Anxiety Disorders — MCQs

Anxiety Disorders Indian Medical PG Practice Questions and MCQs

Question 31: What is the treatment for agoraphobia?

A. Systemic desensitization
B. Psychodynamic therapy
C. Exposure therapy
D. All of the above (Correct Answer)

Explanation: **Explanation:** Agoraphobia is characterized by an intense fear of being in situations where escape might be difficult or help unavailable (e.g., crowds, open spaces, or public transport). The management of agoraphobia is multifaceted, involving both pharmacological and psychological interventions. **Why "All of the above" is correct:** The treatment of agoraphobia typically requires a combination of behavioral and psychological approaches: * **Exposure Therapy:** This is the **treatment of choice** (specifically *In-vivo* exposure). It involves the patient gradually facing the feared situations until the anxiety response habituates. * **Systemic Desensitization:** A behavioral technique where the patient is exposed to increasingly anxiety-provoking stimuli while practicing relaxation techniques. It is a structured form of exposure therapy. * **Psychodynamic Therapy:** While behavioral therapy is first-line, psychodynamic psychotherapy is used to explore underlying emotional conflicts or childhood triggers that contribute to the phobic avoidance. **Analysis of Options:** * **Option A & C:** These are the gold-standard behavioral interventions. Exposure therapy is the most effective component of Cognitive Behavioral Therapy (CBT) for phobias. * **Option B:** Although less commonly used than CBT, it remains a recognized modality for patients who do not respond to behavioral therapy or who wish to explore the "why" behind their symptoms. **NEET-PG High-Yield Pearls:** * **First-line Pharmacotherapy:** SSRIs (e.g., Paroxetine, Sertraline) are the drugs of choice. * **Best Psychological Treatment:** Cognitive Behavioral Therapy (CBT) with **In-vivo exposure**. * **Diagnosis:** According to DSM-5, the fear must occur in at least **2 out of 5** specific situations (public transport, open spaces, enclosed spaces, standing in line/crowds, or being outside home alone) for at least **6 months**. * **Comorbidity:** Agoraphobia is most commonly associated with **Panic Disorder**.

Question 32: A woman reports an inability to urinate in public restrooms due to embarrassment, which significantly restricts her ability to leave home. What is the most appropriate diagnosis?

A. Specific phobia
B. Separation anxiety disorder
C. Social phobia (Correct Answer)
D. Post-traumatic stress disorder

Explanation: **Explanation:** The correct diagnosis is **Social Phobia (Social Anxiety Disorder)**. This specific presentation is clinically known as **Paruresis** (or "shy bladder syndrome"). **Why Social Phobia is Correct:** The core feature of Social Phobia is a marked and persistent fear of social or performance situations in which the individual is exposed to unfamiliar people or to possible scrutiny by others. The patient fears acting in a way that will be humiliating or embarrassing. In this case, the inability to urinate is not a physical pathology but a psychological one, driven by the fear of being judged or heard by others in a public restroom. **Why Other Options are Incorrect:** * **Specific Phobia:** This involves fear of a specific object or situation (e.g., heights, spiders). While "public toilets" might seem like a situational phobia, the underlying driver here is **social scrutiny/embarrassment**, which categorizes it under Social Phobia. * **Separation Anxiety Disorder:** This involves excessive fear concerning separation from home or attachment figures, which is not the primary issue here. * **Post-traumatic Stress Disorder (PTSD):** This requires a history of exposure to a traumatic event (death, serious injury, or sexual violence) followed by intrusive symptoms and avoidance, which is not mentioned in the clinical vignette. **Clinical Pearls for NEET-PG:** * **Treatment of Choice:** Cognitive Behavioral Therapy (CBT) is the most effective long-term therapy. * **Pharmacotherapy:** **SSRIs** (e.g., Paroxetine, Sertraline) are the first-line medications. * **Performance Anxiety:** For specific performance-related social anxiety (e.g., public speaking), **Beta-blockers** (Propranolol) are used 30–60 minutes before the event. * **Key Differentiator:** If the avoidance is due to fear of not being able to escape or get help during a panic attack, consider **Agoraphobia**; if it is due to fear of scrutiny/embarrassment, it is **Social Phobia**.

