Anxiety Disorders — MCQs

A middle-aged person reported to the Psychiatric OPD with complaints of fear of leaving home, fear of traveling alone, and fear of being in a crowd. He develops marked anxiety with palpitations and sweating when he is in these situations. He often avoids public transportation to go to his place of work. The most likely diagnosis is

Q158

A 43-year-old lady presents to the emergency department with an acute attack of anxiety, accompanied by physical symptoms such as hyperventilation, increased heart rate, and sweating, and is diagnosed with an acute panic attack. Which of the following is the most suitable drug for this patient?

Q159

A 40-year-old female reports sudden bouts of anxiety that can occur at any time, accompanied by sweating, palpitations, derealization, and a feeling of going crazy. These episodes typically last 20-25 minutes. Despite normal routine investigations, she is concerned about having future episodes. What is the diagnosis?

Q160

Which of the following is the LEAST common symptom of anxiety?

Anxiety Disorders Indian Medical PG Practice Questions and MCQs

Question 151: What is the term for a persistent preoccupation with serious illness despite having no or only mild symptoms?

A. Somatic symptom disorder
B. Conversion disorder
C. Body dysmorphic disorder
D. Illness anxiety disorder (Correct Answer)

Explanation: ***Illness anxiety disorder*** - This condition is characterized by a **preoccupation with having or acquiring a serious illness** despite having few or no somatic symptoms. - Individuals with illness anxiety disorder engage in **excessive health-related behaviors** (e.g., repeated checking) or maladaptive avoidance (e.g., avoiding doctor appointments). *Somatic symptom disorder* - Involves **distressing somatic symptoms** that result in significant disruption of daily life, with excessive thoughts or behaviors related to the symptoms. - The focus is on the **symptoms themselves**, rather than the fear of a specific undiagnosed illness. *Conversion disorder* - Features neurological symptoms (e.g., weakness, paralysis, seizures) that are **incompatible with recognized neurological or medical conditions**. - There is a **lack of voluntary control** over the symptoms, and they are not intentionally feigned. *Body dysmorphic disorder* - Characterized by a **preoccupation with perceived flaws** or defects in physical appearance that are not observable or appear slight to others. - This preoccupation leads to **repetitive behaviors** (e.g., mirror checking) or mental acts (e.g., comparing oneself to others).

Question 152: Which of the following is NOT a characteristic feature of somatization disorder?

A. Absence of pseudo neurological symptoms
B. Absence of pain symptoms
C. Rejection of the sick role (Correct Answer)
D. Lack of sexual symptoms

Explanation: ***Rejection of the sick role*** - Patients with somatization disorder (now classified under **somatic symptom disorder** in DSM-5) characteristically **embrace the sick role**, not reject it - They actively seek medical attention, present with multiple chronic physical symptoms, express significant distress, and often become preoccupied with their perceived illnesses - This adoption of the sick role is a key behavioral pattern distinguishing somatization disorder from malingering or factitious disorder *Absence of pseudo-neurological symptoms* - This is incorrect because **pseudo-neurological (conversion) symptoms** are characteristic features of somatization disorder - Examples include paralysis, blindness, seizures, sensory loss, aphonia, and loss of coordination - These symptoms resemble neurological conditions but lack organic pathology *Absence of pain symptoms* - This is incorrect because **pain symptoms** are among the most common presentations in somatization disorder - Patients typically report pain in multiple sites: headaches, back pain, joint pain, chest pain, abdominal pain - Pain complaints are often one of the primary reasons these patients seek medical care *Lack of sexual symptoms* - This is incorrect because **sexual and reproductive symptoms** are frequently reported in somatization disorder - Examples include sexual indifference, erectile dysfunction, dyspareunia, irregular menses, excessive menstrual bleeding, and vomiting throughout pregnancy - These contribute to the widespread and varied somatic complaints characteristic of the disorder

Question 153: What is the definition of phobia?

