Anxiety Disorders — MCQs

A 23-year-old woman presents to the psychiatry outpatient department reporting increasing anxiety since her promotion, which required her to move her office from the first floor to the tenth floor. She reports a lifelong discomfort with heights, having avoided past job opportunities in high-rise buildings. She lives on the ground floor. Since her promotion, she has been using alprazolam to manage her anxiety but seeks a more definitive solution. What is the most appropriate treatment for her condition?

Q27Easy

Anxiety is classified as which of the following?

Q28Easy

All of the following can be considered as treatment for anxiety except?

Q29Medium

A 50-year-old man consults you because he has been having transient periods of rapid heart beat accompanied by sweating, flushing, and a sense of impending doom. Examination is unrevealing, with no evidence of arrhythmia at the time of the exam. However, the man's wife is a nurse, so the physician asks that she take vital signs the next time one of the episodes occurs. She does, and demonstrates a BP of 195/140 with heart rate 160/min during the episode. She promptly brings him to you, but the spell is over by the time that he is seen. Urinary measurement of which of the following would most likely be diagnostic in this case?

Q30Easy

A 30-year-old lady presents with sudden onset breathlessness, anxiety, palpitation, and a feeling of impending doom. Physical examination is normal. What is the diagnosis?

Anxiety Disorders Indian Medical PG Practice Questions and MCQs

Question 21: Which of the following treatments is most effective for phobic disorders?

A. Fluoxetine
B. Systematic Desensitisation (Correct Answer)
C. Imipramine
D. Motivational Therapy

Explanation: ### Explanation **Correct Answer: B. Systematic Desensitisation** **Why it is correct:** Phobic disorders are characterized by an irrational, persistent fear of a specific object or situation. According to the **Behavioral Theory**, phobias are learned responses (classical conditioning). Therefore, the most effective treatment is **Behavior Therapy**. **Systematic Desensitization**, developed by Joseph Wolpe, is the gold standard for specific phobias. It involves three steps: 1. **Relaxation training** (e.g., Jacobson’s Progressive Muscle Relaxation). 2. **Hierarchy construction** (ranking fearful stimuli from least to most scary). 3. **Counter-conditioning** (gradually exposing the patient to the hierarchy while maintaining a relaxed state to "unlearn" the fear response). **Why other options are incorrect:** * **A & C (Fluoxetine & Imipramine):** While SSRIs (Fluoxetine) and TCAs (Imipramine) are used in Panic Disorder and Social Anxiety Disorder, they are generally **ineffective for Specific Phobias**, where behavioral intervention is the primary modality. * **D (Motivational Therapy):** This is primarily used in **Substance Use Disorders** (Addiction) to resolve ambivalence and increase the patient's internal motivation to change behavior. It has no established role in treating phobias. --- ### High-Yield Clinical Pearls for NEET-PG: * **Most common phobia in the general population:** Agoraphobia (though some texts cite Specific Phobia as more common, Agoraphobia leads to more clinical visits). * **Most common specific phobia:** Arachnophobia (fear of spiders) or Ophidiophobia (fear of snakes). * **Treatment of choice for Social Phobia:** SSRIs + Cognitive Behavioral Therapy (CBT). * **Performance Anxiety (Stage fright):** Propranolol (Beta-blocker) given 30–60 minutes before the event. * **Flooding:** A behavioral technique where the patient is exposed to the most feared stimulus immediately (no hierarchy); it is effective but less tolerated than systematic desensitization.

Question 22: A medical student was unable to deliver a seminar due to fear of seniors, despite being aware of the irrationality of this fear. What is the likely diagnosis?

