Mental Disorders 3rd year 2nd semester

Question 1

Which of the following is a key feature of Social Anxiety Disorder (SAD)?
A) Avoidance of specific objects or situations
B) Persistent fear of social or performance situations leading to embarrassment
C) Recurrent panic attacks triggered by enclosed spaces
D) Fear of open spaces and using public transportation

Answer 1

Correct Answer: B) Persistent fear of social or performance situations leading to embarrassment

Explanation: Social Anxiety Disorder is characterized by intense fear of being judged or embarrassed in social situations, leading to avoidance. Specific phobias involve triggers like heights, panic disorder involves sudden panic attacks, and agoraphobia includes fear of open spaces and crowds.

Social Anxiety Disorder Criteria
The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.
The social situations are avoided or endured with intense fear or anxiety.
The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug
of abuse, a medication) or another medical condition.
The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.

Question 2

Which of the following best describes Generalized Anxiety Disorder (GAD)?
A) Recurrent, unexpected panic attacks with persistent worry about recurrence
B) Excessive worry and anxiety about various events for at least 6 months
C) Severe anxiety triggered by a specific object or situation
D) Anxiety caused by a medical condition or substance use

Answer 2

Explanation: GAD is characterized by excessive worry and anxiety about multiple aspects of life for 6 months or more. Panic disorder involves recurrent panic attacks, specific phobias involve triggers like heights or spiders, and substance-induced anxiety results from drugs or medical conditions.

Correct Answer: B) Excessive worry and anxiety about various events for at least 6 months

What is General Anxiety Disorder?
* Generalized anxiety disorder (GAD) is characterized by excessive and uncontrollable worry related to everyday life concerns such as the safety of family members, financial/job security, and health occurring most of the time for ≥6 months
* It is also the most common anxiety disorder in people >65 years of age
GAD is not always easily diagnosed, so only one-third of those affected are adequately treated

With its vague symptomatology, generalized anxiety disorder is the anxiety disorder that occurs most often in association with other psychiatric comorbidities, including depression and other anxiety disorders, as well as physical disorders, including pain syndrome, hypertension, cardiovascular diseases, and gastrointestinal disorders

Question 3

How long does it typically take to see the full clinical response to an antidepressant in anxiety disorders?
A) 2–4 weeks
B) 4–6 weeks
C) 8–12 weeks
D) 16–20 weeks

Answer 3

Correct Answer: C) 8–12 weeks
Explanation: Unlike depression, anxiety disorders often require 8–12 weeks for a full response to antidepressant treatment. Initial side effects may appear earlier, but therapeutic effects take longer.

A) 2–4 weeks - Some improvement in depression, OCD, and PTSD starts appearing, but full response takes longer. Benzodiazepines (for acute anxiety) act within hours.

B) 4–6 weeks- Antidepressants begin to have a more noticeable effect on major depressive disorder (MDD) and generalized anxiety disorder (GAD).
8–12 weeks Full response in anxiety disorders (e.g., panic disorder, social anxiety disorder). OCD and PTSD often require this duration for substantial improvement.

D) 16–20 weeks-Some chronic conditions, such as treatment-resistant depression, bipolar depression, or severe PTSD, may take this long for a significant response. Antipsychotics used in schizophrenia also show full effects within this range.

For anxiety disorders, 8–12 weeks is the typical time frame for full symptom relief, while depression can improve within 4–6 weeks but may take longer for full remission.

Question 4

Which of the following best describes Social Anxiety Disorder?

A) Fear of public spaces, transportation, or crowds, leading to avoidance
B) Intense anxiety in social or performance situations due to fear of embarrassment
C) Recurrent panic attacks with persistent concern about recurrence
D) Anxiety or panic attacks caused by another medical condition

Answer 4

Correct Answer: (B) Correct → Social Anxiety Disorder involves fear of embarrassment in social situations and avoidance behaviors.
💡 Explanation:

(A) Incorrect → Describes Agoraphobia, not Social Anxiety Disorder.
(C) Incorrect → This describes Panic Disorder, not Social Anxiety Disorder.
(D) Incorrect → This describes Anxiety Disorder Due to Another Medical Condition, not Social Anxiety Disorder.

Question 5

Which medication class is generally preferred as initial therapy for anxiety disorders?

