Anxiety Disorders — MCQs

Anxiety Disorders Indian Medical PG Practice Questions and MCQs

Question 61: Which of the following defense mechanisms is seen in phobia?

A. Reaction formation
B. Dissociation
C. Displacement (Correct Answer)
D. Regression

Explanation: ### Explanation In psychiatry, phobias are understood through the psychodynamic lens as a failure of repression. When an individual faces an internal emotional conflict or an unacceptable id impulse, it generates significant anxiety. To manage this, the ego employs specific defense mechanisms. **Why Displacement is Correct:** The primary defense mechanism in phobia is **Displacement**, often working in tandem with **Symbolization** and **Avoidance**. 1. **Displacement:** The anxiety is shifted from the original, internal source (which is too threatening to face) onto an external, neutral object or situation (the phobic stimulus). 2. **Symbolization:** The external object often symbolizes the original conflict. 3. **Avoidance:** By avoiding the external object, the person successfully avoids the internal anxiety. *Classic Example:* In "Little Hans," Freud described how the boy’s fear of his father was displaced onto horses. **Analysis of Incorrect Options:** * **A. Reaction Formation:** This involves transforming an unacceptable impulse into its opposite (e.g., being excessively kind to someone you hate). It is the hallmark defense mechanism of **Obsessive-Compulsive Disorder (OCD)**. * **B. Dissociation:** This involves a temporary but drastic modification of character or identity to avoid emotional distress. It is seen in **Dissociative Identity Disorder** and **Conversion Disorder**. * **D. Regression:** This is a return to an earlier stage of development to avoid the tension of the present. While seen in many psychiatric conditions (like Schizophrenia), it is not the primary mechanism for phobia. **High-Yield Clinical Pearls for NEET-PG:** * **Phobia:** Displacement + Symbolization + Avoidance. * **OCD:** Reaction Formation + Isolation of Affect + Undoing. * **Paranoia/Delusional Disorder:** Projection. * **Conversion Disorder:** Identification + Primary/Secondary Gain. * **Treatment of Choice for Specific Phobia:** Systematic Desensitization (Behavioral Therapy).

Question 62: A 20-year-old female experiences frequent episodes of palpitations, breathlessness, sweating, and a fear of impending death, with one episode occurring weekly and no identifiable triggers. Which of the following is the best drug option for her long-term treatment?

A. Fluoxetine (Correct Answer)
B. Diazepam
C. Olanzapine
D. Beta Blockers

Explanation: ### Explanation **Diagnosis:** The clinical presentation of recurrent, spontaneous episodes of palpitations, breathlessness, sweating, and fear of impending death (angor animi) is characteristic of **Panic Disorder**. **1. Why Fluoxetine is Correct:** Selective Serotonin Reuptake Inhibitors (SSRIs), such as **Fluoxetine**, are the **first-line pharmacological treatment** for the long-term management of Panic Disorder. They are preferred due to their efficacy in reducing the frequency and intensity of panic attacks and their favorable safety profile compared to older antidepressants. While they have a delayed onset of action (2–4 weeks), they are the gold standard for preventing relapse. **2. Why the Other Options are Incorrect:** * **B. Diazepam:** Benzodiazepines provide rapid relief during an acute attack but are **not recommended for long-term use** due to risks of sedation, cognitive impairment, tolerance, and dependence. * **C. Olanzapine:** This is an atypical antipsychotic used primarily in schizophrenia and bipolar disorder. It has no primary role in the standard treatment of uncomplicated Panic Disorder. * **D. Beta Blockers (e.g., Propranolol):** These are effective for **Performance Anxiety** (Social Anxiety Disorder) to control peripheral autonomic symptoms like tremors and tachycardia. However, they do not treat the core psychological symptoms or the "fear of death" in Panic Disorder. **High-Yield Clinical Pearls for NEET-PG:** * **First-line Treatment:** SSRIs (Fluoxetine, Paroxetine, Sertraline) + Cognitive Behavioral Therapy (CBT). * **Acute Attack Management:** Short-acting Benzodiazepines (e.g., Alprazolam or Lorazepam). * **Panic Disorder Definition:** Recurrent unexpected panic attacks followed by at least **one month** of persistent concern about future attacks (anticipatory anxiety). * **Common Comorbidity:** Agoraphobia (fear of places where escape might be difficult).

