Anxiety Disorders Practice Questions

Q: Which of the following is NOT a characteristic feature of somatization disorder?

Rejection of the sick role. ***Rejection of the sick role*** - Patients with somatization disorder (now classified under **somatic symptom disorder** in DSM-5) characteristically **embrace the sick role**, not reject it - They actively seek medical attention, present with multiple chronic physical symptoms, express significant distress, and often become preoccupied with their perceived illnesses - This adoption of the sick role is a key behavioral pattern distinguishing somatization disorder from malingering or factitious disorder *Absence of pseudo-neurological symptoms* - This is incorrect because **pseudo-neurological (conversion) symptoms** are characteristic features of somatization disorder - Examples include paralysis, blindness, seizures, sensory loss, aphonia, and loss of coordination - These symptoms resemble neurological conditions but lack organic pathology *Absence of pain symptoms* - This is incorrect because **pain symptoms** are among the most common presentations in somatization disorder - Patients typically report pain in multiple sites: headaches, back pain, joint pain, chest pain, abdominal pain - Pain complaints are often one of the primary reasons these patients seek medical care *Lack of sexual symptoms* - This is incorrect because **sexual and reproductive symptoms** are frequently reported in somatization disorder - Examples include sexual indifference, erectile dysfunction, dyspareunia, irregular menses, excessive menstrual bleeding, and vomiting throughout pregnancy - These contribute to the widespread and varied somatic complaints characteristic of the disorder

Q: What is the definition of phobia?

An intense, irrational fear that leads to avoidance. ***An intense, irrational fear that leads to avoidance*** - A phobia is primarily an **intense and persistent fear** reaction that is **irrational** in nature, meaning it is disproportionate to the actual danger posed by the object or situation. - This overwhelming fear invariably leads to **avoidance behavior**, where the individual actively tries to stay away from the feared stimulus. *Fear of specific objects or situations* - While phobias often involve specific objects or situations, this definition alone is insufficient as it doesn't capture the **intensity**, **irrationality**, or the **avoidance** component that are hallmarks of a true phobia. - Many people experience fear of specific things without it reaching the clinical threshold of a phobia, as long as it doesn't cause significant distress or impairment. *A type of anxiety disorder characterized by excessive fear* - This definition is broadly correct but is not the most precise or complete definition of a phobia itself. - While phobias are indeed a type of **anxiety disorder** and involve excessive fear, the key defining features of **irrationality** and **avoidance** are not explicitly stated, nor is the clear distinction from generalized anxiety. *A severe anxiety disorder characterized by irrational fear* - Similar to the previous option, this highlights the **irrational fear** and categorizes it as an **anxiety disorder**. - However, it omits the crucial element of **avoidance**, which is a defining diagnostic criterion and a hallmark behavioral response in phobias, and it also uses the broad term "severe" when the impact can vary.

Q: Which of the following is a recognized type of anxiety disorder?

Panic Disorder. ***Panic Disorder*** - **Panic disorder** is a recognized **anxiety disorder** characterized by recurrent unexpected **panic attacks** - sudden episodes of intense fear accompanied by physical symptoms like heart palpitations, shortness of breath, chest pain, dizziness, and trembling. - It involves persistent worry about having more attacks (anticipatory anxiety) and maladaptive behavioral changes to avoid situations where attacks might occur. - Classified under **Anxiety Disorders** in DSM-5 and ICD-11. *Major Depressive Disorder* - **Major Depressive Disorder (MDD)** is a **mood disorder**, not an anxiety disorder. - Characterized by persistent depressed mood, loss of interest or pleasure (anhedonia), changes in appetite/sleep, fatigue, feelings of worthlessness, and potential suicidal ideation. - Classified under **Depressive Disorders** in DSM-5, distinct from anxiety disorders, though anxiety symptoms may co-occur. *Bipolar Disorder* - **Bipolar disorder** is a **mood disorder**, not an anxiety disorder. - Characterized by significant mood swings including episodes of mania/hypomania (elevated, expansive, or irritable mood with increased energy) and depression. - Classified under **Bipolar and Related Disorders** in DSM-5, distinct from anxiety disorders. *Schizophrenia* - **Schizophrenia** is a **psychotic disorder**, not an anxiety disorder. - Characterized by disturbances in thought, perception, emotions, and behavior, including hallucinations, delusions, disorganized thinking, and negative symptoms. - Classified under **Schizophrenia Spectrum and Other Psychotic Disorders** in DSM-5, distinct from anxiety disorders.

Q: Which of the following drugs can induce panic disorder?