A) Selective Serotonin Reuptake Inhibitors (SSRIs)
B) Tricyclic Antidepressants (TCAs)
C) Monoamine Oxidase Inhibitors (MAOIs)
D) Benzodiazepines

Answer 5

Correct Answer: (A) Correct → SSRIs are preferred due to their safety and tolerability in anxiety disorders.

💡 Explanation:

(B) Incorrect → TCAs have similar efficacy but are second-line due to higher risk of side effects and toxicity.
(C) Incorrect → MAOIs are third-line due to dietary restrictions, drug interactions, and side effects.
(D) Incorrect → Benzodiazepines are used for short-term relief but are not first-line due to dependence and withdrawal risks.

Question 6

How long does it typically take for the full clinical response to antidepressants in anxiety disorders?

A) 2–4 weeks
B) 4–6 weeks
C) 8–12 weeks
D) 16–20 weeks

Answer 6

Correct Answer: (C) Correct → Full clinical response takes 8–12 weeks or more, much slower than in depression.
💡 Explanation:

(A) Incorrect → Some symptoms may improve within 2–8 weeks, but full response takes longer.
(B) Incorrect → Clinical response usually takes longer than 4–6 weeks.
(D) Incorrect → While some patients may take longer, 16–20 weeks is beyond the typical timeline.

GENERAL APPROACH
* The target antidepressant dose for anxiety disorders is similar to that
used in major depressive disorder
* The antidepressant is initially introduced at a low dose to ensure tolerance and then titrated every week or 2 until the usual dose for anxiety has been reached
* Once the target dose is reached, some of the symptoms may improve
after 2–8 additional weeks of treatment
* Optimal clinical response can take up to 8–12 weeks or more (much
slower than with depression)

• Patients must be informed that the adverse effects of medication often occur upon treatment initiation, while the beneficial effects on anxiety are only experienced later
• If there is no clinical response (response being defined as a 50% or greater improvement in score on a validated scale), switching to another antidepressant should be attempted before augmenting with a second agent since, despite the paucity of studies on this subject, clinical experience shows that patients can respond to an antidepressant from another class
• Most patients suffering from anxiety disorders must continue pharmacotherapy for at least 12–24 months to achieve functional remission and prevent relapses
• When discontinuation of treatment is considered, tapering of the antidepressant should be done gradually over several months
• Sudden dose reduction or discontinuation of the medication may result in withdrawal syndrome and an increase in anxiety symptoms
• Other drug classes have demonstrated efficacy in specific anxiety disorders
• Not all drug classes improve outcomes in all anxiety disorders

Question 7

Which statement correctly differentiates Panic Disorder from Agoraphobia?

A) Panic Disorder involves unexpected panic attacks, while Agoraphobia involves fear of specific objects or situations.
B) Panic Disorder is treated primarily with benzodiazepines, while Agoraphobia is treated with SSRIs.
C) Panic Disorder includes recurrent panic attacks, while Agoraphobia involves fear and avoidance of public places.
D) Panic Disorder is a chronic condition, while Agoraphobia is self-limiting and resolves without treatment.

Answer 7

Correct Answer: (C) Correct → Panic Disorder involves unexpected panic attacks, while Agoraphobia involves avoidance of certain places due to fear of panic attacks.
💡 Explanation:

(A) Incorrect → This confuses Agoraphobia with Specific Phobia.
(B) Incorrect → Panic Disorder is treated with SSRIs and SNRIs first, not benzodiazepines as first-line.

(D) Incorrect → Agoraphobia can be chronic and significantly impact daily functioning.

Question 8

Which statement about agoraphobia is TRUE?
A) It only occurs in individuals with panic disorder
B) It can occur independently of panic disorder
C) Medication is highly effective for agoraphobia-related avoidance behaviors
D) The pharmacologic treatment of agoraphobia is different from that of panic disorder

Answer 8

B) Correct – Agoraphobia can occur independently of panic disorder.

Explanation:
A) Incorrect – Agoraphobia can occur with or without panic disorder.
C) Incorrect – Medication helps with panic symptoms but does not effectively treat avoidance behaviors.
D) Incorrect – The pharmacologic treatment of agoraphobia is the same as for panic disorder.

