Anxiety Disorders in the Elderly — MCQs
A 28-year-old woman who reports being a "nervous person" and experiences chronic tension, exhibits symptoms of both sympathetic and parasympathetic nervous system activation, and has insomnia is most likely to be suffering from which condition?
Biochemical etiology of Alzheimer's disease relates to:
Which of the following disorders is classified under somatic symptom and related disorders in the DSM-5?
In which of the following conditions is behavior therapy considered most effective?
A 45-year-old male presents with recurrent episodes of palpitations, sweating, and a fear of losing control. He has been experiencing these episodes for the past six months. What is the most likely diagnosis?
Which of the following is the LEAST common symptom of anxiety?
Which of the following treatments cannot be used for management of Obsessive Compulsive Disorder (OCD)?
A 43-year-old lady presents to the emergency department with an acute attack of anxiety, accompanied by physical symptoms such as hyperventilation, increased heart rate, and sweating, and is diagnosed with an acute panic attack. Which of the following is the most suitable drug for this patient?
A patient with a history of RTA before 2 months presents with complaints of dreams of accidents. He is able to visualize the same scene whenever he visits the place. Hence is afraid to go back to the accident site. Identify the type of disorder that he might be suffering from?
What is the first-line treatment for generalized anxiety disorder?
Anxiety Disorders in the Elderly Indian Medical PG Practice Questions and MCQs
Question 1: A 28-year-old woman who reports being a "nervous person" and experiences chronic tension, exhibits symptoms of both sympathetic and parasympathetic nervous system activation, and has insomnia is most likely to be suffering from which condition?
- A. Post-traumatic stress disorder
- B. Generalized anxiety disorder (Correct Answer)
- C. Obsessive-compulsive disorder
- D. Agoraphobia
Explanation: ***Generalized anxiety disorder*** - This condition is characterized by **persistent and excessive worry** about various aspects of life, often accompanied by physical symptoms of autonomic arousal, such as muscle tension, nervousness, and sleep disturbances (insomnia). - The patient's description of being a "nervous person" and experiencing **chronic tension** and insomnia, along with symptoms of both sympathetic and parasympathetic activation, is highly consistent with GAD. *Post-traumatic stress disorder* - This disorder typically develops after exposure to a **traumatic event** and involves symptoms such as re-experiencing the trauma, avoidance, negative alterations in cognition and mood, and hyperarousal. - While it can involve hyperarousal and sleep disturbances, the absence of a specified traumatic event and the focus on "nervousness" and "chronic tension" makes GAD a more direct fit. *Obsessive-compulsive disorder* - OCD involves **recurrent, intrusive thoughts (obsessions)** and repetitive behaviors or mental acts (compulsions) performed to alleviate anxiety. - The symptoms described do not include typical obsessions or compulsions, making this diagnosis less likely. *Agoraphobia* - This is an anxiety disorder characterized by intense fear and avoidance of situations where escape might be difficult or help unavailable, often involving public places or crowds. - While agoraphobia can cause anxiety and autonomic symptoms, the primary description of chronic tension and generalized nervousness is not the hallmark feature of this condition.
Question 2: Biochemical etiology of Alzheimer's disease relates to:
- A. Dopamine
- B. Acetylcholine (Correct Answer)
- C. GABA
- D. Serotonin
Explanation: ***Acetylcholine*** - Alzheimer's disease is significantly associated with a **reduction in cholinergic neuronal activity** in the brain, impacting memory and learning. - Medications for Alzheimer's disease often aim to **increase acetylcholine levels** or prevent its breakdown (e.g., cholinesterase inhibitors). *Dopamine* - **Dopamine deficits** are primarily associated with **Parkinson's disease**, affecting motor control and movement. - While dopamine may play a minor role, it is **not considered the primary biochemical etiology** of Alzheimer's. *GABA* - **GABA (gamma-aminobutyric acid)** is the main inhibitory neurotransmitter in the brain and is often associated with anxiety disorders and epilepsy. - While GABAergic system changes can occur in Alzheimer's, they are **secondary to the primary cholinergic dysfunction**. *Serotonin* - **Serotonin** is widely known for its role in mood, sleep, and appetite regulation, and its imbalances are linked to depression and anxiety. - While some **serotonergic changes** can be observed in Alzheimer's disease, the primary biochemical deficit is not serotonin.
Question 3: Which of the following disorders is classified under somatic symptom and related disorders in the DSM-5?
