Anxiety Disorders Practice Questions

Q: A patient presents with recurrent, unexpected panic attacks and persistent concern about additional attacks for the past month. What is the best treatment option?

SSRI. ***SSRI*** - **Selective Serotonin Reuptake Inhibitors (SSRIs)** are considered first-line for **panic disorder** due to their efficacy in reducing the frequency and severity of panic attacks and associated anticipatory anxiety. - They work by increasing serotonin levels in the brain, helping to regulate mood and anxiety over time, with full effects typically seen after several weeks of consistent use. *Benzodiazepines* - While effective for acute panic attacks due to their rapid onset of action, **benzodiazepines** are generally not the best long-term treatment for panic disorder. - Their use carries risks of **dependence**, **tolerance**, and **withdrawal symptoms**, and they do not address the underlying mechanisms of panic disorder. *Tricyclic antidepressants* - **Tricyclic antidepressants (TCAs)** can be effective for panic disorder, but they are typically considered second-line due to a less favorable side effect profile compared to SSRIs. - Side effects such as **anticholinergic effects**, **cardiac effects**, and sedation can limit their tolerability. *Beta-blockers* - **Beta-blockers** can help manage the **physical symptoms of anxiety** like palpitations and tremors, but they do not treat the core psychological aspects of panic disorder. - They are generally used for performance anxiety or situational anxiety, not as a primary treatment for recurrent, unexpected panic attacks.

Q: A 25-year-old woman experiences persistent, excessive worrying about multiple events or activities for the past 8 months. What is the most appropriate diagnosis?

Generalized anxiety disorder. ***Generalized anxiety disorder*** - This condition is characterized by **persistent, excessive worry** about various events or activities for at least **six months**, which aligns with the patient's presentation of 8 months of worry. - The worry is often difficult to control and is associated with symptoms like **restlessness**, **fatigue**, difficulty concentrating, irritability, muscle tension, and sleep disturbance. *Panic disorder* - This disorder involves recurrent, unexpected **panic attacks**, which are sudden episodes of intense fear accompanied by physical symptoms such as palpitations, shortness of breath, and dizziness. - It does not primarily involve persistent, generalized worrying about multiple life domains, but rather fear of future panic attacks. *Obsessive-compulsive disorder* - This condition is characterized by the presence of **obsessions** (recurrent, intrusive thoughts or urges) and/or **compulsions** (repetitive behaviors or mental acts performed to reduce anxiety). - While it involves anxiety, the nature of the anxiety is distinct from the free-floating worry seen in the patient, being tied to specific intrusive thoughts and rituals. *Social anxiety disorder* - This disorder involves intense fear or anxiety about social situations where the individual might be scrutinized or judged by others. - The patient's symptoms describe **generalized worry** about multiple events, not specifically fear related to social performance or interaction.

Q: Generalized anxiety disorder is diagnosed when anxiety and worry continue for at least?

6 months. ***6 months*** - This duration is a key diagnostic criterion for **Generalized Anxiety Disorder (GAD)**, as defined by the **DSM-5**. - It signifies that the **excessive anxiety and worry** about various events or activities are chronic and persistent, indicating a pervasive condition rather than a transient reaction to stress. *2 months* - This duration is **too short** to meet the diagnostic criteria for GAD according to the DSM-5. - A shorter period of anxiety might be indicative of an **acute stress disorder** or a specific phobia, but not generalized anxiety. *4 months* - While a significant duration, **4 months** does not meet the minimum diagnostic timeframe for GAD. - The persistence of symptoms beyond this point, specifically up to 6 months, is crucial for diagnosis. *8 months* - While 8 months of symptoms certainly qualifies for GAD, the **minimum duration** for diagnosis is 6 months. - This option incorrectly suggests a longer minimum period than is actually required by diagnostic manuals.

Q: What is the term for an extreme or irrational fear of darkness?

