The two components of anxiety are:

A. Memory loss and avoidance
B. Autonomic awareness and fear awareness
C. Sad mood and guilt
D. Delusion and panic

B. Autonomic awareness and fear awareness

Anxiety is best described as:

A. Loss of contact with reality
B. A response to past trauma
C. A failure of memory retrieval
D. A response to upcoming fear

D. A response to upcoming fear

Anxiety disorders beginning in childhood are especially concerning because they may:

A. Cause pirmarily brief distress
B. Spare later functioning
C. Prevent physical maturation
D. Impair later social and work function

D. Impair later social and work function

Which symptom cluster most strongly reflects autonomic manifestations of anxiety?

A. Headache, sweating, palpitations
B. Flat affect, mutism, tremor
C. Delusions, apathy, insomnia
D. Euphoria, tremor, ataxia

A. Headache, sweating, palpitations

Which finding best represents a motor symptom of anxiety?

A. Hyperreflexia
B. Restlessness
C. Palpitations with chest tightness
D. Stomach pain after meals

B. Restlessness

A patient in acute anxiety says thoughts are “moving too fast.” This is best described as:

A. Rapid thoughts
B. Thought blocking
C. Neologism formation
D. Concrete thinking

A. Rapid thoughts

Progression from anxiety to severe anxiety is most associated with:

A. Disorganized thinking
B. Elevated mood
C. Increased appetite
D. Reduced startle response

A. Disorganized thinking

Which statement best fits extreme anxiety?

A. Speech becomes pressured only
B. Thought content becomes grandiose
C. Thinking clearly becomes difficult
D. Memory becomes unusually sharp

C. Thinking clearly becomes difficult

During a panic attack, which speech pattern may occur?

A. Echolalia and clangs
B. Pressured rhyming
C. Mutism and stupor
D. Rumination and stammering

D. Rumination and stammering

Acute anxiety most often focuses thoughts on:

A. A perceived cause
B. Childhood conflicts
C. Random sensory details
D. Unrelated future goals

A. A perceived cause

A patient with anxiety interprets minor chest discomfort as impending death. This most reflects:

A. Somatic passivity
B. Catastrophizing danger
C. Thought insertion
D. Primary gain seeking

B. Catastrophizing danger

During panic attacks, feared death is often attributed to which systems?

A. Cardiac or respiratory
B. Hepatic or renal
C. Endocrine or lymphatic
D. Muscular or skeletal

A. Cardiac or respiratory

A patient says, “These palpitations mean I’m dying.” This best shows:

A. Reality testing intact
B. Conversion disorder
C. Misreading symptoms as fatal
D. No insight into symptoms

C. Misreading symptoms as fatal

Chronic anxiety is most associated with:

A. Expansive thinking
B. Flight of ideas
C. Thought poverty
D. More negative thinking

D. More negative thinking

Severe anxiety may distort perception of all except:

A. Time and space
B. Person and meaning
C. Events and context
D. Location and olfaction

D. Location and olfaction

Which cognitive effect is most expected in severe anxiety?

A. Hypercalculia
B. Improved abstraction
C. Better divided attention
D. Poor focus and recall

D. Poor focus and recall

An anxious patient selectively notices only threatening cues and ignores reassuring details. This best describes:

A. Environmental overinterpretation
B. Selective interpretation bias
C. Formal thought disorder
D. Confabulation tendency

B. Selective interpretation bias

Why might an anxious patient focus only on selected environmental details?

A. To justify their reaction
B. To improve concentration
C. To suppress palpitations
D. To avoid all stimuli

A. To justify their reaction

Which statement about suicide risk in anxiety is most accurate?

A. Risk is absent
B. Risk rises only with psychosis
C. Talking about it is constant
D. Risk may rise despite silence

D. Risk may rise despite silence

Which combination best distinguishes severe from acute anxiety?

A. Better clarity and calm
B. Confusion with distorted perception
C. Fewer somatic symptoms only
D. Less danger overestimation

B. Confusion with distorted perception

Compared with typical adults, which groups may present with more somatic symptoms of anxiety disorders?

A. Children and elderly
B. Adolescents and athletes
C. Men and adolescents
D. Adults and infants

A. Children and elderly

A patient has sudden episodes of intense anxiety with feelings of impending doom. Which diagnosis is most directly suggested?

A. Specific phobia
B. Panic disorder
C. Agoraphobia
D. Generalized anxiety disorder

B. Panic disorder

Panic disorder classically occurs with:

A. Emotional blunting
B. Intense fear
C. Social indifference
D. Euphoric mood

B. Intense fear

Which pattern of attack frequency is most consistent with panic disorder?

A. Two weekly episodes
B. Three monthly episodes
C. Few attacks per lifetime
D. Several daily to yearly

D. Several daily to yearly

Panic disorder commonly presents with which comorbidity?