Question 63: What is the most common psychiatric disorder?

A. Anxiety disorder (Correct Answer)
B. Schizophrenia
C. Depression
D. Mania

Explanation: **Explanation:** The correct answer is **Anxiety disorder**. According to global epidemiological data and the National Mental Health Survey (NMHS) of India, anxiety disorders are the most prevalent class of mental health conditions in the general population. * **Anxiety Disorders (Correct):** This category includes Generalized Anxiety Disorder (GAD), Panic Disorder, Social Anxiety Disorder, and Specific Phobias. Collectively, they have the highest lifetime prevalence (approximately 15-30%) compared to any other psychiatric category. * **Depression (Incorrect):** While Major Depressive Disorder (MDD) is the leading cause of disability worldwide and the most common *individual* diagnosis seen in clinical practice, it ranks second to the collective group of anxiety disorders in terms of overall community prevalence. * **Schizophrenia (Incorrect):** This is a severe psychotic disorder with a relatively stable global prevalence of approximately 1%. It is much less common than mood or anxiety disorders. * **Mania (Incorrect):** Mania is a phase of Bipolar Disorder. Bipolar affective disorder (BPAD) has a lifetime prevalence of roughly 1-2%, making it significantly less common than anxiety. **High-Yield Clinical Pearls for NEET-PG:** * **Most common individual psychiatric disorder:** Major Depressive Disorder (MDD). * **Most common psychiatric disorder in the community:** Anxiety Disorders (specifically Specific Phobia is the most common subtype). * **Most common comorbid condition with Depression:** Anxiety. * **Most common psychiatric symptom in general medical clinics:** Anxiety. * **Gender Predominance:** Almost all anxiety disorders are more common in females (ratio approx. 2:1).

Question 64: Which of the following situations is characteristic of Agoraphobia?

A. Fear of public spaces
B. Fear of crowds
C. Fear of going away from home alone
D. All of the above (Correct Answer)

Explanation: **Explanation:** Agoraphobia is characterized by marked 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. According to the DSM-5 criteria, a diagnosis requires intense fear in at least **two** of the following five situations: 1. Using public transportation. 2. Being in open spaces (e.g., parking lots, bridges). 3. Being in enclosed places (e.g., shops, cinemas). 4. Standing in line or being in a **crowd**. 5. Being **outside of the home alone**. **Analysis of Options:** * **Option A & B:** Public spaces and crowds are classic triggers. The patient fears these environments not because of the people themselves (which would be Social Anxiety), but because these settings represent "trapped" scenarios where a quick exit is impossible. * **Option C:** Fear of leaving the safety of the home alone is the hallmark of severe agoraphobia. Patients often become "housebound" unless accompanied by a trusted companion. Since all three scenarios are core clinical presentations of the disorder, **Option D** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** * **Comorbidity:** Agoraphobia is most commonly associated with **Panic Disorder**, though it is now classified as a standalone diagnosis in DSM-5. * **Duration:** Symptoms must persist for at least **6 months** for diagnosis. * **Treatment of Choice:** Cognitive Behavioral Therapy (CBT) is the most effective psychotherapy; **SSRIs** (e.g., Sertraline, Paroxetine) are the first-line pharmacological treatment. * **Differential:** Unlike Social Anxiety Disorder (fear of scrutiny), Agoraphobia focuses on the **physical inability to escape**.

Question 65: A 34-year-old female presents with complaints of 'always feeling worried.' She reports that she always feels anxious and irritable, and her sleep is gradually worsening. What is the likely diagnosis?