Fear of darkness. ***Fear of darkness*** - **Nyctophobia** is the specific and persistent **irrational fear of darkness** or night. - This phobia can cause significant distress and impairment in daily life, often leading to avoidance of dark environments. *Fear of confined spaces* - This describes **claustrophobia**, which is the fear of being in **tight or enclosed spaces**. - While it can be exacerbated in dark confined spaces, the primary fear is of the confinement itself, not the darkness. *Fear of strangers or foreigners* - This is known as **xenophobia**, an intense or irrational dislike or fear of people from other countries or cultures. - This is unrelated to the fear of darkness, as it pertains to social and cultural anxieties. *Fear of germs or dirt* - This condition is called **mysophobia**, characterized by an **irrational fear of contamination** by germs, dirt, or disease. - It often manifests as excessive handwashing or avoidance of public places, and is distinct from nyctophobia.

Q: What is the treatment of choice for acute panic attacks?

Benzodiazepines. ***Correct: Benzodiazepines*** - Benzodiazepines are the **treatment of choice for acute panic attacks** due to their **rapid onset of action** (within minutes) - They work by enhancing **GABA-A receptor** activity, providing immediate anxiolytic effects - Commonly used agents include **alprazolam, lorazepam, and clonazepam** - While effective acutely, they are not recommended for long-term management due to dependence risk *Incorrect: Tricyclic antidepressants (TCAs)* - TCAs are effective for **long-term prophylaxis** of panic disorder, not acute attacks - They have a **delayed onset of action** (2-4 weeks), making them unsuitable for immediate relief - Significant **anticholinergic effects** and potential cardiotoxicity limit their use *Incorrect: Monoamine oxidase inhibitors (MAOIs)* - MAOIs can be effective for panic disorder but are reserved for **treatment-resistant cases** - **Delayed onset of action** (several weeks) makes them inappropriate for acute attacks - Require **dietary restrictions** and have risk of hypertensive crisis with tyramine-containing foods *Incorrect: Barbiturates* - Largely **obsolete** in psychiatric practice, replaced by safer benzodiazepines - **Narrow therapeutic index** with high risk of overdose and respiratory depression - Greater potential for dependence and withdrawal complications - No role in modern management of panic attacks

Q: In which of the following conditions is behavioral therapy most commonly utilized?

Agoraphobia. ***Agoraphobia*** - **Behavioral therapy**, particularly **exposure therapy**, is the **gold standard and first-line treatment** for agoraphobia. - It involves **systematic desensitization** and gradual exposure to feared situations (e.g., crowded places, public transport, open spaces). - This approach directly reduces **avoidance behaviors** and anxiety responses, making it the most commonly utilized behavioral intervention among these conditions. *Schizophrenia* - While behavioral interventions can be part of a comprehensive treatment plan, **pharmacotherapy** (antipsychotics) is the cornerstone for managing positive and negative symptoms. - Behavioral approaches often focus on **social skills training** and vocational rehabilitation, not primary symptom reduction. *Delirium* - The primary management for delirium involves identifying and treating the **underlying medical cause** and providing supportive care. - Behavioral therapy is generally not indicated as this condition is an **acute organic brain syndrome** requiring medical management. *Neurotic depression* - This term is largely outdated; current diagnostic manuals use terms like **persistent depressive disorder (dysthymia)** or **major depressive disorder**. - While behavioral activation is a component of CBT for depression, the primary treatments are **cognitive behavioral therapy (CBT)** and/or **pharmacotherapy** (antidepressants), rather than purely behavioral therapy.

Q: Which of the following symptoms is NOT included in the diagnostic criteria for DSM-IV-TR somatization disorder?