Question 33: A person exhibits poor performance in front of seniors in public, experiences tachycardia when required to deliver a lecture, and avoids social gatherings. What is the most likely diagnosis?

A. Panic disorder
B. Schizophrenia
C. Social phobia (Correct Answer)
D. Avoidant personality

Explanation: ### Explanation **Correct Answer: C. Social Phobia (Social Anxiety Disorder)** The clinical presentation described is classic for **Social Phobia**. The core feature is a marked and persistent fear of social or performance situations where the individual is exposed to unfamiliar people or possible scrutiny by others. * **Key Clinical Features:** The patient experiences physical symptoms of anxiety (tachycardia) specifically triggered by performance-based tasks (delivering a lecture) and social interaction (seniors, gatherings). This leads to **anticipatory anxiety** and **avoidance behavior**, which significantly interferes with their professional and social life. **Why other options are incorrect:** * **Panic Disorder:** Characterized by recurrent, *unexpected* panic attacks that occur "out of the blue," rather than being strictly tied to social performance. * **Schizophrenia:** A psychotic disorder involving hallucinations, delusions, and disorganized thinking. While social withdrawal occurs, it is due to negative symptoms or paranoia, not a fear of social scrutiny. * **Avoidant Personality Disorder (APD):** While similar, APD is a pervasive, lifelong pattern of feelings of inadequacy and hypersensitivity to negative evaluation across *all* areas of life. Social Phobia is often more specific to performance situations (though the two can coexist). **High-Yield NEET-PG Pearls:** * **Treatment of Choice:** **SSRIs** (e.g., Paroxetine, Sertraline) are the first-line long-term treatment. * **Performance Anxiety:** For specific situations (like a one-time lecture), **Beta-blockers** (e.g., Propranolol) are used 30–60 minutes before the event to control peripheral symptoms like tremors and tachycardia. * **Cognitive Behavioral Therapy (CBT):** The most effective psychological intervention.

Question 34: All of the following are seen in generalized anxiety disorder (GAD), EXCEPT:

A. Muscle tension
B. Irritability
C. Fear of impending doom (Correct Answer)
D. Restlessness

Explanation: **Explanation:** The correct answer is **C. Fear of impending doom**. In psychiatry, it is crucial to distinguish between **Generalized Anxiety Disorder (GAD)** and **Panic Disorder**. GAD is characterized by "free-floating anxiety"—a persistent, pervasive, and excessive worry about everyday events (finances, health, work) lasting for at least **6 months**. In contrast, a **"Fear of impending doom"** (or fear of dying/losing control) is a hallmark symptom of a **Panic Attack**. Panic attacks are discrete, intense periods of fear that peak within minutes, whereas GAD is a chronic, low-grade state of tension. **Analysis of Options:** * **A. Muscle tension:** This is a core somatic symptom of GAD. Patients often present with "tension headaches" or backaches due to chronic muscle rigidity. * **B. Irritability:** Chronic worry often leads to a low threshold for frustration, making irritability a diagnostic criterion in DSM-5. * **D. Restlessness:** Also described as feeling "keyed up" or "on edge," this reflects the psychomotor agitation common in GAD. **High-Yield Clinical Pearls for NEET-PG:** * **DSM-5 Criteria for GAD:** Anxiety + at least 3 of 6 symptoms: Restlessness, Easy fatigability, Difficulty concentrating, Irritability, Muscle tension, and Sleep disturbance. * **Duration:** Symptoms must be present for ≥ 6 months. * **Drug of Choice (DOC):** SSRIs (e.g., Escitalopram) are the first-line long-term treatment. Benzodiazepines are used only for short-term symptomatic relief. * **Psychotherapy:** Cognitive Behavioral Therapy (CBT) is the most effective psychological intervention.

