Anxiety Disorders — MCQs

Anxiety Disorders Indian Medical PG Practice Questions and MCQs

Question 11: Phobia is an exaggerated form of which of the following?

A. Fear (Correct Answer)
B. Anger
C. Suspicion
D. Love

Explanation: **Explanation:** **1. Why Fear is the Correct Answer:** A phobia is defined as an **irrational, excessive, and persistent fear** of a specific object, situation, or activity. While fear is a normal physiological response to a real or perceived immediate threat, a phobia is considered pathological because the anxiety experienced is significantly out of proportion to the actual danger posed. The core psychopathology involves the displacement of internal anxiety onto an external object (as per psychoanalytic theory) or learned avoidance behavior (as per behavioral theory). **2. Why Other Options are Incorrect:** * **Anger:** This is an emotional response to provocation or frustration. While it can coexist with anxiety, it is not the foundational element of a phobic disorder. * **Suspicion:** This is a hallmark of **Paranoid** personality traits or delusional disorders. It involves a lack of trust rather than an avoidant fear response. * **Love:** This is an affiliative emotion. While "erotomania" (De Clerambault’s syndrome) involves pathological love/delusion, it is unrelated to the avoidant nature of phobias. **3. Clinical Pearls for NEET-PG:** * **Agoraphobia:** Fear of being in situations where escape might be difficult (most common phobia seeking treatment). * **Social Anxiety Disorder (Social Phobia):** Fear of scrutiny or embarrassment in social situations; treated first-line with **SSRIs** and CBT. * **Specific Phobia:** The most common psychiatric disorder in the general population (lifetime prevalence ~12%). * **Treatment of Choice:** For specific phobias, **Systematic Desensitization** (a type of Exposure Therapy) is the most effective behavioral intervention. * **Defense Mechanism:** The primary defense mechanism used in phobias is **Displacement**.

Question 12: Hysteria is primarily related to which of the following body organ?

A. Mind (Correct Answer)
B. Face
C. Eyes
D. Uterus

Explanation: **Explanation:** The term **Hysteria** is a historical label used to describe a wide range of psychological symptoms, including emotional outbursts and physical deficits without an organic cause. In modern psychiatry (ICD-10 and DSM-5), these are classified under **Dissociative (Conversion) Disorders**. **Why "Mind" is the correct answer:** While the word's etymology suggests a physical origin, Hysteria is fundamentally a **psychogenic disorder**. It is characterized by the unconscious conversion of psychological distress into physical symptoms or a dissociation of identity/memory. Therefore, it is a disorder of the **Mind**, rooted in intrapsychic conflict rather than structural organ pathology. **Analysis of Incorrect Options:** * **Uterus:** This is a common distractor. The word "Hysteria" comes from the Greek word *hystera* (uterus). Ancient Greeks believed the condition was caused by a "wandering womb." However, this theory was debunked centuries ago as medical science recognized the psychological nature of the condition. * **Face and Eyes:** While hysterical symptoms can manifest in these areas (e.g., facial tics or hysterical blindness/amaurosis), these are merely sites of **symptom expression**, not the primary origin of the disorder. **NEET-PG High-Yield Pearls:** * **Modern Classification:** Hysteria is now split into **Dissociative Disorders** (disruption of memory/identity) and **Conversion Disorder** (functional neurological symptom disorder). * **Primary Gain:** The internal relief achieved by keeping an emotional conflict out of conscious awareness. * **Secondary Gain:** The external benefits obtained from being sick (e.g., attention, avoiding work). * **La Belle Indifférence:** A classic sign where the patient shows a surprising lack of concern regarding their severe physical disability (e.g., sudden paralysis).

Question 13: What is the treatment of choice for phobias?

A. Psychotherapy
B. Behavior therapy (Correct Answer)
C. Sedatives
D. Electroconvulsive Therapy (ECT)

Explanation: **Explanation:** The treatment of choice for phobias (Specific Phobia, Social Phobia, and Agoraphobia) is **Behavior Therapy**. Phobias are characterized by an irrational, persistent fear of a specific object or situation, leading to avoidance behavior. Behavior therapy works on the principle of **deconditioning** the fear response. * **Why Behavior Therapy is Correct:** The most effective technique is **Exposure Therapy** (specifically **Systematic Desensitization** or **Flooding**). By repeatedly exposing the patient to the phobic stimulus in a controlled manner, the patient undergoes "extinction" of the fear response. For Specific Phobias, behavior therapy is significantly more effective than pharmacological interventions. * **Why other options are incorrect:** * **Psychotherapy:** While supportive or insight-oriented psychotherapy may help explore underlying conflicts, it is not as effective or rapid as behavior therapy for symptom resolution in phobias. * **Sedatives:** Benzodiazepines may provide temporary symptomatic relief from acute anxiety but do not treat the underlying phobia and carry a risk of dependence. * **ECT:** This is reserved for severe, treatment-resistant depression or catatonia and has no role in the management of simple phobias. **High-Yield Clinical Pearls for NEET-PG:** * **Specific Phobia:** Treatment of choice is **Exposure Therapy** (Behavior therapy). * **Social Anxiety Disorder (Social Phobia):** Treatment of choice is **Cognitive Behavior Therapy (CBT)**. If pharmacotherapy is needed, **SSRIs** are the first line. * **Performance Anxiety:** A sub-type of social phobia (e.g., stage fright) is best managed with **Beta-blockers (Propranolol)** taken 30–60 minutes before the event. * **Agoraphobia:** Most commonly associated with **Panic Disorder**; treated with a combination of CBT and SSRIs.

