rate, there is a sudden, massive **vasovagal response** (parasympathetic overactivity) leading to a drop in blood pressure and heart rate, often resulting in **fainting (syncope)**. **Applied Tension** is a specific behavioral technique designed to counteract this. Patients are taught to tense the large muscle groups in their arms, legs, and trunk at the first sign of a drop in blood pressure. This physical tension increases peripheral resistance and raises blood pressure, preventing syncope during exposure to needles or blood. **2. Why other options are incorrect:** * **Claustrophobia (Fear of enclosed spaces):** Managed primarily through systematic desensitization or flooding. It does not typically involve a vasovagal syncopal response. * **Thanatophobia (Fear of death):** A complex phobia often linked to generalized anxiety or existential distress; it does not require physiological tension techniques. * **Hydrophobia (Fear of water):** Classically associated with Rabies (due to painful spasms) or a specific phobia. Treatment involves standard exposure therapy. **3. Clinical Pearls for NEET-PG:** * **BII Phobia** has the highest **familial aggregation** among all phobias (approx. 60-70%). * **Standard treatment for most phobias:** Cognitive Behavioral Therapy (CBT) with **Exposure Therapy** (Graded exposure/Systematic Desensitization) is the gold standard. * **Pharmacotherapy:** Benzodiazepines (short-term) or SSRIs may be used, but behavioral therapy is more effective for long-term remission. * **Key Distinction:** Applied tension is for BII phobia; **Relaxation training** is used for most other anxiety disorders.

Q: What is a panic attack?

Acute anxiety. **Explanation:** A **Panic Attack** is defined as a discrete period of intense fear or discomfort that reaches a peak within minutes. In psychiatric terms, it represents **Acute Anxiety** because of its sudden onset, short duration (usually 10–30 minutes), and the presence of intense autonomic hyperactivity. * **Why Option A is Correct:** Panic attacks are characterized by an "acute" or paroxysmal surge of sympathetic nervous system activity. Patients experience physical symptoms like palpitations, sweating, tremors, and shortness of breath, alongside psychological symptoms like "fear of dying" or "fear of going crazy." * **Why Options B, C, and D are Incorrect:** * **Chronic Anxiety:** Refers to conditions like Generalized Anxiety Disorder (GAD), where the anxiety is persistent and long-lasting (at least 6 months) rather than episodic. * **Acute/Chronic Depression:** These involve disturbances in mood (anhedonia, low mood) rather than the acute physiological "fight-or-flight" response seen in panic. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** According to DSM-5, a panic attack requires the presence of at least **4 out of 13** specific somatic or cognitive symptoms. * **Panic Disorder:** Diagnosed when a patient has recurrent, unexpected panic attacks followed by at least **one month** of persistent concern about future attacks (anticipatory anxiety). * **Treatment:** * **Acute Episode:** Benzodiazepines (e.g., Alprazolam, Lorazepam) are the drugs of choice for immediate relief. * **Prophylaxis/Long-term:** SSRIs (e.g., Sertraline, Paroxetine) are the first-line maintenance treatment. * **Medical Mimic:** Always rule out **Pheochromocytoma** or **Hyperthyroidism** in patients presenting with panic-like symptoms.

Q: A fugue state may be seen in which of the following conditions?

All of the above. **Explanation:** A **fugue state** (Dissociative Fugue) is characterized by sudden, unexpected travel away from home or one’s workplace, accompanied by an inability to recall one's past and confusion about personal identity or the assumption of a new identity. While traditionally classified under Dissociative Disorders, it is a clinical phenomenon that can manifest in several psychiatric and neurological conditions. 1. **Hysteria (Dissociative Disorders):** This is the most common association. In ICD-10, it is termed "Dissociative Fugue." It is typically triggered by severe psychological stress or trauma, where the patient "escapes" their reality. 2. **Epilepsy:** Specifically, **Temporal Lobe Epilepsy (TLE)** or complex partial seizures can lead to "epileptic fugue" or post-ictal automatisms. During these states, patients may wander aimlessly with impaired consciousness and subsequent amnesia. 3. **Schizophrenia:** Patients with schizophrenia may wander away in a state of "schizophrenic fugue" or "wandering," often driven by command hallucinations or systematized delusions. **Clinical Pearls for NEET-PG:** * **Key Feature:** The hallmark of fugue is **purposeful travel** that appears normal to observers, unlike the aimless wandering seen in delirium. * **Recovery:** Recovery is usually spontaneous and rapid; however, the patient typically remains amnestic for the events that occurred *during* the fugue state. * **Differential Diagnosis:** Always rule out **Alcoholic Blackouts** and **Malingering** (where the fugue is feigned to avoid legal or financial consequences). * **Management:** The primary focus is on psychotherapy (abreaction) for dissociative causes and EEG/Antiepileptics for organic (epileptic) causes.