AGORAPHOBIA AND PANIC DISORDER WITH
AGORAPHOBIA
* Although the prevalence of agoraphobia is higher with panic disorder, it can also occur alone.
* The pharmacologic treatment of agoraphobia with or without panic disorder is the same as for panic disorder
* The avoidance behaviour can be addressed with CBT since medication is not very effective even if it reduces or eliminates the accompanying panic attacks

Question 9

Which of the following is a diagnostic criterion for Generalized Anxiety Disorder (GAD)?

a) Restlessness or feeling keyed up
b) Palpitations and accelerated heart rate
c) Recurrent, involuntary, and intrusive distressing memories of a traumatic event
d) Avoidance of social situations due to fear of scrutiny

Answer 9

Correct Answer: a) Restlessness or feeling keyed up
Explanation:
Generalized Anxiety Disorder (GAD) is characterized by excessive anxiety and worry occurring for at least 6 months, associated with three or more symptoms, one of which is restlessness or feeling keyed up.

b) Palpitations and accelerated heart rate is associated with panic disorder, not GAD.
c) Recurrent, involuntary, and intrusive distressing memories of a traumatic event is a criterion for Post-Traumatic Stress Disorder (PTSD), not GAD.
d) Avoidance of social situations is characteristic of Social Anxiety Disorder, not GAD.

Question 10

Which of the following anxiety disorders is most likely to appear in childhood or early adolescence?

A) Panic disorder
B) Generalized anxiety disorder
C) Separation anxiety disorder
D) Agoraphobia

Answer 10

Answer: (C) Correct – Separation anxiety disorder, along with specific phobias and social anxiety disorder, typically emerges in childhood or early adolescence.

Explanation:

(A) Incorrect – Panic disorder generally appears later in adolescence or adulthood.
(B) Incorrect – Generalized anxiety disorder tends to develop later than childhood.
(D) Incorrect – Agoraphobia generally appears later, often in late adolescence or adulthood.

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TREATMENT IN CHILDREN AND ADOLESCENTS
* The average age of onset for anxiety disorders is 11 years old; separation anxiety, specific phobias, and social anxiety disorder appear in childhood or early adolescence, while panic disorder, agoraphobia, and generalized anxiety disorder generally appear later
* Untreated anxiety disorders can have serious consequences, including impaired social and academic development and functioning, and lead to other psychiatric disorders in adulthood, such as depression and substance abuse
* Panic disorder or generalized anxiety disorder combined with depression is the most significant risk factor for developing suicidal ideation or behaviour in adolescents

Question 11

What is the most significant risk factor for suicidal ideation or behavior in adolescents?

A) Social anxiety disorder
B) Panic disorder or generalized anxiety disorder combined with depression
C) Specific phobia
D) Obsessive-compulsive disorder

Answer 11

Answer: B) Correct – Panic disorder or generalized anxiety disorder, when combined with depression, poses the highest risk for suicidal ideation or behavior.
Explanation:

(A) Incorrect – While social anxiety disorder can impact quality of life, it is not the most significant risk factor for suicidal ideation.
(C) Incorrect – Specific phobia does not have a strong association with suicidal ideation.
(D) Incorrect – OCD can cause distress but is not identified as the most significant risk factor for suicide in adolescents.

Question 12

What is the lifetime prevalence of Major Depressive Disorder (MDD) in Canada?
A) 5%
B) 10% ✅
C) 15%
D) 20%

Answer 12

✅ B) 10% is correct – The lifetime prevalence of MDD in Canada is approximately 10%, meaning that about 1 in 10 people will experience MDD at some point in their lives.

Explanation:
❌ A) 5% is incorrect – This represents the annual prevalence of a major depressive episode, not the lifetime prevalence.
❌ C) 15% and D) 20% are incorrect – These figures overestimate the actual prevalence based on Canadian data.

Statistics on MDD in Canada
* Focus on major depressive disorder and persistent depression disorder (aka dysthymia)
* The lifetime prevalence of MDD in Canada is approximately 10% and the annual prevalence of a major depressive episode is just under 5%

Question 13

What is the primary characteristic that defines bipolar disorder?
A) The presence of major depressive episodes only
B) The experience of at least one manic or hypomanic episode
C) Persistent low energy and pessimism without mood elevation
D) Chronic anxiety with occasional depressive symptoms

Answer 13

✅ Correct Answer: B) The experience of at least one manic or hypomanic episode
➡️ Explanation: Bipolar disorder is defined by the presence of at least one manic (Bipolar I) or hypomanic episode (Bipolar II). Depressive episodes may also occur, but they are not required for a Bipolar I diagnosis.