Yohimbine (a panicogenic agent). ***Yohimbine (a panicogenic agent)*** - **Yohimbine** is an alpha-2 adrenergic receptor antagonist which increases **norepinephrine** activity in the brain. - This increase in noradrenergic activity can trigger symptoms of panic, leading to its use as a **panicogenic agent** in research settings. *Sildenafil (Viagra)* - **Sildenafil** is a PDE5 inhibitor primarily used for erectile dysfunction; its main effects are **vasodilation** and increased blood flow to specific tissues. - While it can cause side effects like headache or flushing, it is not known to directly induce **panic attacks** or panic disorder. *PGE1 (Prostaglandin E1)* - **Prostaglandin E1 (alprostadil)** is a vasodilator used to treat erectile dysfunction or maintain patent ductus arteriosus in neonates. - Its effects are primarily on **vascular smooth muscle** and do not typically involve the neural pathways associated with panic. *All of the options* - As **sildenafil** and **PGE1** do not induce panic disorder, this option is incorrect. - Only **yohimbine** is recognized for its panicogenic effects.

Q: Which of the following is a defense mechanism in phobia?

Displacement. ***Displacement*** - In phobias, **displacement** occurs when the anxiety associated with a forbidden impulse or an unacceptable object is redirected to a **less threatening object**, leading to fear of the latter. - For example, fear of parental disapproval might be displaced onto a phobia of animals. *Sublimation* - **Sublimation** involves channeling unacceptable impulses into **socially acceptable** and often productive activities. - This mechanism is not typically associated with the development or maintenance of phobias. *Substitution* - **Substitution** is a more general term and not a specific Freudian defense mechanism; while an object or idea might be "substituted" for another, a more precise term like **displacement** is used when anxiety is transferred. - It lacks the specific theoretical underpinnings that describe how anxiety is managed in phobias. *Projection* - **Projection** is a defense mechanism where unacceptable thoughts, feelings, or impulses are attributed to **another person or external source**. - While projection can be involved in other psychiatric conditions, it doesn't directly explain the mechanism of fear transference in phobias.

Q: A 40-year-old female reports sudden bouts of anxiety that can occur at any time, accompanied by sweating, palpitations, derealization, and a feeling of going crazy. These episodes typically last 20-25 minutes. Despite normal routine investigations, she is concerned about having future episodes. What is the diagnosis?

Panic disorder. ***Panic disorder*** - This patient presents with **recurrent, unexpected panic attacks** characterized by sudden intense fear, physical symptoms such as **sweating and palpitations**, and cognitive symptoms like **derealization** and fear of losing control. - The persistent concern about having future attacks (**anticipatory anxiety**) is a key diagnostic criterion for panic disorder. - Episodes lasting 20-25 minutes with spontaneous occurrence (not triggered by specific situations) are typical of panic disorder. *Generalized anxiety disorder (GAD)* - GAD involves **chronic, excessive worry** about various aspects of life (e.g., work, health, family) present most days for at least 6 months. - While physical symptoms can be present, they are usually **persistent rather than episodic** and less severe than those in panic attacks. - The primary feature is pervasive worry, not discrete episodes of intense fear with derealization. *Obsessive-compulsive disorder (OCD)* - OCD is characterized by **obsessions** (recurrent, intrusive thoughts) and **compulsions** (repetitive behaviors performed to reduce anxiety). - Anxiety in OCD is typically triggered by obsessional thoughts and relieved by compulsive behaviors, which are not described in this case. - The patient's symptoms represent discrete panic attacks, not anxiety related to obsessions. *Agoraphobia* - Agoraphobia involves **fear and avoidance of situations** where escape might be difficult or help unavailable if panic-like symptoms occur (e.g., public transportation, open spaces, crowds). - While often comorbid with panic disorder, agoraphobia requires the presence of **marked fear or anxiety about specific situations**, which is not mentioned in this case. - The patient has panic attacks that can occur "at any time" without specific situational triggers.

Q: Which of the following is the LEAST common symptom of anxiety?

Syncope. ***Syncope*** - **Syncope** (fainting) is the **LEAST common** symptom among those listed as a direct manifestation of anxiety. - While extreme anxiety can occasionally trigger a **vasovagal response** leading to syncope, this is **rare** and not a typical everyday presentation. - Syncope typically results from temporary reduction in cerebral blood flow and has many other more common causes (cardiac, orthostatic, neurological). *Restlessness* - **Restlessness** is one of the **most common behavioral symptoms** of anxiety disorders, particularly **Generalized Anxiety Disorder (GAD)**. - Patients frequently report feeling **"keyed up,"** on edge, and unable to relax. - This is a **core diagnostic criterion** for GAD in DSM-5. *Palpitations* - **Palpitations** are an extremely **common physical symptom** of anxiety, especially in **panic disorder**. - They reflect **sympathetic nervous system activation** and increased awareness of heartbeat. - Frequently reported during panic attacks and acute anxiety episodes. *Gastrointestinal disturbances* - **GI symptoms** (nausea, diarrhea, abdominal discomfort) are **very common** in anxiety disorders. - Result from **brain-gut axis activation** during stress and anxiety. - Often seen in both acute anxiety and chronic anxiety states.

Q: Which of the following is not classified as an anxiety disorder?