Question 35: Phobia associated with elevators is an example of which of the following?

A. Acrophobia
B. Social phobia
C. Claustrophobia (Correct Answer)
D. Algophobia

Explanation: ### Explanation **Correct Answer: C. Claustrophobia** **Reasoning:** Claustrophobia is defined as the irrational and intense fear of **enclosed or confined spaces**. Elevators are a classic clinical example of a confined space where the individual feels trapped or fears having a panic attack without an easy means of escape. In psychiatry, phobias are categorized under Specific Phobias (ICD-11/DSM-5), characterized by marked anxiety about a specific object or situation. **Analysis of Incorrect Options:** * **A. Acrophobia:** This is the morbid fear of **heights**. While elevators travel to high floors, the primary trigger in an elevator is the confinement (walls/lack of exit), not necessarily the altitude itself. * **B. Social Phobia (Social Anxiety Disorder):** This involves a fear of **scrutiny or humiliation** in social or performance situations (e.g., public speaking). It is not related to physical spaces. * **C. Algophobia:** This is the pathological fear of **pain**. It is unrelated to environmental or situational triggers like elevators. **High-Yield Clinical Pearls for NEET-PG:** * **Treatment of Choice:** For specific phobias, the most effective treatment is **Cognitive Behavioral Therapy (CBT)** with **Exposure Therapy** (specifically Systematic Desensitization or Flooding). * **Pharmacotherapy:** Benzodiazepines or Beta-blockers (like Propranolol) may be used for short-term symptomatic relief or performance-related anxiety, but they are not first-line for long-term management of specific phobias. * **Common Phobia Terminologies:** * *Agoraphobia:* Fear of open spaces or situations where escape is difficult. * *Nyctophobia:* Fear of darkness. * *Ailurophobia:* Fear of cats. * *Cynophobia:* Fear of dogs.

Question 36: Which of the following is NOT true regarding anxiety?

A. Anxiety is an adaptive response.
B. Anxiety acts as an alert signal.
C. Anxiety can manifest as autonomic hyperactivity.
D. Anxiety is always pathological. (Correct Answer)

Explanation: ### Explanation **Correct Answer: D. Anxiety is always pathological.** **1. Why Option D is the correct answer:** Anxiety is a universal human experience and is not inherently a disease. It exists on a spectrum. **Normal (Physiological) Anxiety** is a transient, appropriate response to a perceived threat or stressor (e.g., the day before the NEET-PG exam). It becomes **Pathological Anxiety** only when it is disproportionate to the stimulus, persists in the absence of a threat, or significantly impairs social and occupational functioning. Therefore, the statement that anxiety is "always" pathological is false. **2. Analysis of Incorrect Options:** * **Option A (Adaptive response):** Anxiety is evolutionarily designed to help an individual prepare for challenges. According to the **Yerkes-Dodson Law**, a certain level of anxiety (arousal) actually improves performance on tasks. * **Option B (Alert signal):** Anxiety serves as an internal warning system, signaling the presence of an impending danger (internal or external) and prompting the individual to take measures to quickly deal with the threat. * **Option C (Autonomic hyperactivity):** The physiological manifestation of anxiety involves the activation of the sympathetic nervous system (the "fight or flight" response). This leads to symptoms such as tachycardia, palpitations, sweating, tremors, and tachypnea. **3. NEET-PG High-Yield Pearls:** * **Anxiety vs. Fear:** Fear is a response to a known, external, definite threat; Anxiety is a response to an unknown, internal, vague, or conflictual threat. * **Neurotransmitters:** Anxiety is typically associated with **decreased GABA**, **decreased Serotonin**, and **increased Norepinephrine** levels in the brain. * **Physical Symptoms:** Always rule out medical causes (e.g., Hyperthyroidism, Pheochromocytoma, or Arrhythmias) before diagnosing a primary anxiety disorder.

Question 37: All of the following are treatment modalities used in Generalized Anxiety Disorder, EXCEPT?