A. Agoraphobia
B. Social phobia (Correct Answer)
C. Claustrophobia
D. Specific phobia

Explanation: ### Explanation **Correct Answer: B. Social Phobia (Social Anxiety Disorder)** The core feature of **Social Phobia** is a persistent, irrational fear of situations involving potential scrutiny or evaluation by others (e.g., public speaking, performing, or interacting with authority figures like seniors). * **Key Diagnostic Criteria:** The patient experiences significant anxiety in social situations, recognizes that the fear is excessive or irrational (insight is preserved), and often exhibits avoidance behavior. In this case, the student’s inability to deliver a seminar due to fear of judgment by seniors is a classic presentation. **Why other options are incorrect:** * **A. Agoraphobia:** This is the fear of being in situations or places where escape might be difficult or help unavailable (e.g., open spaces, crowds, or public transport). It is not primarily about social evaluation. * **C. Claustrophobia:** A specific type of phobia characterized by an irrational fear of confined or enclosed spaces (e.g., elevators). * **D. Specific Phobia:** This involves fear of a circumscribed object or situation (e.g., spiders, heights, blood). While social phobia is a type of phobia, "Social Phobia" is the most specific and accurate diagnosis for performance-related anxiety. **Clinical Pearls for NEET-PG:** * **Treatment of Choice:** Cognitive Behavioral Therapy (CBT) is the preferred psychological intervention. * **Pharmacotherapy:** **SSRIs** (e.g., Paroxetine, Sertraline) are the first-line long-term medications. * **Performance Anxiety:** For specific "performance-only" social anxiety (like a one-off seminar), **Beta-blockers (Propranolol)** are used 30–60 minutes before the event to control autonomic symptoms like tremors and palpitations. * **Age of Onset:** Typically develops in early adolescence (mid-teens).

Question 23: A 16-year-old boy does not attend school due to the fear of being harmed by schoolmates. He believes his classmates laugh at and talk about him. He is also scared of going to the market. He is most likely suffering from which of the following disorders?

A. Schizophrenia (Correct Answer)
B. Anxiety neurosis
C. Adjustment reaction
D. Manic depressive psychosis

Explanation: ### Explanation The correct answer is **Schizophrenia**. **1. Why Schizophrenia is the Correct Answer:** The clinical presentation highlights two core psychotic symptoms: **Delusions of persecution** (fear of being harmed by schoolmates) and **Delusions of reference** (believing classmates are laughing at or talking about him). In a 16-year-old, the sudden onset of social withdrawal (refusing school and the market) driven by fixed false beliefs (paranoia) is a classic presentation of early-onset Schizophrenia. While the symptoms may mimic social anxiety, the presence of "delusional intensity"—where the patient truly believes there is a conspiracy or targeted mockery—points toward a psychotic disorder rather than a neurotic one. **2. Why the Other Options are Incorrect:** * **Anxiety Neurosis:** While the boy avoids school and markets, his avoidance is not due to simple autonomic arousal or "fear of fear" (as in Panic Disorder) or social scrutiny (Social Anxiety). It is driven by persecutory and referential delusions, which are hallmarks of psychosis, not neurosis. * **Adjustment Reaction:** This diagnosis requires a clear, identifiable psychosocial stressor (e.g., parental divorce, moving house) and symptoms usually resolve within six months. The severity of the paranoia here exceeds a typical maladaptive response to stress. * **Manic Depressive Psychosis (Bipolar Disorder):** There is no mention of mood symptoms such as elation, grandiosity, or pressured speech (Mania), nor pervasive sadness or hopelessness (Depression). **3. Clinical Pearls for NEET-PG:** * **Delusion of Reference:** A common symptom where the patient believes neutral events (people talking, TV news) have a special personal significance. * **Early-Onset Schizophrenia:** Often presents with social withdrawal and a decline in academic performance before the full-blown psychotic episode. * **Differential Diagnosis:** Always distinguish between **Social Phobia** (fear of being judged) and **Delusion of Reference** (conviction of being mocked). The latter confirms psychosis.

Question 24: What is the treatment of choice for phobic disorder?

A. Psychotherapy
B. Behaviour therapy (Correct Answer)
C. SSRI
D. Benzodiazepine

Explanation: **Explanation:** The treatment of choice for phobic disorders (including Specific Phobia and Agoraphobia) is **Behaviour Therapy**, specifically **Systematic Desensitization** or **Exposure Therapy (Flooding)**. **Why Behaviour Therapy is correct:** Phobias are fundamentally learned maladaptive responses. Behaviour therapy works on the principle of **extinction**. By repeatedly exposing the patient to the feared stimulus in a controlled manner without the occurrence of the feared consequence, the conditioned fear response is weakened. **In-vivo exposure** (real-life exposure) is considered the most effective form of treatment for specific phobias. **Analysis of Incorrect Options:** * **Psychotherapy:** While supportive or insight-oriented psychotherapy may help a patient understand the origin of their fears, it is significantly less effective than targeted behavioural interventions for symptom resolution. * **SSRI:** Selective Serotonin Reuptake Inhibitors are the first-line *pharmacological* treatment for **Social Anxiety Disorder** and **Panic Disorder**, but they have limited efficacy in Specific Phobias, where behavioural intervention remains superior. * **Benzodiazepines:** These are used only for short-term symptomatic relief of acute anxiety (e.g., before a flight). They are not a definitive treatment and can actually interfere with the effectiveness of exposure therapy by preventing the patient from experiencing and habituating to the anxiety. **High-Yield Clinical Pearls for NEET-PG:** * **Specific Phobia:** Treatment of choice is **Exposure Therapy**. * **Social Phobia (Social Anxiety Disorder):** Treatment of choice is **SSRIs** + Cognitive Behavioural Therapy (CBT). * **Performance Anxiety (Stage fright):** Treatment of choice is **Beta-blockers** (e.g., Propranolol) taken 30–60 minutes before the event. * **Agoraphobia:** Most effectively treated with **CBT involving graded exposure**.