A. Agoraphobia
B. Generalized anxiety disorder (Correct Answer)
C. Major depression
D. Dysthymia

Explanation: ### Explanation **Correct Answer: B. Generalized Anxiety Disorder (GAD)** The clinical presentation of "always feeling worried" combined with irritability and sleep disturbances is classic for **Generalized Anxiety Disorder (GAD)**. The core feature of GAD is excessive, pervasive, and uncontrollable anxiety and worry about various events or activities (e.g., health, finances, or work) occurring more days than not for at least **6 months**. According to DSM-5 criteria, the anxiety must be associated with at least three of the following: restlessness, easy fatigability, difficulty concentrating, irritability, muscle tension, and sleep disturbance. This patient exhibits the hallmark "free-floating anxiety" that is not restricted to any specific environmental situation. **Why other options are incorrect:** * **Agoraphobia:** Characterized by intense fear or anxiety specifically triggered by being in situations where escape might be difficult or help unavailable (e.g., open spaces, crowds). This patient’s worry is generalized, not situational. * **Major Depression:** While irritability and sleep issues occur in depression, the primary symptom must be a persistent low mood or anhedonia (loss of interest) for at least 2 weeks, which is not the focus here. * **Dysthymia (Persistent Depressive Disorder):** This involves a chronic low mood lasting for at least 2 years. While it can co-occur with anxiety, the patient’s primary complaint of "always feeling worried" points specifically to an anxiety spectrum disorder. **NEET-PG High-Yield Pearls:** * **Duration:** Symptoms must persist for **≥ 6 months** for a GAD diagnosis. * **First-line Treatment:** SSRIs (Selective Serotonin Reuptake Inhibitors) are the drug of choice. * **Acute Management:** Benzodiazepines can be used for short-term symptomatic relief but are avoided long-term due to dependence risk. * **Psychotherapy:** Cognitive Behavioral Therapy (CBT) is the most effective non-pharmacological intervention.

Question 66: Common symptoms of panic attacks include all of the following except?

A. Fear of dying
B. Fear of losing control
C. Fear of going crazy
D. Suicidal thoughts (Correct Answer)

Explanation: **Explanation:** A **Panic Attack** is characterized by a discrete period of intense fear or discomfort, reaching a peak within 10 minutes, accompanied by at least four somatic or cognitive symptoms. **Why "Suicidal thoughts" is the correct answer:** While panic disorder is associated with an increased long-term risk of suicide, **suicidal ideation is not a diagnostic symptom of an acute panic attack**. Panic attacks are characterized by an intense "fight-or-flight" response where the patient typically experiences an overwhelming urge to escape or survive, rather than a desire to end their life. **Why other options are incorrect:** * **Fear of dying (Option A):** This is a hallmark cognitive symptom of a panic attack. Patients often interpret physical symptoms (like chest pain) as an impending catastrophic event, such as a heart attack. * **Fear of losing control (Option B) & Fear of going crazy (Option C):** These are the other two core cognitive symptoms defined in the DSM-5/ICD-11 criteria. They represent the psychological distress caused by the sudden, unexplained autonomic hyperactivity. **High-Yield Clinical Pearls for NEET-PG:** * **Physical Symptoms:** Palpitations, sweating, trembling, dyspnea, choking sensation, chest pain, nausea, dizziness, chills/heat sensations, and paresthesias. * **Diagnostic Criteria:** Panic Disorder requires recurrent *unexpected* attacks followed by at least one month of persistent concern about future attacks or maladaptive behavioral changes. * **Treatment of Choice:** * **Acute attack:** Benzodiazepines (e.g., Alprazolam, Lorazepam). * **Maintenance/Prophylaxis:** SSRIs (First-line) and Cognitive Behavioral Therapy (CBT). * **Differential:** Always rule out medical causes like hyperthyroidism, pheochromocytoma, and hypoglycemia.