A. Antidepressants
B. Electroconvulsive therapy
C. Cognitive behavioral therapy
D. Caffeine (Correct Answer)

Explanation: **Explanation:** **Generalized Anxiety Disorder (GAD)** is characterized by excessive, persistent, and uncontrollable worry about everyday events for at least 6 months. The management involves a combination of pharmacotherapy and psychotherapy. **Why Caffeine is the Correct Answer:** Caffeine is a **methylxanthine** that acts as a central nervous system stimulant. It antagonizes adenosine receptors, leading to increased release of excitatory neurotransmitters like norepinephrine. In patients with GAD, caffeine is **contraindicated** as it can exacerbate symptoms of anxiety, cause palpitations, tremors, and insomnia, and even trigger panic attacks. It is a known "anxiogenic" substance rather than a treatment modality. **Analysis of Incorrect Options:** * **Antidepressants (A):** These are the **first-line pharmacological treatment** for GAD. Selective Serotonin Reuptake Inhibitors (SSRIs) like Escitalopram and Sertraline, and SNRIs like Venlafaxine, are highly effective for long-term management. * **Electroconvulsive therapy (B):** While not a first-line treatment, ECT is a recognized modality in psychiatry for **treatment-resistant** cases of severe anxiety disorders, especially when comorbid with severe depression or suicidal ideation. * **Cognitive Behavioral Therapy (C):** CBT is the **first-line psychotherapy**. It focuses on identifying maladaptive thought patterns (cognitive restructuring) and behavioral modifications to reduce worry. **High-Yield Clinical Pearls for NEET-PG:** * **First-line drug class:** SSRIs (e.g., Escitalopram). * **Drug for performance anxiety:** Propranolol (Beta-blocker). * **Benzodiazepines:** Used only for short-term symptomatic relief due to the risk of dependence. * **Buspirone:** A 5-HT1A partial agonist specifically used for GAD; it has a slow onset of action (2–4 weeks) and no abuse potential.

Question 38: Which of the following is true of panic disorder?

A. It is characterized by recurrent and unpredictable panic attacks. (Correct Answer)
B. The panic attacks always occur in specific situations.
C. Autonomic symptoms are rare in panic disorder.
D. The panic attacks evolve very slowly.

Explanation: **Explanation:** **Panic Disorder** is a type of anxiety disorder characterized by **recurrent, unexpected (unpredictable)** panic attacks. According to DSM-5 criteria, at least one attack must be followed by one month or more of persistent concern about additional attacks (anticipatory anxiety) or a significant maladaptive change in behavior. 1. **Why Option A is Correct:** The hallmark of panic disorder is that attacks occur "out of the blue" without an obvious external trigger. This unpredictability distinguishes it from specific phobias. 2. **Why Option B is Incorrect:** If attacks occur *only* in specific situations (e.g., seeing a spider or being in a crowd), the diagnosis is likely a Specific Phobia or Social Anxiety Disorder, not Panic Disorder. 3. **Why Option C is Incorrect:** Autonomic symptoms are **central** to the diagnosis. Patients typically experience a "sympathetic storm," including palpitations, sweating, trembling, dyspnea, and chest pain. 4. **Why Option D is Incorrect:** Panic attacks have a **sudden onset**, reaching a peak intensity within minutes (usually <10 minutes) and typically lasting about 20–30 minutes. **High-Yield Clinical Pearls for NEET-PG:** * **First-line Treatment:** SSRIs (e.g., Sertraline, Paroxetine) are the long-term treatment of choice. Benzodiazepines (e.g., Alprazolam) may be used for acute management. * **Cognitive Behavioral Therapy (CBT):** The most effective psychological intervention. * **Common Comorbidity:** Agoraphobia (fear of places where escape might be difficult) frequently co-occurs with panic disorder. * **Medical Mimics:** Always rule out hyperthyroidism, pheochromocytoma, and myocardial infarction in a patient presenting with panic-like symptoms.

Question 39: Which of the following statements is FALSE regarding Agoraphobia?