Question 14: What is the term for the fear of the dark or night?

A. Agoraphobia
B. Claustrophobia
C. Nyctophobia (Correct Answer)
D. Thanatophobia

Explanation: **Explanation:** **Correct Answer: C. Nyctophobia** Nyctophobia is derived from the Greek words *'nyx'* (night) and *'phobos'* (fear). It is a specific phobia characterized by an intense, irrational fear of the dark or night. In clinical psychiatry, this is often not a fear of the darkness itself, but a fear of possible or imagined dangers concealed by the darkness. It is common in children but is considered pathological in adults if it causes significant distress or functional impairment. **Analysis of Incorrect Options:** * **A. Agoraphobia:** This is the fear of being in situations or places where escape might be difficult or help might not be available in the event of a panic attack. Common triggers include open spaces, public transport, or being in a crowd. * **B. Claustrophobia:** This is a specific phobia involving the fear of confined or enclosed spaces (e.g., elevators, tunnels, or MRI machines). * **D. Thanatophobia:** This refers to the fear of death or the dying process. It is often linked to health anxiety or generalized anxiety disorder. **High-Yield Clinical Pearls for NEET-PG:** * **Treatment of Choice:** For specific phobias (like Nyctophobia), **Cognitive Behavioral Therapy (CBT)** with **Exposure Therapy** (specifically Systematic Desensitization) is the gold standard. * **Pharmacotherapy:** Benzodiazepines or Beta-blockers (Propranolol) may be used for short-term symptomatic relief in performance-related phobias, but they are not the primary treatment for specific phobias. * **Diagnosis:** According to DSM-5, the fear must be persistent (usually lasting **6 months or more**) to be diagnosed as a specific phobia.

Question 15: A 18-year-old female develops breathlessness with perioral tingling, with two episodes in the past. What is your diagnosis?

A. Obsessive-compulsive disorder
B. Acute respiratory distress
C. Panic disorder (Correct Answer)
D. Phobic disorders

Explanation: ### Explanation **Correct Answer: C. Panic disorder** The clinical presentation of sudden-onset breathlessness (dyspnea) accompanied by **perioral tingling** (paresthesia) in a young patient with a history of similar episodes is a classic description of a **Panic Attack**, which is the hallmark of **Panic Disorder**. The underlying medical concept involves hyperventilation during an acute anxiety episode. Rapid breathing leads to excessive "blowing off" of $CO_2$ (hypocapnia), resulting in **respiratory alkalosis**. This shift in pH decreases ionized calcium levels in the blood, leading to symptoms of hypocalcemia, such as perioral numbness, tingling in the extremities, and carpopedal spasms. **Why other options are incorrect:** * **Obsessive-compulsive disorder (OCD):** Characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions), not acute autonomic surges or respiratory distress. * **Acute respiratory distress:** While this describes the symptom, it is a broad clinical sign. In a young patient with recurrent, self-limiting episodes and neurological symptoms like tingling, a psychiatric etiology (Panic Disorder) is more likely than primary pulmonary pathology. * **Phobic disorders:** These involve intense fear triggered by a *specific* object or situation (e.g., heights, spiders). The question describes spontaneous episodes without a specific external trigger mentioned. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** Panic disorder requires recurrent, unexpected panic attacks followed by at least one month of persistent concern about future attacks (anticipatory anxiety). * **Acute Management:** Reassurance and breathing into a paper bag (to increase $CO_2$ levels). Benzodiazepines (e.g., Alprazolam) can be used for immediate relief. * **Long-term Treatment:** **SSRIs** (Drug of Choice) and Cognitive Behavioral Therapy (CBT). * **Differential:** Always rule out medical mimics like hyperthyroidism, pheochromocytoma, and SVT.

Question 16: A fifty-year-old male experiences discomfort in elevators, crowded places, and while traveling. What is the most appropriate line of treatment?