Q: What is the drug of choice for Generalized Anxiety Disorder?

Sertraline. **Explanation:** **Generalized Anxiety Disorder (GAD)** is characterized by excessive, uncontrollable worry about various aspects of daily life for at least 6 months. **1. Why Sertraline is Correct:** The first-line pharmacological treatment for GAD consists of **Selective Serotonin Reuptake Inhibitors (SSRIs)** or Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs). **Sertraline**, an SSRI, is considered a drug of choice due to its superior safety profile, low potential for abuse, and efficacy in managing both the psychic and somatic symptoms of anxiety over the long term. **2. Analysis of Incorrect Options:** * **Benzodiazepines (e.g., Alprazolam):** While they provide rapid symptomatic relief, they are **not** the drug of choice due to risks of sedation, cognitive impairment, tolerance, and physical dependence. They are typically reserved for short-term "bridge therapy" until SSRIs reach therapeutic levels (usually 2–4 weeks). * **Buspirone:** This is a 5-HT1A partial agonist. While indicated for GAD, it is generally considered a second-line agent because it has a slower onset of action and is often less effective than SSRIs in patients previously treated with benzodiazepines. * **Olanzapine:** This is an atypical antipsychotic. It is not a first-line treatment for GAD and is only used as an off-label augmentation strategy in treatment-resistant cases. **High-Yield Clinical Pearls for NEET-PG:** * **First-line:** SSRIs (Sertraline, Escitalopram, Paroxetine) or SNRIs (Venlafaxine, Duloxetine). * **Duration of treatment:** Once symptoms are controlled, medication should be continued for **6–12 months** to prevent relapse. * **Psychotherapy:** Cognitive Behavioral Therapy (CBT) is the most effective non-pharmacological treatment and is often combined with SSRIs for the best outcomes. * **Propranolol:** Used only for **Performance Anxiety** (a subtype of Social Anxiety Disorder), not for GAD.

Question 1

A 16-year-old female presents with recurrent abdominal pain, but biochemical assays and ultrasound of the abdomen are normal. After waking up from sleep, she suddenly complains of loss of vision in both eyes. An ophthalmologist finds nothing on examination. This condition is most probably due to:

Accepted Answer

Malingering

Answer

Bilateral optic neuritis

Answer

Posterior cerebellar artery infarct

Answer

Occipital hemorrhage

Question 2

What is the definitive treatment for all types of phobias?

Accepted Answer

Behavior therapy

Answer

Social therapy

Answer

Avoidance

Answer

Drug therapy

Question 3

A 25-year-old female presents with chest pain, sweating, restlessness, dyspnea, and palpitations. Initial investigations including enzyme analysis and X-ray are normal. Her symptoms resolve with supportive measures. What is the most probable diagnosis?

Accepted Answer

Panic attack

Answer

Autonomic nervous system instability

Answer

Angina pectoris

Answer

Vasovagal attack

Question 4

Applied tension is characteristically used in which type of phobia?

Accepted Answer

Blood injection phobia

Answer

Claustrophobia

Answer

Thanatophobia

Answer

Hydrophobia

Question 5

What is a panic attack?

Accepted Answer

Acute anxiety

Answer

Chronic anxiety

Answer

Acute depression

Answer

Chronic depression

Question 6

A fugue state may be seen in which of the following conditions?

Accepted Answer

All of the above

Answer

Schizophrenia

Answer

Hysteria

Answer

Epilepsy

Question 7

Which of the following is NOT classified as an anxiety disorder?

Accepted Answer

Conversion disorder

Answer

Phobias

Answer

Obsessive-Compulsive Disorder (OCD)

Answer

Post-Traumatic Stress Disorder (PTSD)

Question 8

Which of the following are true about generalized anxiety disorder?

Accepted Answer

Insomnia, Free floating anxiety, and Benzodiazepine as the treatment of choice

Answer

Insomnia, Hypersomnia, Episodes lasting minutes to hours, Free floating anxiety, Benzodiazepine as the treatment of choice, and Autonomic symptoms

Answer

Insomnia, Hypersomnia, Free floating anxiety, and Autonomic symptoms

Answer

Insomnia, Hypersomnia, Episodes lasting minutes to hours, and Free floating anxiety

Question 9

What is the drug of choice for Generalized Anxiety Disorder?

Accepted Answer

Sertraline

Answer

Benzodiazepines

Answer

Buspirone

Answer

Olanzapine

Question 10

All are true about dementia except:

Accepted Answer

Loss of short-term memory

Answer

Loss of long-term memory

Answer

Deterioration of personality

Answer

Impaired learning

Anxiety Disorders — MCQs

Anxiety Disorders — MCQs

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