A. Mania
B. Obsessions
C. Agoraphobia
D. Delirium

C. Agoraphobia

Agoraphobia is best described as fear or anxiety about:

A. Being judged publicly
B. Losing memory suddenly
C. Hard-to-escape places
D. Intrusive violent thoughts

C. Hard-to-escape places

A panic attack is best defined as a:

A. Chronic state of dread
B. Sudden intense fear episode
C. Persistent depressive spell
D. Repetitive compulsive urge

B. Sudden intense fear episode

Panic attacks usually last:

A. Seconds only
B. Days to weeks
C. Minutes to hours
D. Months continuously

C. Minutes to hours

Diagnosis of panic attacks requires symptoms from which domains?

A. Sleep, appetite, pain
B. Somatic, cognitive, mood
C. Motor, language, memory
D. Perceptual, endocrine, social

B. Somatic, cognitive, mood

Panic attacks can also occur as part of:

A. Dementia or delirium
B. Bipolar or OCD
C. Schizophrenia or bipolar
D. Phobias or PTSD

D. Phobias or PTSD

Which statement about panic attacks and triggers is most accurate?

A. Always have clear triggers
B. Never have clear triggers
C. May or may not
D. Require trauma reminders

C. May or may not

Which statement about unexpected panic attacks is most accurate?

A. They are very rare
B. They are not uncommon
C. They define psychosis
D. They require phobias

B. They are not uncommon

Situationally predisposed panic attacks are best described as attacks that:

A. Occur only during sleep
B. Always follow one trigger
C. Never follow exposure
D. Blur expected and unexpected

D. Blur expected and unexpected

A patient sometimes panics with a trigger, but other times only after a delay. This best fits:

A. Unexpected panic attack
B. Situationally predisposed attack
C. Panic attack specifier absent
D. Pure agoraphobia only

B. Situationally predisposed attack

Based on the visible DSM-5 note, panic disorder diagnosis requires:

A. Recurrent expected attacks
B. Recurrent unexpected attacks
C. Daily attacks only
D. No somatic symptoms

B. Recurrent unexpected attacks

Agoraphobia most impairs functioning in which settings?

A. Work and outside social settings
B. Home chores and appetite
C. Sleep and private hobbies
D. Memory and language tasks

A. Work and outside social settings

A patient insists on leaving home only with a relative, especially when going somewhere crowded. Which diagnosis is most suggested?

A. Social anxiety disorder
B. Agoraphobia
C. Adjustment disorder
D. Acute stress disorder

B. Agoraphobia

Severe agoraphobia may lead a patient to:

A. Refuse to leave home
B. Refuse all food
C. Lose remote memory
D. Become violently manic

A. Refuse to leave home

What common theme links many agoraphobic situations?

A. Fear of contamination only
B. Separation from safety and home
C. Fear of public humiliation
D. Obsession with symmetry

B. Separation from safety and home

A patient has intense persistent fear of elevators because they are perceived as dangerous. Which diagnosis best fits?

A. Panic disorder
B. Agoraphobia
C. Specific phobia
D. Somatic symptom disorder

C. Specific phobia

At the thought of encountering the feared object, a patient immediately anticipates harm and panic. This is most characteristic of:

A. Specific phobia
B. Delirium
C. OCD with insight
D. Cyclothymia

A. Specific phobia

In specific phobia, the feared object is typically viewed as:

A. Neutral but unfamiliar
B. Harmful or dangerous
C. Symbolically meaningful
D. Socially embarrassing only

B. Harmful or dangerous

In specific phobia, anxiety most commonly occurs:

A. After exposure to stimulus
B. Only without exposure
C. Exclusively during sleep
D. Only after reassurance

A. After exposure to stimulus

The behavioral result of specific phobia is usually:

A. Emotional numbing or painful endurance
B. Avoidance or painful endurance
C. Expansive socialization or painful endurance
D. Confused wandering or painful endurance

B. Avoidance or painful endurance

Which minimum duration most supports a phobia diagnosis as a disorder?

A. 2 weeks
B. 1 month
C. 3 months
D. 6 months

D. 6 months

Which finding best distinguishes agoraphobia from specific phobia?

A. Fear linked to hard escape
B. Fear of one object
C. Persistent dangerousness belief
D. Anxiety after exposure

A. Fear linked to hard escape

Which finding best distinguishes specific phobia from panic disorder?

A. Unexpected attacks occur
B. Fear centers on one object
C. Episodes last minutes-hours
D. Intense fear is present

B. Fear centers on one object

A child presents mainly with headache, stomach upset, and palpitations rather than verbalized fear. This is most consistent with which principle?

A. Panic attacks need mania
B. Special populations show more somatic symptoms
C. Elderly show fewer body symptoms
D. Childhood anxiety lacks impairment

B. Special populations show more somatic symptoms

Which description best matches a patient with agoraphobia rather than panic disorder alone?