A. Counselling
B. Relaxation therapy
C. Exposure and response prevention (Correct Answer)
D. Covert sensitization

Explanation: ### Explanation **Correct Answer: C. Exposure and Response Prevention (ERP)** The patient presents with symptoms suggestive of **Agoraphobia** (discomfort in elevators, crowds, and traveling), where the core fear is being in places where escape might be difficult or help unavailable. **Why ERP is correct:** Exposure and Response Prevention (ERP) is a specialized form of Cognitive Behavioral Therapy (CBT) and is considered the gold standard for phobic and anxiety disorders. * **Exposure:** The patient is gradually exposed to the feared stimulus (e.g., entering an elevator). * **Response Prevention:** The patient is prevented from performing "safety behaviors" or escape rituals. Through **habituation**, the patient learns that the feared outcome does not occur, leading to the extinction of the fear response. **Analysis of Incorrect Options:** * **A. Counselling:** While supportive, general counselling lacks the structured behavioral intervention required to desensitize specific phobic triggers. * **B. Relaxation therapy:** Though helpful for generalized anxiety, it is usually an adjunct. On its own, it does not address the avoidance behavior central to agoraphobia. * **D. Covert sensitization:** This is a form of **Aversion Therapy** where an unpleasant stimulus is imagined alongside an undesirable behavior. It is primarily used in treating paraphilias or substance use disorders, not anxiety. **NEET-PG High-Yield Pearls:** * **Agoraphobia** is often associated with **Panic Disorder**. * **Drug of Choice (DOC):** For long-term management of Agoraphobia/Panic Disorder, **SSRIs** (e.g., Sertraline, Escitalopram) are the first-line pharmacological treatment. * **ERP** is also the specific behavioral treatment of choice for **Obsessive-Compulsive Disorder (OCD)**. * **Systematic Desensitization** (Wolpe) is a related technique involving a hierarchy of fears combined with relaxation.

Question 17: Fear of pain is classified as which of the following phobias?

A. Acrophobia
B. Hydrophobia
C. Nyctophobia
D. Algophobia (Correct Answer)

Explanation: **Explanation:** **Algophobia** is the correct answer. It is derived from the Greek word *algos* (pain) and *phobos* (fear). It is a specific phobia characterized by an abnormal and persistent fear of experiencing pain. This condition is often seen in patients with chronic pain syndromes, where it can lead to "fear-avoidance behavior," potentially exacerbating the patient's functional disability. **Analysis of Incorrect Options:** * **Acrophobia:** This is the pathological fear of **heights**. It is one of the most common specific phobias and can lead to panic attacks when the individual is at a significant elevation. * **Hydrophobia:** This is the fear of **water**. In a clinical psychiatry context, it refers to the specific phobia; however, in a broader medical context, it is a classic pathognomonic sign of **Rabies**, caused by spasms of the throat muscles when attempting to swallow. * **Nyctophobia:** This is the intense fear of **darkness** or the night. It is common in childhood but is considered a phobia in adults when it becomes irrational and interferes with sleep or daily functioning. **Clinical Pearls for NEET-PG:** * **Treatment of Choice:** For specific phobias, the most effective treatment is **Cognitive Behavioral Therapy (CBT)** with **Systemic Desensitization** or **Exposure Therapy**. * **Pharmacotherapy:** Benzodiazepines or Beta-blockers (like Propranolol) may be used for short-term symptom relief in specific situational phobias (e.g., performance anxiety), but they are not first-line for long-term management. * **Diagnosis:** According to DSM-5, the fear must be out of proportion to the actual danger, last for **6 months or more**, and cause significant distress or impairment.

Question 18: Propranolol, a non-selective beta-blocker, can be prescribed to decrease anxiety associated with which of the following conditions?

A. Chronic neurotic disorder
B. Schizophrenia
C. Short-term stressful situations (Correct Answer)
D. Endogenous depression

Explanation: **Explanation:** **1. Why "Short-term stressful situations" is correct:** Propranolol is a non-selective beta-adrenergic antagonist. In psychiatry, its primary role is the management of the **peripheral autonomic symptoms** of anxiety, such as palpitations, tremors, sweating, and tachycardia. These symptoms are mediated by the sympathetic nervous system. It is highly effective for **Performance Anxiety** (a subtype of Social Anxiety Disorder) and acute "stage fright." By blocking the physical manifestations of stress, it prevents the positive feedback loop that worsens psychological anxiety during short-term stressful events (e.g., public speaking, exams, or musical performances). **2. Why the other options are incorrect:** * **A. Chronic neurotic disorder:** Conditions like Generalized Anxiety Disorder (GAD) or Panic Disorder require long-term modulation of neurotransmitters (Serotonin/Norepinephrine). Propranolol does not treat the core psychological "worry" or cognitive symptoms of chronic anxiety; SSRIs are the first-line treatment here. * **B. Schizophrenia:** This is a psychotic disorder primarily involving dopamine dysregulation. While propranolol is used to treat **Akathisia** (an extrapyramidal side effect of antipsychotics), it has no role in treating the underlying anxiety or psychosis of schizophrenia. * **D. Endogenous depression:** Depression is treated with antidepressants (SSRIs, SNRIs, TCAs). Beta-blockers are generally avoided in depressed patients as they can occasionally worsen lethargy or mimic depressive symptoms. **3. NEET-PG High-Yield Pearls:** * **Drug of Choice (DOC) for Akathisia:** Propranolol. * **Specific Indication:** Performance-related Social Anxiety Disorder (taken 30–60 minutes before the event). * **Contraindications:** Always screen for **Asthma/COPD** (due to bronchospasm) and **Diabetes Mellitus** (masks hypoglycemia-induced tachycardia). * **Mechanism:** Peripheral blockade of $\beta_1$ and $\beta_2$ receptors; it does not cross the blood-brain barrier in sufficient quantities to act as a primary anxiolytic.