❌ Incorrect Answers:

(A) Depressive episodes alone do not define bipolar disorder—they are part of major depressive disorder (MDD) unless a manic or hypomanic episode has also occurred.
(C) Pessimism and low energy are symptoms of bipolar depression, but the disorder itself requires a manic or hypomanic episode.
(D) Chronic anxiety is more characteristic of generalized anxiety disorder (GAD) rather than bipolar disorder.

Question 14

What is the most common symptom of bipolar depression?
A) Grandiosity and increased energy
B) Oversleeping and profound tiredness
C) Increased sociability and rapid speech
D) Hallucinations and delusions

Answer 14

✅ Correct Answer: B) Oversleeping and profound tiredness
➡️ Explanation: Unlike unipolar depression, bipolar depression often presents with hypersomnia (excessive sleep) and fatigue rather than insomnia.

❌ Incorrect Answers:

(A) Grandiosity and increased energy are features of mania, not bipolar depression.
(C) Increased sociability and rapid speech are also symptoms of mania/hypomania, not depression.
(D) Hallucinations and delusions can occur in severe cases of bipolar disorder, but they are not the most common symptoms of bipolar depression.

Question 15

What is the first step in treating a patient experiencing a manic episode?
A) Prescribe an antidepressant immediately
B) Assess for aggression, violence, suicide risk, and insight
C) Start a second-generation antipsychotic only
D) Wait two weeks before deciding on treatment

Answer 15

✅ Correct Answer: B) Assess for aggression, violence, suicide risk, and insight
➡️ Explanation: Before selecting medication, clinicians must evaluate safety risks such as suicidality, aggression, and treatment adherence.

❌ Incorrect Answers:

(A) Antidepressants should be discontinued, as they can worsen mania.
(C) While antipsychotics are often used, the first step is assessment, not immediate medication.
(D) Waiting to treat mania can be dangerous due to impulsivity, psychotic symptoms, or high-risk behaviors.

Question 16

What is the first step in assessing a patient with a depressive episode in bipolar disorder?
A) Prescribe an antidepressant immediately
B) Assess for safety concerns, including suicidality and comorbid conditions
C) Start cognitive behavioral therapy (CBT) right away
D) Administer a mood stabilizer and send the patient home

Answer 16

Correct Answer: B) Assess for safety concerns, including suicidality and comorbid conditions
✅ Explanation: The first priority in a depressive episode, just like in mania, is to ensure patient safety. This includes evaluating suicidal risk, medical conditions, and substance use, which can complicate treatment.

❌ A) Incorrect: Antidepressants should not be given immediately in bipolar disorder, as they can trigger manic episodes without a mood stabilizer.
❌ C) Incorrect: While therapy (like CBT) is useful, it is not the first step; safety assessment is the priority.
❌ D) Incorrect: Medication should be carefully selected, and sending the patient home without a full assessment can be dangerous.

• As with acute mania, first assess the patient for basic safety issues, including potential suicidality, comorbid medical problems or substance use
• Next, the strategy depends on whether the patient is on medication and has had a breakthrough episode of major depression, or whether they are medication free
• Bipolar depression is difficult to treat

Question 17

Which of the following is considered a first-line monotherapy option for treating an unmedicated depressive episode in bipolar disorder?
A) Lamotrigine
B) Fluoxetine
C) Olanzapine
D) Carbamazepine

Answer 17

Correct Answer: A) Lamotrigine
✅ Explanation: Lamotrigine is a first-line option for bipolar depression, particularly because it has a good safety profile and is well-tolerated. However, it takes time to reach therapeutic levels.

❌ B) Incorrect: Fluoxetine (an SSRI) is not recommended as monotherapy because antidepressants can induce mania in bipolar disorder.
❌ C) Incorrect: Olanzapine is not a first-line option for bipolar depression (it is more often used for mania).
❌ D) Incorrect: Carbamazepine is used for mania, not depressive episodes.

Medication for Bipolar DEPRESSIVE EPISODES
* In an unmedicated patient, therapy may begin with any of the first-line treatments: lithium, lamotrigine, lurasidone, or quetiapine as monotherapies
* Lamotrigine is the best tolerated option, although it may take the longest to work and may be slightly less efficacious

FIRST LINE OPTIONS
* In order of preference
1. Quetiapine
2. Lithium or divalproex PLUS lurasidone
3. Lithium
4. Lamotrigine
5. Lurasidone

Question 18

Can someone with bipolar disorder return to normal without medication?