A. Fears snakes specifically
B. Avoids malls and subways
C. Has tinnitus with anxiety
D. Has compulsive counting rituals

B. Avoids malls and subways

A patient with panic attacks says some attacks are unprovoked, while others seem loosely tied to a setting but not reliably. This pattern is best described as:

A. Purely expected attacks
B. Purely nocturnal attacks
C. Unexpected plus situationally predisposed
D. Factitious symptom production

C. Unexpected plus situationally predisposed

A 19-year-old student avoids class presentations because she fears blushing, stammering, and being judged by peers. Which diagnosis best fits?

A. Panic disorder
B. Social anxiety disorder
C. Agoraphobia
D. Specific phobia

B. Social anxiety disorder

A patient reports marked fear whenever he must interact with unfamiliar people at networking events. This most strongly supports fear of:

A. Contact with strangers
B. Open public spaces
C. Sudden panic symptoms
D. Separation from home

A. Contact with strangers

Which situation is most characteristic of social anxiety disorder?

A. Fear of myocardial death
B. Fear of elevators only
C. Fear of social scrutiny
D. Fear of contamination rituals

C. Fear of social scrutiny

A woman says, “I can go to restaurants, but I panic if anyone watches me eat.” This presentation best illustrates:

A. Recurrent unexpected panic
B. Performance-specific social fear
C. Classic agoraphobia
D. Broad obsessive rumination

B. Performance-specific social fear

Which thought is most typical of social anxiety disorder?

A. “I may be rejected.”
B. “I will stop breathing.”
C. “The room is unsafe.”
D. “My family will die.”

A. “I may be rejected.”

A patient has no fear of the speech itself, but intense fear of embarrassing himself while speaking. This most strongly reflects fear of:

A. Motor symptoms
B. Cardiac collapse
C. Embarrassment in social settings
D. Sensory overstimulation

C. Embarrassment in social settings

Which feature best distinguishes social anxiety disorder from ordinary shyness?

A. Clinically significant impairment
B. Presence of hallucinations
C. Frequent manic episodes
D. Daily suicidal disclosure

A. Clinically significant impairment

Social anxiety disorder can involve which pattern of feared situations?

A. Only broad social fear
B. Only panic in crowds
C. Specific or nonspecific embarrassment fears
D. Only stranger-related avoidance

C. Specific or nonspecific embarrassment fears

A man avoids dating, interviews, and group discussions because he expects humiliation. The central psychopathology is best described as:

A. Fear of social situations
B. Fear of internal impulses
C. Fear of public transport
D. Fear of serious illness

A. Fear of social situations

A resident worries constantly about work, finances, family, health, and future plans nearly every day for months. Which diagnosis best fits?

A. Social anxiety disorder
B. Panic disorder
C. Specific phobia
D. Generalized anxiety disorder

D. Generalized anxiety disorder

Which time course best supports generalized anxiety disorder?

A. Two weeks of severe fear
B. Six months of pervasive worry
C. One panic attack monthly
D. Three days after trauma

B. Six months of pervasive worry

In generalized anxiety disorder, worry is usually directed toward:

A. One circumscribed object
B. Only social performance
C. Several events or activities
D. One unexpected panic trigger

C. Several events or activities

A patient with GAD reports muscle tightness, poor sleep, irritability, and feeling keyed up. These symptoms are best categorized as:

A. Somatic accompaniments of worry
B. Negative symptoms of psychosis
C. Features of dissociation
D. Signs of mania

A. Somatic accompaniments of worry

Which symptom is specifically associated with generalized anxiety disorder in your material?

A. Grandiosity
B. Restlessness
C. Aphasia
D. Compulsions

B. Restlessness

A patient with generalized anxiety says, “Every small issue feels like it could become a disaster.” This best reflects:

A. Catastrophic expectation
B. Thought broadcasting
C. Social embarrassment
D. Panic-trigger avoidance

A. Catastrophic expectation

Which statement best captures a key cognitive feature of generalized anxiety disorder?

A. Worries stay neatly compartmentalized
B. Concerns are easy to defer
C. The patient cannot prioritize worries
D. Fears occur only socially

C. The patient cannot prioritize worries

A patient’s excessive worry interferes with handling urgent real-life problems because minor concerns cannot be set aside. This most strongly indicates:

A. Flight of ideas
B. Impaired prioritization
C. Delusional guilt
D. Performance anxiety

B. Impaired prioritization

What is a hallmark of generalized anxiety disorder rather than normal worry?

A. Hard-to-control worry causing impairment
B. Fear limited to embarrassment
C. Worry only during scrutiny
D. Panic attacks with doom

A. Hard-to-control worry causing impairment

Which statement best differentiates generalized anxiety disorder from panic disorder?

A. GAD is always trigger-specific
B. GAD centers on sudden terror
C. GAD involves chronic excessive worry
D. GAD lacks physical symptoms

C. GAD involves chronic excessive worry

Which presentation most strongly suggests social anxiety disorder rather than generalized anxiety disorder?