Question 19: A male patient presents with symptoms that mimic heart disease, but has a normal ECG and chest X-ray. What is the most likely diagnosis?

A. Angina pectoris
B. Panic attack (Correct Answer)
C. Autonomic nervous system instability
D. Vasovagal attack

Explanation: ### Explanation **Correct Answer: B. Panic attack** **1. Why it is correct:** A **Panic Attack** is characterized by a sudden episode of intense fear that triggers severe physical reactions, often mimicking a myocardial infarction (heart attack). Common symptoms include palpitations, chest pain, shortness of breath, and a sense of impending doom. In a clinical setting, if a patient presents with these "cardiac" symptoms but has a **normal ECG and chest X-ray**, a primary cardiac event is ruled out, making a psychiatric etiology like Panic Disorder the most likely diagnosis. The physical symptoms are driven by an acute surge in the sympathetic nervous system. **2. Why other options are incorrect:** * **A. Angina pectoris:** This is caused by reduced blood flow to the heart. While it presents with chest pain, it is usually associated with exertion and would typically show ischemic changes on an ECG or be supported by a history of cardiovascular risk factors. * **C. Autonomic nervous system instability:** This is a broad, non-specific term. While panic attacks involve autonomic arousal, "instability" is not a recognized clinical diagnosis for this specific presentation. * **D. Vasovagal attack:** This typically presents with **bradycardia and hypotension**, leading to syncope (fainting). In contrast, a panic attack usually involves tachycardia and hypertension. **3. High-Yield NEET-PG Pearls:** * **Duration:** Panic attacks usually peak within 10 minutes and last about 20–30 minutes. * **Diagnosis:** According to DSM-5, a Panic Disorder requires recurrent unexpected attacks followed by at least **one month** of persistent concern about future attacks. * **First-line Treatment:** SSRIs (Long-term) and Benzodiazepines (for acute abortive therapy). * **Differential:** Always rule out **Pheochromocytoma** (check urinary VMA) and **Hyperthyroidism** (check TSH) if symptoms are recurrent.

Question 20: Which of the following agents is most specifically used for the treatment of erectile disorder in males?

A. Sildenafil (Correct Answer)
B. Diazepam
C. Fluoxetine
D. Zolpidem

Explanation: **Explanation:** **Correct Option: A. Sildenafil** Sildenafil is a selective **Phosphodiesterase-5 (PDE-5) inhibitor**. It works by inhibiting the degradation of cyclic Guanosine Monophosphate (cGMP) in the corpus cavernosum. Increased levels of cGMP lead to smooth muscle relaxation and increased blood inflow, facilitating an erection in response to sexual stimulation. It is the first-line pharmacological treatment for Erectile Disorder (ED). **Incorrect Options:** * **B. Diazepam:** A Benzodiazepine used primarily for Generalized Anxiety Disorder (GAD) and alcohol withdrawal. It can actually cause sexual dysfunction (decreased libido) as a side effect due to its CNS depressant properties. * **C. Fluoxetine:** An SSRI used for Depression and OCD. It is notorious for causing sexual side effects, including delayed ejaculation and decreased libido. However, it is sometimes used off-label to treat *Premature Ejaculation*. * **D. Zolpidem:** A non-benzodiazepine sedative-hypnotic (Z-drug) used specifically for the short-term treatment of insomnia; it has no role in treating erectile dysfunction. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Sildenafil increases **cGMP**, not cAMP. * **Contraindication:** Never co-administer Sildenafil with **Nitrates** (e.g., Nitroglycerin) as it can lead to severe, life-threatening hypotension. * **Psychiatry Link:** Erectile dysfunction is a common side effect of many antipsychotics (due to hyperprolactinemia) and SSRIs. * **Alprostadil:** A PGE1 analogue used as a second-line treatment for ED (intracavernosal injection).

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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