The short answer is: it’s very unlikely, especially in the long term. While some individuals may go extended periods without an episode, most will relapse without treatment due to the underlying neurobiology of the disorder.

Answer 18

1. Neurobiological Factors:

Bipolar disorder involves dysregulation of neurotransmitters (dopamine, serotonin, norepinephrine, glutamate) and structural brain abnormalities (e.g., changes in the prefrontal cortex, amygdala, and hippocampus).
These imbalances make mood stability difficult to maintain naturally.

2. Kindling Effect (Episode Sensitization):

Each mood episode increases the likelihood of future episodes, even if the person was stable before.
Over time, episodes may become more frequent and severe without proper management.

3. Sleep Disruptions:

Irregular sleep patterns can trigger mood episodes, especially mania.
Many with bipolar disorder have circadian rhythm dysfunction, which makes it harder to maintain stable moods without medication.

4. Psychosocial Stressors:

Stress, trauma, or major life changes can trigger relapse, and those with bipolar disorder may be more sensitive to stress than the general population.
Without therapy or medication, coping mechanisms might not be enough to prevent episodes.

5. Cognitive and Emotional Dysregulation:

Even in remission, people with bipolar disorder often struggle with mood instability, impulsivity, and cognitive difficulties, increasing the risk of relapse.
Can Some People Stay Stable Without Medication?
Yes, but it’s rare and usually depends on:
✅ Milder forms of bipolar disorder (e.g., Bipolar II, Cyclothymia)
✅ Strong psychosocial support, therapy, and lifestyle management
✅ Strict routine (sleep, stress management, exercise, diet)
✅ No substance use or major stressors
✅ Good self-awareness of early warning signs

However, most people (even with these factors) still relapse without medication. That’s why treatment often includes both medication and non-medication strategies (e.g., therapy, lifestyle modifications).

Key Takeaway:
The 70% relapse risk within 1 year and 95% within 5 years is due to the chronic, neurobiological nature of bipolar disorder. While some may stay stable without meds, most require long-term treatment (medication, therapy, and lifestyle changes) to prevent relapse and maintain stability.

Question 19

Which of the following is NOT a symptom of Panic Disorder?

a) Feeling of choking
b) Nausea or abdominal distress
c) Avoidance of social situations
d) Feeling of dizziness or faintness

Answer 19

Correct Answer: c) Avoidance of social situations
Explanation:
Panic Disorder involves abrupt surges of intense fear or discomfort, leading to symptoms like choking, nausea, and dizziness, but avoidance of social situations is a characteristic of Social Anxiety Disorder, not Panic Disorder.

a), b), d) are all symptoms listed under Panic Disorder diagnostic criteria.

Panic Disorder Diagnostic criteria
An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and during which time four or more of the following symptoms occur.
1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feeling of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, lightheaded, or faint
9. Derealization (feelings of unreality) or depersonalization (being detached from oneself)
10. Fear of losing control or “going crazy”
11. Fear of dying
12. Paresthesias (numbness or tingling sensation)
13. Chills or hot flushes.

Question 20

In the diagnostic criteria for PTSD, which of the following describes an example of an intrusion symptom?

a) Recurrent distressing dreams related to the traumatic event
b) Avoidance of reminders of the traumatic event
c) Irritable behavior and angry outbursts
d) Markedly diminished interest in significant activities

Answer 20

Correct Answer: a) Recurrent distressing dreams related to the traumatic event
Explanation:
Intrusion symptoms in PTSD include distressing memories, recurrent dreams, or flashbacks related to the traumatic event.

b) describes avoidance symptoms.
c) is part of the arousal and reactivity symptoms.
d) is a symptom under negative alterations in mood and cognitions.

Post traumatic stress disorder (PTSD) Criteria
Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening
after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative
amnesia, and not to other factors such as head injury, alcohol, or drugs).
2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
5. Markedly diminished interest or participation in significant activities.
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

Question 21

Which of the following is NOT a diagnostic symptom for Obsessive-Compulsive Disorder (OCD)?

a) Recurrent and persistent thoughts that cause marked anxiety
b) Repetitive behaviors that aim to prevent or reduce distress
c) Fear of losing control or “going crazy”
d) The compulsive behavior must be performed according to rigid rules

Answer 21

Correct Answer: c) Fear of losing control or “going crazy”
Explanation:
The fear of losing control or “going crazy” is a symptom of Panic Disorder, not OCD.

a), b), d) are all key diagnostic criteria for OCD, as they relate to obsessions (persistent thoughts) and compulsions (repetitive behaviors).