A. Diffuse worry about many domains
B. Six months of hard-to-control worry
C. Fear of scrutiny while eating
D. Muscle tension and insomnia

C. Fear of scrutiny while eating

The key question to distinguish panic disorder from social anxiety disorder is whether the patient primarily fears:

A. Being judged while speaking
B. Having another panic attack
C. Looking physically unattractive
D. Forgetting prepared material

B. Having another panic attack

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Which psychiatric disorder is the most common cause of agoraphobia?

A. Specific phobia
B. Panic disorder
C. OCD
D. PTSD

B. Panic disorder

Panic attacks should prompt consideration of which endocrine disorder?

A. Hypothyroidism
B. Hyperparathyroidism
C. Pheochromocytoma
D. All of the above

D. All of the above

Episodic hypoglycemia causing panic-like episodes should raise suspicion for:

A. Insulinoma
B. Glucagonoma
C. Pheochromocytoma
D. Hyperthyroidism

A. Insulinoma

A panic-like presentation may actually reflect a primary neurologic process such as:

A. Seizure disorder
B. Osteoarthritis
C. Iron deficiency
D. Migraine aura

A. Seizure disorder

Which cardiopulmonary condition can mimic panic attacks?

A. Asthma
B. Cellulitis
C. Pancreatitis
D. Nephrolithiasis

A. Asthma

Which feature is most atypical for primary panic disorder and should suggest another diagnosis?

A. Sweating
B. Dyspnea
C. Ataxia
D. Palpitations

C. Ataxia

Panic disorder commonly coexists with which mood feature?

A. Grandiosity
B. Depressive symptoms
C. Expansive affect
D. Euphoria

B. Depressive symptoms

Which disorder may coexist with panic disorder?

A. OCD
B. Delirium
C. Mania
D. Catatonia

A. OCD

Which additional comorbidity can occur in patients with panic disorder?

A. Alcohol use disorder
B. Wilson disease
C. Huntington disease
D. Somatic paralysis

A. Alcohol use disorder

Which event may precipitate later panic attacks after an initial spontaneous episode?

A. Physical exertion
B. Severe anemia
C. Slow-wave sleep
D. Eating large meals

A. Physical exertion

Which mental symptom is most characteristic of a panic attack?

A. Thought insertion
B. Extreme fear and doom
C. Grandiose certainty
D. Blank indifference

B. Extreme fear and doom

During a panic attack, patients often cannot identify the source of fear and may also have:

A. Hypergraphia and echolalia
B. Confusion and poor concentration
C. Aphasia and neglect
D. Elation and pressured speech

B. Confusion and poor concentration

Which physical sign is commonly seen during a panic attack?

A. Dyspnea
B. Jaundice
C. Edema
D. Hematuria

A. Dyspnea

Panic disorder most commonly begins in:

A. Early childhood
B. Late adolescence
C. Late adulthood
D. Infancy

B. Late adolescence

Most cases of panic disorder are associated with:

A. Clear psychosocial stressors
B. No identifiable stressors
C. Recent head trauma
D. Ongoing psychosis

B. No identifiable stressors

Panic disorder is best described as:

A. Brief and self-limited
B. Episodic but nonrecurrent
C. Chronic
D. Usually one-time only

C. Chronic

Between panic attacks, patients often experience:

A. Anticipatory anxiety
B. Complete symptom resolution
C. Elevated mood
D. Confabulatory recall

A. Anticipatory anxiety

The frequency and severity of panic attacks typically:

A. Stay fixed over time
B. Fluctuate
C. Improve daily
D. Worsen uniformly

B. Fluctuate

Excessive intake of which substances can worsen panic symptoms?

A. Caffeine and nicotine
B. Calcium and magnesium
C. Iron and folate
D. Fiber and protein

A. Caffeine and nicotine

Which treatment most rapidly and completely reduces agoraphobia?

A. Behavioral therapy
B. Lithium
C. Haloperidol
D. Benztropine

A. Behavioral therapy

Agoraphobia without a history of panic disorder is often:

A. Mild and transient
B. Incapacitating and chronic
C. Psychotic and violent
D. Limited to children

B. Incapacitating and chronic

Which comorbid conditions may complicate the course of panic disorder?

A. Depression and alcohol misuse
B. Asthma and eczema
C. Obesity and gout
D. Migraine and tinnitus

A. Depression and alcohol misuse

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Most anxiety disorders have which overall course?

A. Single episode, full remission
B. Chronic with multiple relapses
C. Rapidly progressive dementia
D. Brief episodes without recurrence

B. Chronic with multiple relapses

Generalized anxiety disorder is notable for:

A. Single lifelong episode
B. Multiple relapses
C. Predominant mania
D. Progressive aphasia

B. Multiple relapses

Most of these anxiety disorders are associated with increased risk of:

A. Stroke
B. Suicide
C. Seizures
D. Blindness

B. Suicide

Which group best represents the psychosocial therapies listed for anxiety disorders?