- A. Post-Traumatic Stress Disorder (PTSD)
- B. Phobic disorders (e.g., social anxiety disorder)
- C. Conversion disorder (functional neurological symptom disorder) (Correct Answer)
- D. Obsessive-Compulsive Disorder (OCD)
Explanation: ***Conversion disorder (functional neurological symptom disorder)*** - **Conversion disorder** is characterized by neurological symptoms (e.g., paralysis, blindness) that are **incompatible with recognized neurological or medical conditions**, yet are not intentionally produced. - It falls under **somatic symptom and related disorders** because the primary features are physical symptoms causing distress or functional impairment, rather than being malingered or feigned. *Phobic disorders (e.g., social anxiety disorder)* - **Phobic disorders** are classified under **anxiety disorders** in the DSM-5, not somatic symptom and related disorders. - They are primarily characterized by **intense, irrational fears** of specific objects or situations, leading to avoidance rather than prominent physical symptoms without a medical cause. *Post-Traumatic Stress Disorder (PTSD)* - **PTSD** is classified under **trauma- and stressor-related disorders** in the DSM-5, distinguished by symptoms developing after exposure to a traumatic event. - Its core features include **intrusive memories, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity**, rather than unexplained physical symptoms. *Obsessive-Compulsive Disorder (OCD)* - **OCD** is classified under **obsessive-compulsive and related disorders** in the DSM-5. - It is primarily characterized by the presence of **obsessions (recurrent, intrusive thoughts)** and/or **compulsions (repetitive behaviors or mental acts)**, which are distinct from somatic symptoms.
Question 4: In which of the following conditions is behavior therapy considered most effective?
- A. Panic Attack
- B. Psychosis
- C. Obsessive-Compulsive Disorder (OCD) (Correct Answer)
- D. Generalized Anxiety Disorder
Explanation: ***Obsessive-Compulsive Disorder (OCD)*** - **Exposure and Response Prevention (ERP)**, a type of behavior therapy, is the gold standard and most effective treatment for OCD. - ERP directly targets the **obsessions** and **compulsions** by gradually exposing individuals to feared situations without allowing them to perform their rituals. - OCD shows the **highest response rates** to pure behavior therapy compared to other psychiatric conditions. *Psychosis* - While supportive therapy and cognitive behavioral therapy for psychosis (CBTp) can be helpful, **behavior therapy alone is not considered the primary or most effective treatment** for core psychotic symptoms. - Management of psychosis primarily relies on **antipsychotic medications** to address symptoms like hallucinations and delusions. *Panic Attack* - Behavior therapy and CBT are effective for **Panic Disorder**, but the effectiveness is somewhat lower than for OCD. - Treatment for panic disorder often requires a **combination of behavioral and cognitive techniques** rather than pure behavior therapy alone. - Management typically includes breathing exercises, exposure to physical sensations, and cognitive restructuring. *Generalized Anxiety Disorder* - **Cognitive Behavioral Therapy (CBT)**, which includes behavioral components, is highly effective for GAD, but the **cognitive elements are essential** for addressing worry and rumination. - Pure behavior therapy (e.g., systematic desensitization) is less effective for GAD compared to OCD, as GAD involves pervasive cognitive distortions that require cognitive restructuring.
Question 5: A 45-year-old male presents with recurrent episodes of palpitations, sweating, and a fear of losing control. He has been experiencing these episodes for the past six months. What is the most likely diagnosis?
- A. Generalized anxiety disorder
- B. Panic disorder (Correct Answer)
- C. Social anxiety disorder
- D. Obsessive-compulsive disorder
Explanation: ***Panic disorder*** - The presentation of recurrent, unexpected **panic attacks** characterized by sudden episodes of intense fear, palpitations, sweating, and a fear of losing control is classic for **panic disorder**. - These episodes often manifest with physical symptoms that mimic a medical emergency, leading to significant distress and avoidance behaviors. *Generalized anxiety disorder* - This condition involves **persistent and excessive worry** about various life circumstances for at least six months, rather than discrete, intense episodes of fear. - While physical symptoms like restlessness and fatigue can occur, they are generally less acute and not as severe as the sudden "fight-or-flight" response seen in panic attacks. *Social anxiety disorder* - This disorder is characterized by marked fear or anxiety about **social situations** where the individual might be scrutinized by others. - While it can involve symptoms like palpitations and sweating in social contexts, it doesn't typically present with unexpected attacks unrelated to social performance. *Obsessive-compulsive disorder* - This disorder is defined by the presence of **obsessions** (recurrent and persistent thoughts, urges, or images) and/or **compulsions** (repetitive behaviors or mental acts) that the individual feels driven to perform. - The symptoms described—palpitations, sweating, and fear of losing control—are not typical primary manifestations of OCD, which focuses on specific obsessions and compulsions.
Question 6: Which of the following is the LEAST common symptom of anxiety?
- A. Palpitations
- B. Gastrointestinal disturbances
- C. Syncope (Correct Answer)
- D. Restlessness
Explanation: ***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.
Question 7: Which of the following treatments cannot be used for management of Obsessive Compulsive Disorder (OCD)?
- A. Fluoxetine
- B. Carbamazepine (Correct Answer)
- C. Cognitive Behaviour Therapy
- D. Clomipramine
Explanation: ***Carbamazepine*** - **Carbamazepine** is an **anticonvulsant** and **mood stabilizer** primarily used for epilepsy and bipolar disorder. - It does not have established efficacy for the treatment of **Obsessive-Compulsive Disorder (OCD)**. *Fluoxetine* - **Fluoxetine** is a **Selective Serotonin Reuptake Inhibitor (SSRI)** and is a **first-line pharmacotherapy** for OCD. - SSRIs, including fluoxetine, are effective in reducing the severity of **obsessions and compulsions**. *Cognitive Behaviour Therapy* - **Cognitive Behavioural Therapy (CBT)**, specifically **Exposure and Response Prevention (ERP)**, is the **gold standard psychotherapy** for OCD. - It involves gradually exposing patients to feared situations or thoughts while preventing their ritualistic responses. *Clomipramine* - **Clomipramine** is a **tricyclic antidepressant (TCA)** that has potent inhibitory effects on **serotonin reuptake**. - It is one of the **most effective medications** for OCD, often used when SSRIs are insufficient.