Obsessive compulsive disorder (OCD)
Presence of obsessions, compulsions or both.
Obsessions are defined by (1) and (2)
1. Recurrent and persistent thoughts, urges or images that are experienced, at some time during the disturbance, as intrusive, unwanted, and that in most individuals cause marked anxiety or distress
2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some thought or action. Compulsion as defined by (1) and (2)
1. Repetitive behaviours (e.g. hand washing, checking) or mental acts (e.g. praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to the rules that must be applied rigidly.
2. The behaviours or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation. However, these behaviours or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.
The obsessions or compulsions are time consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Question 22

Which of the following is a common cause of anxiety disorders?

a) Genetic predisposition
b) Low levels of serotonin only
c) A single traumatic event
d) Social anxiety due to avoiding all social situations

Answer 22

Correct Answer: a) Genetic predisposition
Explanation:
Anxiety disorders have a genetic component, where a predisposition to anxiety can be inherited.

b) Anxiety is associated with more than just serotonin; hormonal imbalances, neurotransmitters like norepinephrine, and other factors are involved.
c) While traumatic events can trigger anxiety disorders, anxiety itself is not solely caused by a single event.
d) Social anxiety is not caused simply by avoiding social situations but is marked by the fear of being scrutinized in them.

Question 23

Which of the following is NOT associated with the neurological basis of anxiety disorders?

a) Elevated cortisol levels
b) Increased norepinephrine levels
c) Activation of the amygdala
d) Low glutamate levels

Answer 23

Correct Answer: d) Low glutamate levels
Explanation:
Anxiety disorders are associated with elevated cortisol, increased norepinephrine, and activation of the amygdala. These factors are linked to heightened anxiety.

d) Glutamate levels in the brain are often elevated in anxiety disorders, not low.

Question 24

Which of the following is an example of a potential contributor to anxiety?

a) High blood sugar levels
b) Low blood pressure
c) Hormonal imbalances
d) High serotonin levels

Answer 24

Correct Answer: c) Hormonal imbalances
Explanation:
Hormonal imbalances, such as thyroid issues or perimenopause, are common contributors to anxiety.

a) Low blood sugar, not high, can contribute to anxiety symptoms.
b) Low blood pressure is not typically associated with anxiety disorders.
d) High serotonin levels are generally associated with well-being and not anxiety.

Question 25

Which of the following is a hallmark symptom of Post-Traumatic Stress Disorder (PTSD)? Choices: a) Avoidance of all social interactions. b) Intrusive thoughts or flashbacks related to the trauma. c) Overexaggerated startle response due to an external trigger. d) Excessive worry about daily events and activities.

Answer 25

**b) Intrusive thoughts or flashbacks related to the trauma. Correct: This is one of the hallmark symptoms of PTSD. Intrusive thoughts and flashbacks (dissociative reactions) are classic signs of the disorder, as individuals re-experience the trauma.** Explanation: a) Avoidance of all social interactions. Incorrect: While avoidance is a symptom of PTSD, it is specifically avoidance of reminders related to the traumatic event, not avoidance of all social interactions. Avoidance of social situations is more associated with Social Anxiety Disorder. c) Overexaggerated startle response due to an external trigger. Incorrect: An exaggerated startle response is indeed a symptom of PTSD, but it refers specifically to internal or external cues that symbolize or resemble aspects of the traumatic event, rather than all external triggers. d) Excessive worry about daily events and activities. Incorrect: This symptom is more characteristic of Generalized Anxiety Disorder (GAD), where the worry is about multiple daily activities rather than a specific traumatic event.

Question 26

What is the primary neurological system involved in Generalized Anxiety Disorder (GAD)? Choices: a) Amygdala activation leading to heightened awareness of potential danger. b) Decreased serotonin activity. c) Increased dopamine production in the brain. d) Disrupted blood flow in the frontal cortex.