A. An intense, irrational fear that leads to avoidance (Correct Answer)
B. Fear of specific objects or situations
C. A type of anxiety disorder characterized by excessive fear
D. A severe anxiety disorder characterized by irrational fear

Explanation: ***An intense, irrational fear that leads to avoidance*** - A phobia is primarily an **intense and persistent fear** reaction that is **irrational** in nature, meaning it is disproportionate to the actual danger posed by the object or situation. - This overwhelming fear invariably leads to **avoidance behavior**, where the individual actively tries to stay away from the feared stimulus. *Fear of specific objects or situations* - While phobias often involve specific objects or situations, this definition alone is insufficient as it doesn't capture the **intensity**, **irrationality**, or the **avoidance** component that are hallmarks of a true phobia. - Many people experience fear of specific things without it reaching the clinical threshold of a phobia, as long as it doesn't cause significant distress or impairment. *A type of anxiety disorder characterized by excessive fear* - This definition is broadly correct but is not the most precise or complete definition of a phobia itself. - While phobias are indeed a type of **anxiety disorder** and involve excessive fear, the key defining features of **irrationality** and **avoidance** are not explicitly stated, nor is the clear distinction from generalized anxiety. *A severe anxiety disorder characterized by irrational fear* - Similar to the previous option, this highlights the **irrational fear** and categorizes it as an **anxiety disorder**. - However, it omits the crucial element of **avoidance**, which is a defining diagnostic criterion and a hallmark behavioral response in phobias, and it also uses the broad term "severe" when the impact can vary.

Question 154: What is the drug of choice for rapid relief of an acute panic attack?

A. Benzodiazepines (rapid anxiolytic action) (Correct Answer)
B. Neuroleptics (antipsychotic agents)
C. Beta-blockers (manage physical symptoms)
D. Tricyclic Antidepressants (long-term management)

Explanation: ***Benzodiazepines (rapid anxiolytic action)*** - **Benzodiazepines** are used for **rapid symptomatic relief** of acute panic attacks due to their **fast onset of action** (within 30-60 minutes) and potent anxiolytic effects. - They work by enhancing the effect of **GABA**, an inhibitory neurotransmitter, leading to CNS depression and reduced anxiety. - **Important note:** While effective for acute relief, benzodiazepines are recommended only for **short-term use** (2-4 weeks) due to risks of dependence, tolerance, and withdrawal. - **First-line long-term treatment** for panic disorder is **SSRIs** (not benzodiazepines). *Beta-blockers (manage physical symptoms)* - **Beta-blockers** can help manage **physical symptoms** of anxiety such as palpitations and tremors, but they do not address the core psychological component of a panic attack. - They are often used as an adjunct or in performance anxiety situations, but not for acute panic attack relief. *Neuroleptics (antipsychotic agents)* - **Neuroleptics** (antipsychotic agents) are primarily used for treating **psychotic disorders** like schizophrenia, not panic attacks. - Their side effect profile and mechanism of action make them unsuitable for acute anxiety or panic. *Tricyclic Antidepressants (long-term management)* - **Tricyclic Antidepressants (TCAs)** like imipramine and clomipramine can be used for **long-term management** of panic disorder. - However, their onset of action is slow (2-4 weeks), making them unsuitable for acute panic attack relief. - **SSRIs are preferred over TCAs** for long-term management due to better tolerability.

Question 155: Which of the following drugs can induce panic disorder?

A. Sildenafil (Viagra)
B. Yohimbine (a panicogenic agent) (Correct Answer)
C. PGE1 (Prostaglandin E1)
D. All of the options

Explanation: ***Yohimbine (a panicogenic agent)*** - **Yohimbine** is an alpha-2 adrenergic receptor antagonist which increases **norepinephrine** activity in the brain. - This increase in noradrenergic activity can trigger symptoms of panic, leading to its use as a **panicogenic agent** in research settings. *Sildenafil (Viagra)* - **Sildenafil** is a PDE5 inhibitor primarily used for erectile dysfunction; its main effects are **vasodilation** and increased blood flow to specific tissues. - While it can cause side effects like headache or flushing, it is not known to directly induce **panic attacks** or panic disorder. *PGE1 (Prostaglandin E1)* - **Prostaglandin E1 (alprostadil)** is a vasodilator used to treat erectile dysfunction or maintain patent ductus arteriosus in neonates. - Its effects are primarily on **vascular smooth muscle** and do not typically involve the neural pathways associated with panic. *All of the options* - As **sildenafil** and **PGE1** do not induce panic disorder, this option is incorrect. - Only **yohimbine** is recognized for its panicogenic effects.

Question 156: Which of the following is a defense mechanism in phobia?

