Anxiety Disorders Practice Questions

Q: 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?

Social phobia. ### 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.

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

Fear of impending doom. **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.

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

Claustrophobia. ### 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.

Q: Which of the following is NOT true regarding anxiety?

Anxiety is always pathological.. ### 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.

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

Caffeine. **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.

Q: Which of the following statements is FALSE regarding Agoraphobia?

Shy bladder (social anxiety disorder) is commonly seen.. **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 1

What is the treatment for agoraphobia?

Accepted Answer

All of the above

Answer

Systemic desensitization

Answer

Psychodynamic therapy

Answer

Exposure therapy

Question 2

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?

Accepted Answer

Social phobia

Answer

Specific phobia

Answer

Separation anxiety disorder

Answer

Post-traumatic stress disorder

Question 3

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?

Accepted Answer

Social phobia

Answer

Panic disorder

Answer

Schizophrenia

Answer

Avoidant personality

Question 4

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

Accepted Answer

Fear of impending doom

Answer

Muscle tension

Answer

Irritability

Answer

Restlessness

Question 5

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

Accepted Answer

Claustrophobia

Answer

Acrophobia

Answer

Social phobia

Answer

Algophobia

Question 6

Which of the following is NOT true regarding anxiety?

Accepted Answer

Anxiety is always pathological.

Answer

Anxiety is an adaptive response.

Answer

Anxiety acts as an alert signal.

Answer

Anxiety can manifest as autonomic hyperactivity.

Question 7

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

Accepted Answer

Caffeine

Answer

Antidepressants

Answer

Electroconvulsive therapy

Answer

Cognitive behavioral therapy

Question 8

Which of the following is true of panic disorder?

Accepted Answer

It is characterized by recurrent and unpredictable panic attacks.

Answer

The panic attacks always occur in specific situations.

Answer

Autonomic symptoms are rare in panic disorder.

Answer

The panic attacks evolve very slowly.

Question 9

Which of the following statements is FALSE regarding Agoraphobia?

Accepted Answer

Shy bladder (social anxiety disorder) is commonly seen.

Answer

It is the commonest type of specific phobia.

Answer

Women outnumber men in western countries.

Answer

It involves a fear of public places or situations.

Question 10

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

Accepted Answer

Recollection of traumatic events

Answer

Nightmares

Answer

Depression

Answer

Increased sexual desire

Anxiety Disorders — MCQs

Anxiety Disorders — MCQs

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