Answer 26

**a) Amygdala activation leading to heightened awareness of potential danger. Correct: The amygdala plays a significant role in processing emotions, particularly fear and anxiety. In GAD, activation of the amygdala is involved in the heightened perception of potential threats, contributing to excessive worry and anxiety.** Explanation: b) Decreased serotonin activity. Incorrect: While serotonin dysregulation is implicated in various mental health disorders, GAD is more closely related to elevated norepinephrine levels, heightened amygdala activity, and increased cortisol levels rather than a direct decrease in serotonin. c) Increased dopamine production in the brain. Incorrect: Dopamine is more commonly linked to reward systems and mood disorders like depression, rather than GAD. GAD is more associated with anxiety and fear responses, not dopamine overactivity. d) Disrupted blood flow in the frontal cortex. Incorrect: While there is evidence that brain activity in regions like the prefrontal cortex may be affected in anxiety disorders, amygdala activation is more directly linked to the heightened anxiety seen in GAD. Disruption in the frontal cortex is more commonly associated with mood disorders and not the core symptomatology of GAD.

Question 27

Which of the following is considered an environmental contributor to anxiety disorders? Choices: a) High blood sugar levels b) Excessive social interactions c) Traumatic or stressful life events d) Low vitamin D levels

Answer 27

**c) Traumatic or stressful life events Correct: Traumatic or stressful life events are recognized environmental contributors to anxiety disorders. Such events can exacerbate underlying anxiety disorders, trigger new episodes, or increase susceptibility to developing one.** Explanation: a) High blood sugar levels Incorrect: While low blood sugar levels can contribute to anxiety symptoms, high blood sugar (e.g., in diabetes) is not typically recognized as an environmental contributor to anxiety disorders. This would be more of a physiological issue that could exacerbate anxiety. b) Excessive social interactions Incorrect: Excessive social interactions could cause anxiety in some individuals, but Social Anxiety Disorder specifically refers to fear of scrutiny and judgment in social settings, not excessive interaction itself. Anxiety typically arises from fear of embarrassment or humiliation rather than too much socializing. d) Low vitamin D levels Incorrect: Low vitamin D levels are more of a biological contributor to anxiety, as deficiencies in certain nutrients can affect mood and anxiety regulation, but this would not be considered an environmental factor in the same way traumatic events or stressors are.

Question 28

What is a core characteristic of Obsessive-Compulsive Disorder (OCD)? Choices: a) Recurrent, unwanted thoughts or urges (obsessions) b) Consistent avoidance of social situations c) Inability to experience positive emotions d) Excessive concern over the future

Answer 28

Explanation: a) Recurrent, unwanted thoughts or urges (obsessions) Correct: One of the primary features of OCD is the presence of obsessions, which are intrusive, unwanted thoughts or urges that cause anxiety. b) Consistent avoidance of social situations Incorrect: While avoidance can be a feature of many anxiety disorders, it is not a defining characteristic of OCD. This is more applicable to Social Anxiety Disorder. c) Inability to experience positive emotions Incorrect: This symptom is often more associated with Post-Traumatic Stress Disorder (PTSD), particularly in the context of negative mood alterations. d) Excessive concern over the future Incorrect: While worry is a feature of some anxiety disorders like GAD, it’s not a hallmark of OCD. OCD is centered around obsessions and compulsions related to preventing perceived threats.

Question 29

In diagnosing Panic Disorder, which of the following is a necessary criterion? Choices: a) The panic attacks must occur unexpectedly and without warning. b) The panic attacks must only last for a few minutes. c) The individual must experience extreme mood swings between panic attacks. d) The individual must experience symptoms for at least 6 months.

Answer 29

**a) The panic attacks must occur unexpectedly and without warning. Correct: Panic Disorder is characterized by recurrent and unexpected panic attacks. These attacks cause significant distress or concern about future attacks.** Explanation: b) The panic attacks must only last for a few minutes. Incorrect: Panic attacks typically peak within minutes, but they don’t necessarily last only a few minutes. The critical point is that they occur unexpectedly. c) The individual must experience extreme mood swings between panic attacks. Incorrect: Mood swings are not a diagnostic criterion for Panic Disorder. Panic attacks are the focus, not extreme mood swings. Mood instability is more typical of Bipolar Disorder. d) The individual must experience symptoms for at least 6 months. Incorrect: While Panic Disorder can cause distress over time, the 6-month duration is more relevant to Generalized Anxiety Disorder (GAD), not panic disorder.