Question 25: Phobia is defined as?

A. Palpitation on thinking about a definite entity
B. Excessive unreasonable fear about a specific situation (Correct Answer)
C. Perception without stimulation
D. Altered perception

Explanation: ### Explanation **Phobia** is defined as an **excessive, persistent, and unreasonable fear** triggered by the presence or anticipation of a specific object or situation. According to DSM-5 criteria, the hallmark of a phobia is that the fear is **disproportionate** to the actual danger posed and leads to significant distress or **avoidance behavior**. #### Analysis of Options: * **Option B (Correct):** This captures the core components of phobia: it is "excessive" (out of proportion), "unreasonable" (irrational), and linked to a "specific situation" (e.g., heights, spiders, or enclosed spaces). * **Option A:** While palpitations (autonomic arousal) are a common *symptom* of anxiety during a phobic encounter, they do not define the disorder itself. Anxiety can occur without physical palpitations. * **Option C:** This is the definition of a **Hallucination** (perception in the absence of an external stimulus). * **Option D:** This refers to an **Illusion** (misinterpretation of a real external stimulus) or general sensory distortions. #### High-Yield Clinical Pearls for NEET-PG: * **Agoraphobia:** Fear of being in situations where escape might be difficult (e.g., crowds, open spaces). It is now a standalone diagnosis, separate from Panic Disorder. * **Social Anxiety Disorder (Social Phobia):** Fear of scrutiny or humiliation in social or performance situations. * **Treatment of Choice:** * **Specific Phobia:** Cognitive Behavioral Therapy (CBT) with **Exposure Therapy** (Systematic Desensitization) is the most effective. * **Social Phobia:** SSRIs are the first-line pharmacological treatment; Beta-blockers (Propranolol) are used for performance anxiety. * **Defense Mechanism:** The primary defense mechanism used in phobia is **Displacement**.

Question 26: A 23-year-old woman presents to the psychiatry outpatient department reporting increasing anxiety since her promotion, which required her to move her office from the first floor to the tenth floor. She reports a lifelong discomfort with heights, having avoided past job opportunities in high-rise buildings. She lives on the ground floor. Since her promotion, she has been using alprazolam to manage her anxiety but seeks a more definitive solution. What is the most appropriate treatment for her condition?

A. Switch to long-acting benzodiazepines such as clonazepam
B. Start an SSRI like escitalopram
C. Start exposure-based therapy (Correct Answer)
D. Provide counseling sessions

Explanation: **Explanation:** The clinical presentation describes a classic case of **Specific Phobia (Acrophobia)**. The patient exhibits a persistent, irrational fear of heights that leads to significant avoidance behavior (avoiding jobs in high-rises) and functional impairment (anxiety following a promotion to the 10th floor). **1. Why Option C is Correct:** **Exposure-based therapy**, specifically **Systematic Desensitization** or **In-vivo Exposure**, is the **gold standard and first-line treatment** for Specific Phobias. The underlying medical concept is "extinction," where repeated, controlled exposure to the feared stimulus (heights) without an adverse outcome reduces the conditioned fear response. Cognitive Behavioral Therapy (CBT) techniques are highly effective and provide more durable results than pharmacotherapy. **2. Why Other Options are Incorrect:** * **Options A & B:** While benzodiazepines (Alprazolam/Clonazepam) or SSRIs (Escitalopram) may be used for generalized anxiety or panic disorder, they are **not** the treatment of choice for Specific Phobias. Medications only provide temporary symptomatic relief and do not address the underlying phobic trigger. * **Option D:** General counseling is too non-specific. Specific Phobias require structured, goal-oriented behavioral interventions (Exposure) rather than supportive talk therapy. **Clinical Pearls for NEET-PG:** * **Diagnosis:** Specific Phobia requires symptoms to persist for at least **6 months**. * **Treatment of Choice:** Behavioral therapy (Exposure) is superior to drugs. * **Exception:** For **Performance-type Social Anxiety Disorder** (e.g., stage fright), **Beta-blockers** (Propranolol) are the drug of choice. * **Benzodiazepine use:** Should be avoided long-term due to the risk of dependence and "rebound" anxiety when the drug wears off.