Question 67: Free-floating persistent anxiety and excessive worry are characteristic features of which of the following conditions?

A. Generalized anxiety disorder (Correct Answer)
B. Obsessive compulsive disorder
C. Schizotypal disorder
D. Panic disorder

Explanation: **Explanation:** The correct answer is **Generalized Anxiety Disorder (GAD)**. **1. Why GAD is correct:** Generalized Anxiety Disorder is characterized by **"free-floating anxiety,"** which refers to a persistent, pervasive, and generalized sense of apprehension that is not restricted to any particular environmental circumstances. According to ICD-10 and DSM-5 criteria, the core feature is **excessive worry** (apprehensive expectation) occurring more days than not for at least **6 months**, about a number of events or activities (such as work or school performance). Patients often experience physical symptoms like muscle tension, restlessness, and sleep disturbances. **2. Why the other options are incorrect:** * **Obsessive Compulsive Disorder (OCD):** Characterized by intrusive, repetitive thoughts (obsessions) and ritualistic behaviors (compulsions) performed to reduce distress, rather than generalized worry. * **Schizotypal Disorder:** A personality disorder (or part of the schizophrenia spectrum) characterized by eccentric behavior, odd beliefs, and social anxiety related to paranoid fears rather than generalized worry. * **Panic Disorder:** Characterized by recurrent, unexpected **Panic Attacks**—discrete periods of intense fear with sudden onset. Between attacks, the anxiety is usually focused on the fear of having another attack (anticipatory anxiety), not "free-floating" worry. **Clinical Pearls for NEET-PG:** * **Duration:** GAD requires symptoms for at least **6 months** (DSM-5/ICD-10). * **First-line Treatment:** SSRIs (Selective Serotonin Reuptake Inhibitors) are the gold standard for long-term management. * **Acute Management:** Benzodiazepines can be used for short-term symptomatic relief but carry a risk of dependence. * **Psychotherapy:** Cognitive Behavioral Therapy (CBT) is the most effective non-pharmacological intervention.

Question 68: Fear is due to:

A. Abnormal experiences of childhood
B. Over consciousness
C. Excess perception of danger
D. All of the above (Correct Answer)

Explanation: **Explanation:** Fear is an emotional response to a perceived threat or danger. In psychiatry, the etiology of fear and anxiety is multifactorial, involving developmental, cognitive, and physiological components. * **Abnormal experiences of childhood (Option A):** According to the **Psychoanalytic theory** (Freud), early childhood experiences and unresolved conflicts are foundational to the development of fear. Traumatic events or insecure attachment styles in childhood can sensitize the amygdala and prime the individual to perceive the world as threatening. * **Over-consciousness (Option B):** This refers to hypervigilance and excessive self-awareness. In many anxiety disorders, patients exhibit an increased focus on internal bodily sensations (interoceptive awareness) or external stimuli, leading to an exaggerated fear response. * **Excess perception of danger (Option C):** This is the **Cognitive model** of fear. It involves "catastrophizing" or overestimating the probability and severity of a threat while underestimating one's ability to cope. Since all three factors—developmental history, heightened awareness, and cognitive appraisal—contribute to the manifestation of fear, **Option D** is the correct answer. **Clinical Pearls for NEET-PG:** * **Fear vs. Anxiety:** Fear is a response to a *known, external, definite* threat (e.g., a stray dog). Anxiety is a response to an *unknown, internal, vague* threat (e.g., "something bad might happen"). * **Neurobiology:** The **Amygdala** is the "fear center" of the brain. The **Locus Coeruleus** (norepinephrine) is responsible for the physiological "fight or flight" symptoms. * **Conditioning:** According to Behavioral Theory (Watson), fear is a learned response through **Classical Conditioning**.

Question 69: Which of the following situations is most specific of a panic disorder?