Visual symptoms. ***Visual symptoms*** - **Visual symptoms** is NOT a separate diagnostic category in DSM-IV-TR somatization disorder criteria. - While visual symptoms (such as **double vision** or **blindness**) ARE part of the diagnostic criteria, they fall under the **pseudoneurological symptom** category, not as a distinct standalone category. - The DSM-IV-TR required **one pseudoneurological symptom** (which could include visual, motor, sensory symptoms, or seizures), but did not list "visual symptoms" as one of the four main symptom categories. *Sexual symptom* - The DSM-IV-TR diagnostic criteria for somatization disorder explicitly included **sexual symptoms** as one of the four main categories. - At least **one sexual symptom** was required (such as sexual indifference, erectile dysfunction, irregular menses, or painful intercourse). *Pain symptom* - The DSM-IV-TR criteria included **pain symptoms** as one of the four main categories. - The criteria required **four pain symptoms** occurring in at least four different sites or functions (e.g., head, abdomen, back, joints, chest). *GI symptom* - The DSM-IV-TR criteria included **gastrointestinal symptoms** as one of the four main categories. - At least **two gastrointestinal symptoms** were required (such as nausea, bloating, vomiting other than during pregnancy, or diarrhea). **Key Point:** The four DSM-IV-TR symptom categories for somatization disorder were: (1) Pain, (2) Gastrointestinal, (3) Sexual, and (4) Pseudoneurological—NOT "visual symptoms" as a separate category.

Q: A student unable to deliver speech before an audience is suffering from?

Social anxiety disorder. ***Social anxiety disorder*** - This condition involves an intense, persistent fear of social situations, particularly those where one might be scrutinized or judged by others. - Public speaking is a classic scenario that can trigger significant distress and avoidance in individuals with **social anxiety disorder**. *Fear of open spaces* - This symptom describes **agoraphobia**, which is an anxiety disorder characterized by fear and avoidance of situations or places that might cause panic, helplessness, or embarrassment, often due to a perceived inability to escape. - While it can sometimes involve fear of public gatherings, its core is about escape/safety from open, unfamiliar, or overwhelming spaces, not specifically about performance. *Fear of enclosed spaces* - This refers to **claustrophobia**, which is an anxiety disorder characterized by an irrational fear of confined spaces. - It does not involve the fear of speaking or performance before an audience. *Obsessive Compulsive Disorder* - **OCD** is characterized by recurrent and persistent thoughts (obsessions) and/or repetitive behaviors or mental acts (compulsions) performed to reduce anxiety. - It does not typically manifest as an inability to deliver a speech before an audience unless the obsessions or compulsions directly interfere with such an activity, which is not the primary mechanism of this symptom.

Q: What is the drug of choice for treating generalized anxiety disorder?

Buspirone. ***Buspirone*** - **Buspirone** is a non-benzodiazepine anxiolytic that is effective for generalized anxiety disorder (GAD) and has a lower risk of dependence and sedation compared to benzodiazepines. - It acts as a partial agonist at **5-HT1A serotonin receptors**, which contributes to its anxiolytic effects without affecting GABAergic systems. *β-blocker* - **β-blockers** are primarily used to manage the **physical symptoms of anxiety**, such as palpitations and tremors, often in performance anxiety, rather than the core cognitive and emotional symptoms of GAD. - They do not address the underlying psychological aspects of generalized anxiety. *Alprazolam* - **Alprazolam** is a **benzodiazepine** that provides rapid relief of anxiety symptoms but carries a significant risk of **dependence, withdrawal, and sedation**, making it less suitable for long-term treatment of GAD. - Due to these risks, benzodiazepines are typically reserved for short-term use or acute anxiety management rather than as a first-line treatment for chronic GAD. *Phenytoin* - **Phenytoin** is an **antiepileptic drug** primarily used to treat seizures and does not have a recognized role in the management of generalized anxiety disorder. - Its mechanism of action involves stabilizing neuronal membranes and is unrelated to the neurochemical pathways targeted in anxiety disorders.

Q: Which of the following is a recognized type of anxiety disorder?