Question 27: Anxiety is classified as which of the following?

A. Neurosis (Correct Answer)
B. Psychosis
C. Personality disorder
D. None of the above

Explanation: ### Explanation **Correct Option: A. Neurosis** In traditional psychiatric classification (ICD-9 and earlier psychodynamic models), mental disorders are broadly divided into **Neurosis** and **Psychosis**. Anxiety is the hallmark of neurosis. * **The underlying concept:** In neurosis, the individual maintains **intact reality testing** and has **insight** into their condition (they recognize their symptoms as distressing and abnormal). The personality remains organized, and there are no hallucinations or delusions. Anxiety disorders, phobias, and OCD fall under this category. **Why other options are incorrect:** * **B. Psychosis:** This is characterized by a "loss of contact with reality." Key features include impaired reality testing, lack of insight, and the presence of delusions or hallucinations (e.g., Schizophrenia). In anxiety, the patient’s perception of reality remains functional. * **C. Personality Disorder:** These are enduring, pervasive, and inflexible patterns of inner experience and behavior that deviate markedly from cultural expectations (e.g., Borderline or Antisocial PD). While anxiety can be a symptom, it is not the defining classification for the state of anxiety itself. **High-Yield Clinical Pearls for NEET-PG:** * **Insight:** Present in Neurosis; Absent/Impaired in Psychosis. * **Reality Testing:** Intact in Neurosis; Impaired in Psychosis. * **Modern Classification:** While the term "Neurosis" was removed from the DSM-III onwards to favor descriptive categories (like Anxiety Disorders), it remains a frequent conceptual question in exams. * **Hierarchy of Diagnosis:** Always rule out organic causes (Medical/Substance-induced) before diagnosing a primary Anxiety Disorder.

Question 28: All of the following can be considered as treatment for anxiety except?

A. Buspirone
B. Benzodiazepines
C. Serotonin reuptake inhibitors
D. Dopaminergic blockers (Correct Answer)

Explanation: **Explanation:** The correct answer is **D. Dopaminergic blockers**. **Why Dopaminergic blockers are the exception:** Dopaminergic blockers (Antipsychotics) are primarily used to treat psychosis (e.g., Schizophrenia) and Mania. While some atypical antipsychotics are used as adjuncts in treatment-resistant cases, they are **not** considered a primary or standard treatment for anxiety disorders. In fact, blocking dopamine can sometimes lead to **Akathisia** (subjective restlessness), which can mimic or worsen the symptoms of anxiety. **Why the other options are incorrect:** * **Buspirone:** A selective 5-HT1A partial agonist specifically indicated for **Generalized Anxiety Disorder (GAD)**. It is preferred for long-term use as it lacks the sedative and addictive potential of benzodiazepines. * **Benzodiazepines (BZDs):** These act by enhancing GABAergic inhibition. They are highly effective for **acute symptomatic relief** of anxiety and panic attacks due to their rapid onset of action. * **Serotonin Reuptake Inhibitors (SSRIs/SNRIs):** These are currently the **First-line pharmacological treatment** for almost all chronic anxiety disorders (GAD, Panic Disorder, Social Anxiety, and OCD) due to their efficacy and safety profile. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice (DOC) for GAD/Panic Disorder:** SSRIs (Long-term); Benzodiazepines (Acute/Short-term). * **Buspirone** takes 2–4 weeks to show effects; it is ineffective "as needed" (PRN). * **Performance Anxiety:** Propropanol (Beta-blocker) is the DOC, taken 30–60 minutes before the event. * **OCD:** Requires higher doses of SSRIs compared to depression or GAD.

Question 29: A 50-year-old man consults you because he has been having transient periods of rapid heart beat accompanied by sweating, flushing, and a sense of impending doom. Examination is unrevealing, with no evidence of arrhythmia at the time of the exam. However, the man's wife is a nurse, so the physician asks that she take vital signs the next time one of the episodes occurs. She does, and demonstrates a BP of 195/140 with heart rate 160/min during the episode. She promptly brings him to you, but the spell is over by the time that he is seen. Urinary measurement of which of the following would most likely be diagnostic in this case?