A. Panic attack during a funeral
B. Panic attack before an interview
C. Panic attack during an exam
D. Panic attack upon waking from sleep (Correct Answer)

Explanation: To diagnose **Panic Disorder**, the core clinical requirement is the presence of **recurrent, unexpected (uncued)** panic attacks. ### Why Option D is Correct **Panic attack upon waking from sleep** (also known as **Nocturnal Panic Attacks**) is highly specific to Panic Disorder. These attacks occur without an obvious external trigger or situational cue. Since they often happen during the transition from late Stage 2 to Stage 3 (NREM) sleep, they are considered "out of the blue." In the context of the DSM-5 criteria, an "unexpected" attack is the hallmark of Panic Disorder, distinguishing it from other anxiety disorders where attacks are usually "cued" by specific stressors. ### Why Other Options are Incorrect * **Options A, B, and C** (Funeral, Interview, Exam) describe **"cued" or "situationally bound"** panic attacks. * **Funeral:** May be related to acute grief or post-traumatic stress. * **Interview/Exam:** These are classic triggers for **Social Anxiety Disorder** or **Performance Anxiety**. * While a person with Panic Disorder *can* have attacks in these settings, these situations are not *specific* to the diagnosis because the attacks are predictable responses to stressful stimuli. ### NEET-PG High-Yield Pearls * **Definition:** Panic Disorder requires at least one month of persistent concern about future attacks or a significant maladaptive change in behavior (e.g., avoidance). * **Nocturnal Panic:** Occurs in about 20-40% of patients with Panic Disorder. It is **not** associated with nightmares (which occur in REM sleep). * **Medical Mimics:** Always rule out Pheochromocytoma, Hyperthyroidism, and Arrhythmias (MVP is often associated). * **Treatment of Choice:** * **Acute attack:** Benzodiazepines (e.g., Alprazolam). * **Long-term/Maintenance:** SSRIs (First-line) + Cognitive Behavioral Therapy (CBT).

Question 70: Which of the following conditions does NOT mimic an anxiety disorder?

A. Temporal lobe epilepsy
B. Hypothyroidism (Correct Answer)
C. Pheochromocytoma
D. Myocardial Infarction

Explanation: **Explanation:** The core concept in differentiating medical mimics of anxiety is understanding whether the underlying condition causes **sympathetic overactivity** (tachycardia, tremors, sweating) or **central nervous system irritability**. **Why Hypothyroidism is the Correct Answer:** Hypothyroidism is characterized by a "slowing down" of metabolic processes. Clinical features include bradycardia, lethargy, weight gain, and depression. It does **not** mimic anxiety. In contrast, **Hyperthyroidism** (Thyrotoxicosis) is a classic mimic of anxiety disorders, presenting with palpitations, tremors, and nervousness. **Analysis of Incorrect Options:** * **Temporal Lobe Epilepsy (TLE):** Ictal phenomena in TLE often include "aura" symptoms like intense fear, panic, or autonomic arousal, which can be indistinguishable from a Panic Attack. * **Pheochromocytoma:** This catecholamine-secreting tumor causes paroxysmal surges of adrenaline/noradrenaline, leading to the "classic triad" of headaches, sweating, and palpitations, mimicking a severe Panic Disorder. * **Myocardial Infarction (MI):** An acute MI often presents with chest pain, dyspnea, diaphoresis, and a "sense of impending doom," all of which are hallmark symptoms of a Panic Attack. **High-Yield Clinical Pearls for NEET-PG:** * **Endocrine mimics:** Hyperthyroidism, Hypoglycemia, and Hyperparathyroidism (due to hypercalcemia) are common anxiety mimics. * **Drug-induced anxiety:** Caffeine, sympathomimetics (pseudoephedrine), and withdrawal from alcohol or benzodiazepines are high-yield causes. * **Rule of thumb:** Always rule out organic causes (especially cardiac and endocrine) before diagnosing a primary psychiatric anxiety disorder.

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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