A. It is the commonest type of specific phobia.
B. Women outnumber men in western countries.
C. Shy bladder (social anxiety disorder) is commonly seen. (Correct Answer)
D. It involves a fear of public places or situations.

Explanation: **Explanation:** **Agoraphobia** is characterized by intense fear or anxiety about being in situations where escape might be difficult or help might not be available in the event of developing panic-like symptoms. **Why Option C is the correct (False) statement:** "Shy bladder" (Paruresis) is the inability to urinate in public restrooms due to a fear of being judged or observed. This is a specific subtype of **Social Anxiety Disorder (Social Phobia)**, not Agoraphobia. While patients with Agoraphobia avoid public places, their fear is rooted in "trapped" sensations or safety, whereas Social Anxiety is rooted in "scrutiny" or "embarrassment." **Analysis of other options:** * **Option A:** Agoraphobia is indeed the **most common phobia** seen in clinical practice (psychiatric clinics), as it is often the most disabling, though specific phobias are more common in the general population. * **Option B:** Epidemiological data consistently shows a higher prevalence in **females** (roughly 2:1 ratio), particularly in Western studies. * **Option D:** This is the core definition. According to DSM-5, it involves fear in at least two of five situations: using public transport, being in open spaces, being in enclosed spaces, standing in line/crowds, or being outside the home alone. **High-Yield Clinical Pearls for NEET-PG:** * **DSM-5 Change:** Agoraphobia is now a **standalone diagnosis**, independent of Panic Disorder (previously they were linked). * **Treatment:** The drug of choice (DOC) is **SSRIs**. Cognitive Behavioral Therapy (CBT) is the most effective psychotherapy. * **Age of Onset:** Typically late adolescence or early adulthood (late 20s).

Question 40: Which of the following is true about post-traumatic stress disorder?

A. Nightmares
B. Recollection of traumatic events (Correct Answer)
C. Depression
D. Increased sexual desire

Explanation: **Explanation:** Post-Traumatic Stress Disorder (PTSD) is a psychiatric disorder that occurs in people who have experienced or witnessed a traumatic event. According to DSM-5 and ICD-11 criteria, the hallmark of PTSD is the **re-experiencing** of the trauma. **Why Option B is Correct:** **Recollection of traumatic events** (intrusive memories) is a core symptom cluster of PTSD. Patients experience involuntary, distressing memories, flashbacks (where they feel as if the event is recurring), and intense psychological distress when exposed to cues that resemble the trauma. While nightmares (Option A) are a form of re-experiencing, "recollection" is the broader, more definitive clinical feature encompassing the cognitive re-living of the event. **Analysis of Incorrect Options:** * **A. Nightmares:** While common in PTSD, they are a *subset* of re-experiencing symptoms. In many standardized exams, "Recollection" or "Intrusive thoughts" is considered the primary diagnostic anchor. * **C. Depression:** Although frequently comorbid with PTSD, depression is a separate mood disorder. PTSD involves "negative alterations in mood and cognition," but depression itself is not a diagnostic requirement. * **D. Increased sexual desire:** PTSD is typically associated with **decreased** libido or sexual dysfunction due to hyperarousal, emotional numbing, or the psychological impact of the trauma (especially in cases of sexual assault). **High-Yield Clinical Pearls for NEET-PG:** * **Duration:** Symptoms must persist for **>1 month**. If symptoms last <1 month, the diagnosis is **Acute Stress Disorder**. * **Core Symptom Clusters:** 1. Re-experiencing (Flashbacks/Recollections), 2. Avoidance, 3. Hyperarousal, 4. Negative alterations in cognition/mood. * **Drug of Choice (DOC):** SSRIs (e.g., Sertraline, Paroxetine). * **Specific Treatment:** Prazosin is highly effective for PTSD-related nightmares. * **Therapy:** Trauma-focused Cognitive Behavioral Therapy (CBT) and EMDR (Eye Movement Desensitization and Reprocessing).

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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