A. Dehydroepiandrosterone (DHEA)
B. Human chorionic gonadotropin (hCG)
C. 17-ketosteroids
D. Vanillylmandelic acid (VMA) (Correct Answer)

Explanation: ### Explanation The clinical presentation of paroxysmal hypertension (195/140 mmHg), tachycardia (160/min), sweating, flushing, and a sense of "impending doom" is classic for **Pheochromocytoma**. While these symptoms mimic a **Panic Attack**, the presence of severe objective hypertension during the episode strongly points toward a secondary medical cause rather than a primary psychiatric disorder. **1. Why Vanillylmandelic acid (VMA) is correct:** Pheochromocytoma is a catecholamine-secreting tumor (usually of the adrenal medulla). Catecholamines (epinephrine and norepinephrine) are metabolized into **metanephrines** and then into **Vanillylmandelic acid (VMA)**. A 24-hour urinary measurement of VMA or metanephrines is a standard diagnostic test to confirm excess catecholamine production. **2. Why the other options are incorrect:** * **A. DHEA:** An androgen precursor produced by the adrenal cortex; it is used to evaluate adrenal tumors causing virilization, not paroxysmal hypertension. * **B. hCG:** A hormone produced during pregnancy or by certain germ cell tumors; it has no role in blood pressure regulation. * **C. 17-ketosteroids:** These are metabolites of androgens. While they can be elevated in certain adrenal cortical carcinomas, they do not cause the sympathetic "fight or flight" symptoms seen here. **3. High-Yield Clinical Pearls for NEET-PG:** * **The 5 P’s of Pheochromocytoma:** **P**aroxysmal hypertension, **P**alpitations, **P**erspiration (sweating), **P**ain (headache), and **P**allor (though flushing can occur). * **Rule of 10s:** 10% are bilateral, 10% are malignant, 10% are extra-adrenal (Paragangliomas), and 10% occur in children. * **Differential Diagnosis:** Always rule out Pheochromocytoma before diagnosing Panic Disorder if the patient has severe hypertension during episodes. * **Pre-operative Management:** Always give **Alpha-blockers first** (e.g., Phenoxybenzamine) followed by Beta-blockers to avoid an unopposed alpha-adrenergic hypertensive crisis.

Question 30: A 30-year-old lady presents with sudden onset breathlessness, anxiety, palpitation, and a feeling of impending doom. Physical examination is normal. What is the diagnosis?

A. Panic attack (Correct Answer)
B. Anxiety disorder
C. Conversion disorder
D. Acute psychosis

Explanation: ### Explanation **Correct Option: A. Panic attack** The clinical presentation is a classic description of a **Panic Attack**. It is characterized by a discrete period of intense fear or discomfort that reaches a peak within minutes. The hallmark symptoms include autonomic hyperactivity (palpitations, tachycardia, sweating), respiratory distress (breathlessness, choking sensation), and cognitive symptoms like the **"feeling of impending doom"** or fear of dying. The fact that the physical examination is normal is crucial, as it helps rule out organic causes like myocardial infarction or pulmonary embolism. **Why other options are incorrect:** * **B. Anxiety disorder:** This is a broad category (including GAD, Phobias, etc.). Generalized Anxiety Disorder (GAD) involves chronic, persistent "free-floating" anxiety lasting at least 6 months, rather than sudden, acute episodes. * **C. Conversion disorder (Functional Neurological Symptom Disorder):** This involves deficits in voluntary motor or sensory functions (e.g., paralysis, blindness, or seizures) that are inconsistent with neurological conditions, usually triggered by psychological stress. It does not typically present with autonomic surge. * **D. Acute psychosis:** This is characterized by a loss of contact with reality, involving delusions, hallucinations, or severely disorganized behavior, which are absent in this patient. **NEET-PG High-Yield Pearls:** * **Duration:** Panic attacks usually peak within 10 minutes and last less than 30–60 minutes. * **Diagnosis of Panic Disorder:** Requires recurrent, unexpected attacks followed by at least **one month** of persistent concern about future attacks (anticipatory anxiety) or maladaptive behavioral changes. * **Treatment:** * **Acute episode:** Benzodiazepines (e.g., Alprazolam, Lorazepam). * **Long-term/Prophylaxis:** SSRIs (Drug of Choice) and Cognitive Behavioral Therapy (CBT). * **Medical Mimics:** Always rule out Hyperthyroidism, Pheochromocytoma, and Hypoglycemia in exams.

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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