A. Substitution
B. Projection
C. Displacement (Correct Answer)
D. Sublimation

Explanation: ***Displacement*** - In phobias, **displacement** occurs when the anxiety associated with a forbidden impulse or an unacceptable object is redirected to a **less threatening object**, leading to fear of the latter. - For example, fear of parental disapproval might be displaced onto a phobia of animals. *Sublimation* - **Sublimation** involves channeling unacceptable impulses into **socially acceptable** and often productive activities. - This mechanism is not typically associated with the development or maintenance of phobias. *Substitution* - **Substitution** is a more general term and not a specific Freudian defense mechanism; while an object or idea might be "substituted" for another, a more precise term like **displacement** is used when anxiety is transferred. - It lacks the specific theoretical underpinnings that describe how anxiety is managed in phobias. *Projection* - **Projection** is a defense mechanism where unacceptable thoughts, feelings, or impulses are attributed to **another person or external source**. - While projection can be involved in other psychiatric conditions, it doesn't directly explain the mechanism of fear transference in phobias.

Question 157: A middle-aged person reported to the Psychiatric OPD with complaints of fear of leaving home, fear of traveling alone, and fear of being in a crowd. He develops marked anxiety with palpitations and sweating when he is in these situations. He often avoids public transportation to go to his place of work. The most likely diagnosis is

A. Generalised anxiety disorder
B. Schizophrenia
C. Personality disorder
D. Agoraphobia (Correct Answer)

Explanation: ***Agoraphobia*** - The patient's presentation of **fear of leaving home**, traveling alone, and being in a crowd, along with marked anxiety symptoms like palpitations and sweating when in these situations, are classic signs of **agoraphobia**. - **DSM-5 diagnostic criteria** require fear/anxiety about ≥2 of the following: public transportation, open spaces, enclosed spaces, crowds, or being outside home alone—this patient meets multiple criteria. - **Avoidance behavior** of public transportation and the associated functional impairment (difficulty going to work) directly align with agoraphobia, where individuals actively avoid situations that trigger anxiety or panic symptoms. - The anxiety is **situation-specific** rather than generalized, with clear autonomic symptoms (palpitations, sweating) triggered by specific environmental contexts. *Generalised anxiety disorder* - While GAD involves **excessive worry** about various aspects of life, it typically doesn't present with specific fears related to being in certain places or situations with such intense avoidance behaviors. - The anxiety in GAD is **pervasive and free-floating**, not situation-specific—it lacks the characteristic **fear of open or public spaces** and targeted avoidance seen in this case. - GAD worry is difficult to control and involves multiple life domains, not restricted to specific environmental triggers. *Schizophrenia* - Schizophrenia is a **psychotic disorder** characterized by hallucinations, delusions, disorganized thought, and negative symptoms; it does not primarily manifest as specific phobias or anxiety related to public spaces. - The patient's symptoms do not align with the core features of **psychosis**, such as impaired reality testing, thought disorders, or perceptual disturbances. - Social withdrawal in schizophrenia is due to negative symptoms or paranoid delusions, not situation-specific anxiety with autonomic arousal. *Personality disorder* - Personality disorders involve **long-standing maladaptive patterns** of thinking, feeling, and behaving across various contexts, rather than specific phobias and anxiety attacks in particular situations. - The symptoms described are acute situational anxieties with clear triggers and avoidance, not a pervasive and enduring pattern of inner experience and behavior typical of a **personality disorder**. - Onset would typically be traceable to early adulthood with chronic interpersonal dysfunction, unlike the symptom-focused presentation here.

Question 158: A 43-year-old lady presents to the emergency department with an acute attack of anxiety, accompanied by physical symptoms such as hyperventilation, increased heart rate, and sweating, and is diagnosed with an acute panic attack. Which of the following is the most suitable drug for this patient?

A. Sertraline
B. Alprazolam (Correct Answer)
C. Propranolol
D. Eszopiclone

Explanation: ***Alprazolam*** - **Alprazolam** is a **fast-acting benzodiazepine** with a quick onset of action, making it ideal for the immediate relief of acute panic attack symptoms. - It works by enhancing the effect of **GABA**, leading to rapid central nervous system depression and swift reduction of anxiety. *Sertraline* - **Sertraline** is a **selective serotonin reuptake inhibitor (SSRI)** that is effective for long-term management of panic disorder. - However, its **therapeutic effects** take several weeks to manifest, making it unsuitable for acute symptom relief. *Propranolol* - **Propranolol** is a **beta-blocker** that can help manage the physical symptoms of anxiety like palpitations and tremor. - It does not directly address the psychological component of **anxiety** or **panic attacks** effectively. *Eszopiclone* - **Eszopiclone** is a **non-benzodiazepine hypnotic** primarily used for the treatment of insomnia. - It is not indicated for the management of **acute anxiety** or **panic attacks**.