Schizophrenia. ***Schizophrenia*** - This is the correct answer because **Schizophrenia** is classified as a **psychotic disorder**, not an anxiety disorder. - It is characterized by disturbances in thought processes, perceptions, emotions, and behavior, including **hallucinations**, delusions, disorganized speech, and negative symptoms like blunted affect or avolition. - According to **DSM-5** and **ICD-11**, schizophrenia falls under the category of psychotic disorders, distinctly separate from anxiety disorders. *Generalized anxiety disorder (GAD)* - This is incorrect because GAD **is** a recognized anxiety disorder. - Characterized by persistent and excessive worry about various life events or activities for at least **6 months**. - Common symptoms include **restlessness**, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance. *Panic disorder* - This is incorrect because panic disorder **is** a recognized anxiety disorder. - Defined by recurrent, unexpected **panic attacks** - sudden episodes of intense fear with physical symptoms. - Symptoms include **palpitations**, sweating, trembling, chest pain, shortness of breath, dizziness, and fear of losing control or dying. *None of the options* - This is incorrect because Schizophrenia is indeed not classified as an anxiety disorder, making it the correct answer to this negation question.

Q: Specific phobias are best classified under which of the following categories?

Anxiety disorders. **Anxiety disorders** - **Specific phobias** are characterized by marked and persistent fear of a specific object or situation, which falls under the umbrella of **anxiety disorders**. - The core feature is intense anxiety or panic when exposed to the phobic stimulus, leading to avoidance behavior. *Psychotic disorders* - These involve a significant loss of contact with reality, often featuring **hallucinations, delusions**, or disorganized thought and speech. - Specific phobias do not involve such a profound disruption of reality or psychotic symptoms. *Mood disorders* - These are primarily characterized by a disturbance in the person's sustained emotional state, such as **depression (low mood)** or **mania (elevated mood)**. - While anxiety can co-occur with mood disorders, specific phobias are distinct conditions defined by their fear response to specific triggers. *Personality disorders* - These are characterized by **enduring patterns of inner experience and behavior** that deviate significantly from cultural expectations, are pervasive and inflexible, and cause distress or impairment. - Specific phobias are not considered deeply ingrained, pervasive patterns of relating to the world, but rather a focused fear response.

Question 1

Which of the following is NOT a characteristic feature of somatization disorder?

Accepted Answer

Rejection of the sick role

Answer

Absence of pseudo neurological symptoms

Answer

Absence of pain symptoms

Answer

Lack of sexual symptoms

Question 2

What is the definition of phobia?

Accepted Answer

An intense, irrational fear that leads to avoidance

Answer

Fear of specific objects or situations

Answer

A type of anxiety disorder characterized by excessive fear

Answer

A severe anxiety disorder characterized by irrational fear

Question 3

Which of the following is a recognized type of anxiety disorder?

Accepted Answer

Panic Disorder

Answer

Bipolar Disorder

Answer

Major Depressive Disorder

Answer

Schizophrenia

Question 4

Which of the following drugs can induce panic disorder?

Accepted Answer

Yohimbine (a panicogenic agent)

Answer

Sildenafil (Viagra)

Answer

PGE1 (Prostaglandin E1)

Answer

All of the options

Question 5

Which of the following is a defense mechanism in phobia?

Accepted Answer

Displacement

Answer

Substitution

Answer

Projection

Answer

Sublimation

Question 6

A middle-aged person reported to the Psychiatric OPD with complaints of fear of leaving home, fear of traveling alone, and fear of being in a crowd. He develops marked anxiety with palpitations and sweating when he is in these situations. He often avoids public transportation to go to his place of work. The most likely diagnosis is

Accepted Answer

Agoraphobia

Answer

Generalised anxiety disorder

Answer

Schizophrenia

Answer

Personality disorder

Question 7

A 40-year-old female reports sudden bouts of anxiety that can occur at any time, accompanied by sweating, palpitations, derealization, and a feeling of going crazy. These episodes typically last 20-25 minutes. Despite normal routine investigations, she is concerned about having future episodes. What is the diagnosis?

Accepted Answer

Panic disorder

Answer

Generalized anxiety disorder (GAD)

Answer

Obsessive-compulsive disorder (OCD)

Answer

Agoraphobia

Question 8

Which of the following is the LEAST common symptom of anxiety?

Accepted Answer

Syncope

Answer

Palpitations

Answer

Gastrointestinal disturbances

Answer

Restlessness

Question 9

Which of the following is not classified as an anxiety disorder?

Accepted Answer

Schizophrenia

Answer

Generalized anxiety disorder

Answer

Panic disorder

Answer

None of the options

Question 10

Specific phobias are best classified under which of the following categories?

Accepted Answer

Anxiety disorders

Answer

Mood disorders

Answer

Psychotic disorders

Answer

Personality disorders

Anxiety Disorders — MCQs

Anxiety Disorders — MCQs

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