Panic Disorder. ***Panic Disorder*** - **Panic disorder** is a recognized **anxiety disorder** characterized by recurrent unexpected **panic attacks** - sudden episodes of intense fear accompanied by physical symptoms like heart palpitations, shortness of breath, chest pain, dizziness, and trembling. - It involves persistent worry about having more attacks (anticipatory anxiety) and maladaptive behavioral changes to avoid situations where attacks might occur. - Classified under **Anxiety Disorders** in DSM-5 and ICD-11. *Major Depressive Disorder* - **Major Depressive Disorder (MDD)** is a **mood disorder**, not an anxiety disorder. - Characterized by persistent depressed mood, loss of interest or pleasure (anhedonia), changes in appetite/sleep, fatigue, feelings of worthlessness, and potential suicidal ideation. - Classified under **Depressive Disorders** in DSM-5, distinct from anxiety disorders, though anxiety symptoms may co-occur. *Bipolar Disorder* - **Bipolar disorder** is a **mood disorder**, not an anxiety disorder. - Characterized by significant mood swings including episodes of mania/hypomania (elevated, expansive, or irritable mood with increased energy) and depression. - Classified under **Bipolar and Related Disorders** in DSM-5, distinct from anxiety disorders. *Schizophrenia* - **Schizophrenia** is a **psychotic disorder**, not an anxiety disorder. - Characterized by disturbances in thought, perception, emotions, and behavior, including hallucinations, delusions, disorganized thinking, and negative symptoms. - Classified under **Schizophrenia Spectrum and Other Psychotic Disorders** in DSM-5, distinct from anxiety disorders.

Question 1

A patient presents with recurrent, unexpected panic attacks and persistent concern about additional attacks for the past month. What is the best treatment option?

Accepted Answer

SSRI

Answer

Benzodiazepines

Answer

Tricyclic antidepressants

Answer

Beta-blockers

Question 2

A 25-year-old woman experiences persistent, excessive worrying about multiple events or activities for the past 8 months. What is the most appropriate diagnosis?

Accepted Answer

Generalized anxiety disorder

Answer

Panic disorder

Answer

Obsessive-compulsive disorder

Answer

Social anxiety disorder

Question 3

Generalized anxiety disorder is diagnosed when anxiety and worry continue for at least?

Accepted Answer

6 months

Answer

2 months

Answer

4 months

Answer

8 months

Question 4

What is the term for an extreme or irrational fear of darkness?

Accepted Answer

Fear of darkness

Answer

Fear of confined spaces

Answer

Fear of strangers or foreigners

Answer

Fear of germs or dirt

Question 5

What is the treatment of choice for acute panic attacks?

Accepted Answer

Benzodiazepines

Answer

Tricyclic antidepressants (TCAs)

Answer

Monoamine oxidase inhibitors (MAOIs)

Answer

Barbiturates

Question 6

In which of the following conditions is behavioral therapy most commonly utilized?

Accepted Answer

Agoraphobia

Answer

Schizophrenia

Answer

Delirium

Answer

Neurotic depression

Question 7

Which of the following symptoms is NOT included in the diagnostic criteria for DSM-IV-TR somatization disorder?

Accepted Answer

Visual symptoms

Answer

Sexual symptom

Answer

Pain symptom

Answer

GI symptom

Question 8

A student unable to deliver speech before an audience is suffering from?

Accepted Answer

Social anxiety disorder

Answer

Fear of open spaces

Answer

Fear of enclosed spaces

Answer

Obsessive Compulsive Disorder

Question 9

What is the drug of choice for treating generalized anxiety disorder?

Accepted Answer

Buspirone

Answer

Alprazolam

Answer

Phenytoin

Answer

β-blocker

Question 10

Which of the following is a recognized type of anxiety disorder?

Accepted Answer

Panic Disorder

Answer

Bipolar Disorder

Answer

Major Depressive Disorder

Answer

Schizophrenia

Anxiety Disorders — MCQs

Anxiety Disorders — MCQs

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