Anxiety Disorders Practice Questions

Q: 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?

Social phobia. ### 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).

Q: What is the treatment of choice for phobic disorder?

Behaviour therapy. **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**.

Q: Phobia is defined as?

Excessive unreasonable fear about a specific situation. ### 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**.

Q: 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?

Start exposure-based therapy. **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.

Q: Anxiety is classified as which of the following?

Neurosis. ### 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.

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

Dopaminergic blockers. **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 1

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

Accepted Answer

Systematic Desensitisation

Answer

Fluoxetine

Answer

Imipramine

Answer

Motivational Therapy

Question 2

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?

Accepted Answer

Social phobia

Answer

Agoraphobia

Answer

Claustrophobia

Answer

Specific phobia

Question 3

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?

Accepted Answer

Schizophrenia

Answer

Anxiety neurosis

Answer

Adjustment reaction

Answer

Manic depressive psychosis

Question 4

What is the treatment of choice for phobic disorder?

Accepted Answer

Behaviour therapy

Answer

Psychotherapy

Answer

SSRI

Answer

Benzodiazepine

Question 5

Phobia is defined as?

Accepted Answer

Excessive unreasonable fear about a specific situation

Answer

Palpitation on thinking about a definite entity

Answer

Perception without stimulation

Answer

Altered perception

Question 6

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?

Accepted Answer

Start exposure-based therapy

Answer

Switch to long-acting benzodiazepines such as clonazepam

Answer

Start an SSRI like escitalopram

Answer

Provide counseling sessions

Question 7

Anxiety is classified as which of the following?

Accepted Answer

Neurosis

Answer

Psychosis

Answer

Personality disorder

Answer

None of the above

Question 8

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

Accepted Answer

Dopaminergic blockers

Answer

Buspirone

Answer

Benzodiazepines

Answer

Serotonin reuptake inhibitors

Question 9

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?

Accepted Answer

Vanillylmandelic acid (VMA)

Answer

Dehydroepiandrosterone (DHEA)

Answer

Human chorionic gonadotropin (hCG)

Answer

17-ketosteroids

Question 10

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?

Accepted Answer

Panic attack

Answer

Anxiety disorder

Answer

Conversion disorder

Answer

Acute psychosis

Anxiety Disorders — MCQs

Anxiety Disorders — MCQs

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