Question 8: A 43-year-old lady presents to the emergency department with an acute attack of anxiety, accompanied by physical symptoms such as hyperventilation, increased heart rate, and sweating, and is diagnosed with an acute panic attack. Which of the following is the most suitable drug for this patient?
- A. Sertraline
- B. Alprazolam (Correct Answer)
- C. Propranolol
- D. Eszopiclone
Explanation: ***Alprazolam*** - **Alprazolam** is a **fast-acting benzodiazepine** with a quick onset of action, making it ideal for the immediate relief of acute panic attack symptoms. - It works by enhancing the effect of **GABA**, leading to rapid central nervous system depression and swift reduction of anxiety. *Sertraline* - **Sertraline** is a **selective serotonin reuptake inhibitor (SSRI)** that is effective for long-term management of panic disorder. - However, its **therapeutic effects** take several weeks to manifest, making it unsuitable for acute symptom relief. *Propranolol* - **Propranolol** is a **beta-blocker** that can help manage the physical symptoms of anxiety like palpitations and tremor. - It does not directly address the psychological component of **anxiety** or **panic attacks** effectively. *Eszopiclone* - **Eszopiclone** is a **non-benzodiazepine hypnotic** primarily used for the treatment of insomnia. - It is not indicated for the management of **acute anxiety** or **panic attacks**.
Question 9: A patient with a history of RTA before 2 months presents with complaints of dreams of accidents. He is able to visualize the same scene whenever he visits the place. Hence is afraid to go back to the accident site. Identify the type of disorder that he might be suffering from?
- A. PTSD (Correct Answer)
- B. Anxiety disorder
- C. Obsessive-Compulsive Disorder (OCD)
- D. Adjustment disorder
Explanation: ***PTSD*** - The patient's symptoms, including **recurrent dreams** of the accident, **intrusive memories** triggered by the accident site, and **avoidance** of the location, are classic diagnostic criteria for **Post-Traumatic Stress Disorder (PTSD)**. - PTSD often develops after exposure to a **traumatic event** like a car accident, with symptoms lasting for more than one month. *Anxiety disorder* - While anxiety is a prominent feature of PTSD, **Generalized Anxiety Disorder** typically involves excessive worry about everyday events rather than a specific traumatic incident. - Other anxiety disorders like **panic disorder** involve sudden, intense fear without the specific re-experiencing and avoidance symptoms seen here. *Obsessive-Compulsive Disorder (OCD)* - OCD is characterized by repetitive, unwanted thoughts (**obsessions**) and ritualistic behaviors (**compulsions**) performed to reduce anxiety, which are not described in this patient's presentation. - The patient's distress stems from a past trauma, not from obsessions or compulsions. *Adjustment disorder* - An adjustment disorder occurs in response to a **stressor**, but the symptoms are typically less severe and do not include the full constellation of **re-experiencing, avoidance, and hyperarousal** seen in PTSD. - An adjustment disorder resolves within 6 months of the stressor or its consequences, however, the persistence and nature of the symptoms here point to a more severe trauma-related condition.
Question 10: What is the first-line treatment for generalized anxiety disorder?
- A. SSRIs (Correct Answer)
- B. Antipsychotics
- C. Benzodiazepines
- D. MAO inhibitors
Explanation: ***SSRIs*** - **Selective Serotonin Reuptake Inhibitors (SSRIs)** are considered first-line pharmacological treatment for generalized anxiety disorder due to their efficacy and generally favorable side effect profile. - They work by increasing the levels of **serotonin** in the brain, which helps regulate mood and anxiety symptoms. *Antipsychotics* - **Antipsychotics** are primarily used to treat psychotic disorders like schizophrenia or severe mood disorders with psychotic features, not typically as first-line for generalized anxiety disorder. - Their significant side effect profile, including metabolic disturbances and movement disorders, makes them a less desirable choice for initial treatment of anxiety. *Benzodiazepines* - While effective for acute anxiety relief, **benzodiazepines** are generally not considered first-line for long-term management of GAD due to the risk of dependence, tolerance, and withdrawal symptoms. - They are often used for short-term relief or as an adjunct in the initial phase of treatment while awaiting the therapeutic effects of SSRIs. *MAO inhibitors* - **Monoamine Oxidase Inhibitors (MAOIs)** are older antidepressants with significant drug-drug and drug-food interactions (e.g., tyramine crisis), making them usually a last-resort treatment for severe mood disorders, not generalized anxiety disorder. - Their complex dietary restrictions and side effect profile preclude their use as a first-line option.
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