A. Psychodynamic, somatic, analytic
B. Virtual, somatic, analytic
C. CBT, behavioral, interpersonal
D. Exposure, biologic, supportive

C. CBT, behavioral, interpersonal

A patient with social anxiety disorder avoids conversations and presentations because of fear of embarrassment. Which treatment is listed as first-line?

A. Supportive psychotherapy
B. Virtual therapy
C. Insight-oriented therapy
D. Individual CBT

D. Individual CBT

Which psychotherapy format is specifically noted as useful for social anxiety when CBT techniques are used?

A. Group psychotherapy using CBT
B. Hypnosis using CBT
C. Interpersonal therapy using CBT
D. Flooding using CBT

A. Group psychotherapy using CBT

A patient with a specific phobia of dogs is treated by directly encountering the feared stimulus in real life. Which method is this?

A. Systematic desensitization
B. In vivo exposure
C. Supportive psychotherapy
D. Insight-oriented therapy

B. In vivo exposure

In panic disorder, cognitive therapy most directly focuses on correcting:

A. Poor autobiographical memory
B. Family role conflicts
C. Vestibular misperceptions
D. False beliefs about panic

D. False beliefs about panic

A patient says, “Every panic attack means I’m dying.” Which explanation is central to cognitive therapy?

A. Attacks are time-limited
B. Attacks always imply arrhythmia
C. Attacks require deep analysis
D. Attacks confirm hidden trauma

A. Attacks are time-limited

Which statement best captures a core idea of behavioral therapy?

A. Symptoms need dream analysis
B. Insight must precede change
C. Change can occur without insight
D. Insight alone abolishes avoidance

C. Change can occur without insight

Which pair is explicitly listed among behavioral techniques?

A. Transference and confrontation
B. Positive and negative reinforcement
C. Free association and silence
D. Interpretation and catharsis

B. Positive and negative reinforcement

A therapist pairs relaxation with progressively more anxiety-provoking cues. Which technique is this?

A. Flooding
B. Thought stopping
C. Implosion
D. Systematic desensitization

D. Systematic desensitization

Which set consists only of exposure-based behavioral techniques named in the material?

A. Flooding, implosion, graded exposure
B. Advice, praise, reflection
C. Interpretation, exposure, insight
D. Self-monitoring, support, modeling

A. Flooding, implosion, graded exposure

Which trio is specifically listed under behavioral therapy?

A. Dream work, hypnosis, abreaction
B. Role-play, journaling, catharsis
C. Response prevention, thought stopping, relaxation
D. Insight, empathy, reassurance

C. Response prevention, thought stopping, relaxation

Which set is explicitly included among behavioral methods?

A. Avatar work, exposure, advice
B. Panic control, self-monitoring, hypnosis
C. Interpretation, support, journaling
D. Relaxation, lithium, desensitization

B. Panic control, self-monitoring, hypnosis

A patient with a snake phobia is gradually exposed to snake-related stimuli while practicing relaxation skills. Which principle is being used?

A. Gradual exposure with relaxation
B. Pure insight development
C. Interpersonal restructuring
D. Supportive defense building

A. Gradual exposure with relaxation

Interpersonal psychotherapy for social anxiety mainly provides:

A. Direct in vivo exposure
B. Cognitive restructuring of panic
C. Reinforcement schedules
D. Interpersonal skills training

D. Interpersonal skills training

In interpersonal psychotherapy, socially anxious patients are often viewed as having:

A. Primary perceptual distortions
B. Interpersonal deficits
C. Severe memory impairment
D. Predominant compulsions

B. Interpersonal deficits

A patient with agoraphobia practices coping in a simulated crowded station before entering one in real life. Which treatment is this?

A. Virtual therapy
B. Group CBT
C. Supportive psychotherapy
D. Insight-oriented therapy

A. Virtual therapy

In virtual therapy, patients often identify with what during computer sessions?

A. Therapists
B. Family members
C. Classmates
D. Avatars

D. Avatars

Supportive psychotherapy is primarily used to promote:

A. Unstructured catharsis
B. Adaptive coping
C. Immediate extinction learning
D. Dream interpretation

B. Adaptive coping

In supportive psychotherapy, adaptive defenses are generally:

A. Weakened to reveal conflict
B. Ignored during treatment
C. Encouraged and strengthened
D. Replaced by exposure

C. Encouraged and strengthened

Which therapist action is specifically part of supportive psychotherapy?

A. Promote transference neurosis
B. Avoid practical guidance
C. Interpret all defenses deeply
D. Assist reality testing

D. Assist reality testing

A therapist helps a patient reality-test anxious beliefs and also gives behavioral advice. Which therapy does this best describe?