Question 159: A 40-year-old female reports sudden bouts of anxiety that can occur at any time, accompanied by sweating, palpitations, derealization, and a feeling of going crazy. These episodes typically last 20-25 minutes. Despite normal routine investigations, she is concerned about having future episodes. What is the diagnosis?

A. Panic disorder (Correct Answer)
B. Generalized anxiety disorder (GAD)
C. Obsessive-compulsive disorder (OCD)
D. Agoraphobia

Explanation: ***Panic disorder*** - This patient presents with **recurrent, unexpected panic attacks** characterized by sudden intense fear, physical symptoms such as **sweating and palpitations**, and cognitive symptoms like **derealization** and fear of losing control. - The persistent concern about having future attacks (**anticipatory anxiety**) is a key diagnostic criterion for panic disorder. - Episodes lasting 20-25 minutes with spontaneous occurrence (not triggered by specific situations) are typical of panic disorder. *Generalized anxiety disorder (GAD)* - GAD involves **chronic, excessive worry** about various aspects of life (e.g., work, health, family) present most days for at least 6 months. - While physical symptoms can be present, they are usually **persistent rather than episodic** and less severe than those in panic attacks. - The primary feature is pervasive worry, not discrete episodes of intense fear with derealization. *Obsessive-compulsive disorder (OCD)* - OCD is characterized by **obsessions** (recurrent, intrusive thoughts) and **compulsions** (repetitive behaviors performed to reduce anxiety). - Anxiety in OCD is typically triggered by obsessional thoughts and relieved by compulsive behaviors, which are not described in this case. - The patient's symptoms represent discrete panic attacks, not anxiety related to obsessions. *Agoraphobia* - Agoraphobia involves **fear and avoidance of situations** where escape might be difficult or help unavailable if panic-like symptoms occur (e.g., public transportation, open spaces, crowds). - While often comorbid with panic disorder, agoraphobia requires the presence of **marked fear or anxiety about specific situations**, which is not mentioned in this case. - The patient has panic attacks that can occur "at any time" without specific situational triggers.

Question 160: Which of the following is the LEAST common symptom of anxiety?

A. Palpitations
B. Gastrointestinal disturbances
C. Syncope (Correct Answer)
D. Restlessness

Explanation: ***Syncope*** - **Syncope** (fainting) is the **LEAST common** symptom among those listed as a direct manifestation of anxiety. - While extreme anxiety can occasionally trigger a **vasovagal response** leading to syncope, this is **rare** and not a typical everyday presentation. - Syncope typically results from temporary reduction in cerebral blood flow and has many other more common causes (cardiac, orthostatic, neurological). *Restlessness* - **Restlessness** is one of the **most common behavioral symptoms** of anxiety disorders, particularly **Generalized Anxiety Disorder (GAD)**. - Patients frequently report feeling **"keyed up,"** on edge, and unable to relax. - This is a **core diagnostic criterion** for GAD in DSM-5. *Palpitations* - **Palpitations** are an extremely **common physical symptom** of anxiety, especially in **panic disorder**. - They reflect **sympathetic nervous system activation** and increased awareness of heartbeat. - Frequently reported during panic attacks and acute anxiety episodes. *Gastrointestinal disturbances* - **GI symptoms** (nausea, diarrhea, abdominal discomfort) are **very common** in anxiety disorders. - Result from **brain-gut axis activation** during stress and anxiety. - Often seen in both acute anxiety and chronic anxiety states.

Practice by Chapter

Generalized Anxiety Disorder

Practice Questions

Panic Disorder

Practice Questions

Social Anxiety Disorder

Practice Questions

Specific Phobias

Practice Questions

Agoraphobia

Practice Questions

Separation Anxiety Disorder

Practice Questions

Selective Mutism

Practice Questions

Pharmacotherapy of Anxiety Disorders

Practice Questions

Cognitive-Behavioral Therapy for Anxiety

Practice Questions

Other Psychotherapies for Anxiety

Practice Questions

Anxiety in Children and Adolescents

Practice Questions

Treatment-Resistant Anxiety

Practice Questions

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