A. Supportive psychotherapy
B. Insight-oriented psychotherapy
C. Pure flooding therapy
D. Interpersonal psychotherapy

A. Supportive psychotherapy

Insight-oriented psychotherapy mainly seeks greater insight into:

A. Reward schedules
B. Psychological conflicts
C. Exposure hierarchies
D. Respiratory misinterpretation

B. Psychological conflicts

In insight-oriented psychotherapy, unresolved conflicts are understood to manifest as:

A. Endocrine dysregulation
B. Neuromuscular disease
C. Symptomatic behavior
D. Pure autonomic discharge

C. Symptomatic behavior

Epidemiologic studies of anxiety disorders most consistently show higher rates in:

A. Men
B. Boys
C. Women
D. Elderly adults

C. Women

Anxiety disorders most commonly begin during:

A. Childhood or adolescence
B. Mid-adulthood
C. Late adulthood
D. Old age

A. Childhood or adolescence

The median age of onset for anxiety disorders is closest to:

A. 6 years
B. 18 years
C. 25 years
D. 12 years

D. 12 years

Which anxiety-disorder group is most stable over time?

A. Panic disorders
B. Phobic disorders
C. Trauma disorders
D. Obsessive disorders

B. Phobic disorders

Panic disorder and generalized anxiety disorder most classically follow which course?

A. Exacerbations and remissions
B. Single lifelong episode
C. Progressive cognitive decline
D. Continuous fixed severity

A. Exacerbations and remissions

Anxiety disorders are more common in individuals with:

A. Higher educational level
B. Greater occupational prestige
C. Lower socioeconomic status
D. Later retirement age

C. Lower socioeconomic status

Genetic studies support which broad conclusion about major anxiety disorders?

A. Purely environmental origin
B. Single-gene inheritance
C. No family clustering
D. Familial aggregation exists

D. Familial aggregation exists

Familial risk in panic disorder is strongest for:

A. Late-onset panic disorder
B. Early-onset panic disorder
C. Panic with substance use
D. Panic after trauma

B. Early-onset panic disorder

In social anxiety disorder, familial loading is strongest for the:

A. Generalized subtype
B. Performance subtype
C. Situational subtype
D. Panic-prone subtype

A. Generalized subtype

Which statement best describes the search for anxiety genes?

A. Highly penetrant genes identified
B. Single major locus proven
C. Findings remain inconsistent
D. Mendelian transmission confirmed

C. Findings remain inconsistent

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Which set has been most studied in anxiety neuroimaging?

A. Basal ganglia, thalamus, pons
B. Cerebellum, insula, medulla
C. Caudate, putamen, occipital lobe
D. Amygdala, frontoamygdala, vlPFC

D. Amygdala, frontoamygdala, vlPFC

The hippocampus is especially important in:

A. Fear learning and extinction
B. Auditory threat detection
C. Motor slowing in panic
D. Language-based worry

A. Fear learning and extinction

In patients with phobias, increased activity has been described in which additional regions?

A. Cerebellum and occipital pole
B. Medulla and hypothalamus
C. OFC, insula, vlPFC
D. Putamen and premotor cortex

C. OFC, insula, vlPFC

Neurochemical models of anxiety most emphasize:

A. Cholinergic and histaminergic systems
B. Noradrenergic, 5-HT, dopamine, GABA
C. Glycinergic and opioid systems
D. Endocannabinoid systems only

B. Noradrenergic, 5-HT, dopamine, GABA

PET and fMRI studies most strongly implicate which circuit set in anxiety disorders?

A. Motor cortex, caudate, pons
B. Thalamus, cerebellum, medulla
C. OFC, red nucleus, amygdala
D. Amygdala, vmPFC, hippocampus

D. Amygdala, vmPFC, hippocampus

In resting-state panic disorder, abnormalities most strongly implicate:

A. Insular and striatal regions
B. Hippocampal and parahippocampal areas
C. Primary motor cortex
D. Ventral occipital cortex

B. Hippocampal and parahippocampal areas

During an acute panic state, imaging most often shows:

A. Increased PFC with thalamic loss
B. Insular/striatal activity, reduced PFC
C. Pure hippocampal overactivity
D. Isolated cerebellar activation

B. Insular/striatal activity, reduced PFC

Structural MRI in panic disorder has suggested abnormalities of gray-matter volume in:

A. Frontal and parietal regions
B. Insular and occipital regions
C. Cerebellar and thalamic regions
D. Parahippocampal and temporal regions

D. Parahippocampal and temporal regions

MRI studies of brain lactate in panic disorder suggest an exaggerated response to:

A. Hypocapnia
B. Hypernatremia
C. Hyperglycemia
D. Hypothermia

A. Hypocapnia

Hyperventilation → ↓ CO₂ (hypocapnia)
→ altered brain pH / metabolism
→ ↑ brain lactate
→ can trigger panic symptoms

The exaggerated lactate-related response in panic disorder has been interpreted as supporting a:

A. vestibular model
B. suffocation response
C. motor disinhibition model
D. frontal seizure model

B. suffocation response

SPECT binding studies in panic disorder have found abnormalities involving:

A. Dopamine and glutamate
B. Acetylcholine and glycine
C. Histamine and NMDA
D. GABA and 5-HT1A

D. GABA and 5-HT1A

SPECT studies in panic disorder point to abnormalities in:

• GABA (↓ inhibitory tone → increased anxiety)
• 5-HT₁A receptors (serotonin system involved in anxiety regulation)

In specific phobias, symptom-provocation studies most strongly suggest activation of:

A. Basal ganglia and cerebellum
B. Hypothalamus and pons
C. Anterior paralimbic and sensory cortices
D. Primary motor and parietal cortex

C. Anterior paralimbic and sensory cortices

• Anterior paralimbic areas (amygdala, anterior cingulate) → fear/emotional processing
• Sensory cortices → heightened perception of the feared object

In social anxiety disorder, neuroimaging shows exaggerated responses to social stimuli in the:

A. medial temporal lobe
B. posterior cingulate
C. occipital cortex
D. cerebellar vermis

A. medial temporal lobe

Which structure is especially hyperresponsive to social threats in social anxiety disorder?

A. Hippocampus
B. Amygdala
C. Caudate
D. Thalamus

B. Amygdala

In a classic conditioning experiment, a tone is repeatedly paired with an electric shock. After learning, the tone alone triggers fear. The tone is best classified as the:

A. unconditioned stimulus
B. conditioned stimulus
C. aversive response
D. extinction cue

B. conditioned stimulus

In the same experiment, the electric shock is the:

A. conditioned stimulus
B. learned reinforcer
C. unconditioned stimulus
D. neutral stimulus

C. unconditioned stimulus

Before conditioning occurs, the auditory tone is initially a:

A. neutral stimulus
B. conditioned response
C. stress hormone
D. fear output

A. neutral stimulus

Repeated pairing of a tone with shock leads the animal to fear the tone. This process is called:

A. extinction
B. conditioning
C. habituation
D. displacement

B. conditioning

After successful Pavlovian fear conditioning, presentation of the tone alone most likely produces:

A. loss of arousal
B. no learned response
C. conditioned fear
D. reward seeking

C. conditioned fear

If the conditioned stimulus is repeatedly presented without the unconditioned stimulus, the animal eventually stops linking them. This is called:

A. generalization
B. reinforcement
C. sensitization
D. extinction

D. extinction

Which statement best describes early life stressors in anxiety etiology?

A. Prevent later anxiety disorders
B. Predispose to later anxiety
C. Only affect adult memory
D. Eliminate fear conditioning

B. Predispose to later anxiety

Connections between the thalamus and which amygdala region are central to fear conditioning for sensory stimuli?

A. lateral nucleus
B. output nucleus
C. basal nucleus
D. corticomedial nucleus

A. lateral nucleus

The most extensive projections from the lateral amygdala go to which nuclei, helping form long-lasting fear traces?

A. central nuclei
B. basal nuclei
C. septal nuclei
D. mammillary nuclei

B. basal nuclei

Which amygdala components organize the behavioral responses reflecting the summed activity of many nuclei?

A. basal nuclei
B. thalamic nuclei
C. output nuclei
D. hippocampal nuclei

C. output nuclei

The central nucleus of the amygdala projects most directly to systems involved in expressing fear through:

A. language and praxis
B. memory consolidation only
C. visual discrimination
D. motor autonomic neuroendocrine pathways

D. motor autonomic neuroendocrine pathways

Which structure can activate CRH to stimulate the stress response?

A. cerebellum
B. hippocampus
C. hypothalamus
D. pons

C. hypothalamus

In addition to fear learning and extinction, the hippocampus helps develop:

A. emotional responses linked to fear
B. motor responses to pain
C. endocrine responses to reward
D. auditory responses to language

A. emotional responses linked to fear

Which brain regions are specifically named as targets of central amygdala output in fear expression?

A. thalamus, cortex, caudate
B. pons, cerebellum, striatum
C. hypothalamus, midbrain, medulla
D. hippocampus, insula, putamen

C. hypothalamus, midbrain, medulla

A 28-year-old with panic symptoms, generalized worry, and social avoidance needs initial pharmacotherapy. What is first-line for most anxiety disorders?

A. Quetiapine
B. Buspirone
C. SSRI
D. Benzodiazepine

C. SSRI

For most anxiety disorders, the most conservative medication strategy is to begin with:

A. SSRI
B. Quetiapine
C. Alprazolam
D. Propranolol

A. SSRI

A patient cannot take an SSRI and needs a common non-SSRI option for anxiety. Which drug fits?

A. Mirtazapine
B. Venlafaxine
C. Hydroxyzine
D. Phenelzine

B. Venlafaxine

Tricyclic antidepressants are generally used less often in anxiety disorders mainly because of:

A. Poor efficacy
B. Slow onset only
C. Severe tolerance
D. Side effects

D. Side effects

A patient with anxiety and marked insomnia may benefit from which agent partly because of its sedative effect?

A. Mirtazapine
B. Buspirone
C. Venlafaxine
D. Propranolol

A. Mirtazapine

Which medication class is described as the most popular treatment for anxiety disorders overall?

A. SSRIs
B. TCAs
C. Benzodiazepines
D. Antipsychotics

C. Benzodiazepines

Best use of benzodiazepines in most anxiety disorders is:

A. First-line monotherapy
B. Short-term adjunct or acute use
C. Lifelong prevention therapy
D. Routine maintenance therapy

B. Short-term adjunct or acute use

Long-term benzodiazepine therapy should generally be considered only in patients who:

A. Prefer rapid relief
B. Have social anxiety
C. Need sleep improvement
D. Fail or cannot tolerate SSRIs

D. Fail or cannot tolerate SSRIs

Which concern most limits long-term benzodiazepine use?

A. Dependence and cognitive effects
B. Severe endocrine toxicity
C. Permanent QT prolongation
D. Delayed antidepressant response

A. Dependence and cognitive effects

Which statement about benzodiazepines is most accurate?

A. Tolerance always develops quickly
B. They are ineffective acutely
C. Anxiolytic tolerance does not develop
D. They worsen all panic attacks

C. Anxiolytic tolerance does not develop

Antipsychotics and anticonvulsants are generally not recommended as:

A. Maintenance therapy
B. Initial therapy
C. Augmentation agents
D. Inpatient treatment

B. Initial therapy

Which drug is listed as a second-line treatment for generalized anxiety disorder in these notes?

A. Hydroxyzine
B. Phenelzine
C. Propranolol
D. Quetiapine

D. Quetiapine

Quetiapine (an atypical antipsychotic) is sometimes used as a second-line option for GAD, especially when first-line treatments (SSRIs/SNRIs, buspirone) are ineffective or not tolerated.

Which drug is effective for generalized anxiety disorder and can also be added to antidepressants for other anxiety disorders?

A. Buspirone
B. Lorazepam
C. Dronedarone
D. Carbamazepine

A. Buspirone

A violinist becomes tremulous only before solo performances. Which medication is especially useful?

A. Hydroxyzine
B. Buspirone
C. Propranolol
D. Mirtazapine

C. Propranolol

A patient needs acute anxiety relief but wants to avoid benzodiazepines. Which alternative is listed?

A. Venlafaxine
B. Hydroxyzine
C. Phenelzine
D. Imipramine

B. Hydroxyzine

Hydroxyzine is an antihistamine that provides rapid, short-term anxiolysis and is commonly used as a non-benzodiazepine option for acute anxiety.

A patient in severe acute distress needs very rapid symptomatic control while long-term treatment is being started. Which class is most useful?

A. SSRIs
B. MAOIs
C. Buspirone
D. Benzodiazepines

D. Benzodiazepines

Which short-term agents are specifically named as helpful benzodiazepines?

A. Lorazepam or alprazolam
B. Diazepam or clonazepam
C. Midazolam or temazepam
D. Oxazepam or chlordiazepoxide

A. Lorazepam or alprazolam

First-line pharmacotherapy options for panic disorder include:

A. TCA or MAOI
B. SSRI or venlafaxine
C. Hydroxyzine or propranolol
D. Quetiapine or buspirone

B. SSRI or venlafaxine

Which statement about panic-disorder pharmacotherapy is most accurate?

A. MAOIs are first choice
B. TCAs are preferred long term
C. Benzodiazepines prevent relapse best
D. TCAs and MAOIs are less preferred

D. TCAs and MAOIs are less preferred

Which medication is listed as a second-line option for panic disorder?

A. Mirtazapine
B. Propranolol
C. Hydroxyzine
D. Phenobarbital

A. Mirtazapine

In panic disorder, long-term antidepressant treatment is most helpful for:

A. Preventing dependence
B. Avoiding hospitalization
C. Preventing relapse
D. Reducing akathisia

C. Preventing relapse

When stopping maintenance therapy for panic disorder, it should be discontinued:

A. Abruptly after remission
B. Very slowly
C. Only during relapse
D. After benzodiazepine switch

B. Very slowly

First-line treatment for generalized anxiety disorder is:

A. Mirtazapine or TCA
B. Quetiapine or buspirone
C. Hydroxyzine or propranolol
D. SSRI or SNRI

D. SSRI or SNRI

Which drug is effective in generalized anxiety disorder but rarely used because of side effects?

A. Phenelzine
B. Fluoxetine
C. Hydroxyzine
D. Alprazolam

A. Phenelzine

Phenelzine is a monoamine oxidase inhibitor (MAOI) that can be effective for anxiety disorders, including GAD, but is rarely used due to significant drawbacks: risk of hypertensive crisis with tyramine-containing foods, multiple drug interactions, etc

A patient has a circumscribed fear of bridges without broader panic symptoms. First-choice treatment is:

A. SSRI
B. Venlafaxine
C. Behavioral psychotherapy
D. Quetiapine

C. Behavioral psychotherapy

In agoraphobia, treatment should especially address:

A. Chronic insomnia
B. Comorbid panic attacks
C. Thyroid screening first
D. Automatic hospitalization

B. Comorbid panic attacks