Question 30

Which of the following statements about Generalized Anxiety Disorder (GAD) is true? a) It is typically triggered by a specific event b) It is caused primarily by low serotonin levels c) It originates in the amygdala and involves norepinephrine, cortisol, and glutamate d) It does not impact hormone levels

Answer 30

✅ Correct Answer: c) It originates in the amygdala and involves norepinephrine, cortisol, and glutamate (c) Correct: The amygdala is the brain's fear center, and in GAD, it signals the release of stress hormones like norepinephrine and cortisol, contributing to heightened anxiety. Explanation: (a) Incorrect: Unlike other anxiety disorders, GAD does not require a specific trigger—it is more pervasive and persistent. (b) Incorrect: While serotonin plays a role in anxiety, GAD is more closely linked to norepinephrine, cortisol, and glutamate dysregulation in the amygdala. (d) Incorrect: GAD can affect hormone levels, especially cortisol and neurotransmitters like glutamate.

Question 31

Which of the following is a key diagnostic criterion for Major Depressive Disorder? A) Depressed mood or loss of interest in activities for more than 2 weeks B) Occurs only in older adults with chronic diseases C) Must include all 9 depressive symptoms D) Symptoms must last for at least 6 months

Answer 31

**A) Correct – Major Depressive Disorder (MDD) is diagnosed when a person has a depressed mood or loss of interest in activities for more than 2 weeks, along with impaired function.** Answer Explanations: B) Incorrect – Late-life depression is associated with older adults and chronic disease, but MDD can occur at any age. C) Incorrect – A person must experience at least 5 out of 9 depressive symptoms, not all 9. D) Incorrect – The minimum duration for MDD is 2 weeks, not 6 months. **Depressive disorders – Diagnostic criteria** - Major depressive disorder - Depressed mood or loss of interest or pleasure in daily activities for more then 2 weeks - Impaired function: social, educational, occupational - Specific Symptoms at least 5/9 must be present daily Depressive disorders – Late-life depression Diagnostic criteria - Begins in older patients who have a depression alongside a chronic disease - About 50% of patients in nursing homes have been prescribed anti-depressant medications - Should be monitoring and treating elevated C-reactive protein and total homocysteine 1. Depressed mood or irritable most of the day, nearly every day by subjective or observations made by others 2. Decreased interest or pleasure in most activities, most of the day 3. Significant weight change (>5%) or change in appetite 4. Change in sleep: insomnia or hypersomnia 5. Change in activity, psychomotor agitation 6. Fatigue or loss of energy 7. Guilt or feeling of worthlessness 8. Diminished concentration or ability to think 9. Suicidality: thoughts of death or suicide

Question 32

Which of the following is true about Postpartum Depression? A) It only occurs after childbirth. B) It affects about 15% of pregnancies. C) It does not require early detection and treatment. D) It is caused by a lack of sleep after birth.

Answer 32

**B) Correct – It occurs in approximately 15% of pregnancies. Answer Explanations:** A) Incorrect – Postpartum depression can begin during pregnancy, not just after childbirth. C) Incorrect – Early detection and treatment are important for managing postpartum depression. D) Incorrect – While sleep deprivation may contribute, postpartum depression has multiple causes, including hormonal and psychological factors. **Postpartum depression Diagnostic criteria** - Begins during pregnancy - Occurs in 15% of pregnancies - Early detection and early treatment are needed

Question 33

What is a common cause of Seasonal Affective Disorder (SAD)? A) Low sunlight exposure during winter months B) High serotonin levels in winter C) A diet high in processed foods D) Vitamin A deficiency

Answer 33

**A) Correct – SAD is caused by reduced sunlight exposure, which affects melatonin and serotonin production.** Answer Explanations: B) Incorrect – Low serotonin levels, not high, contribute to SAD. C) Incorrect – While diet can influence mental health, SAD is primarily linked to light exposure. D) Incorrect – Vitamin D, not vitamin A, is associated with SAD.

Question 34

Which of the following statements about serotonin syndrome is TRUE? A) It can occur when combining SSRIs or SNRIs with 5-HTP or St. John’s Wort. B) Mild cases of serotonin syndrome have no symptoms. C) The only symptom of severe serotonin syndrome is fatigue. D) Serotonin syndrome can be prevented by increasing serotonin levels as much as possible.

Answer 34

**✅ Correct Answer: A) It can occur when combining SSRIs or SNRIs with 5-HTP or St. John’s Wort. 📌 Explanation: Serotonin syndrome results from excessive serotonin and can occur when multiple serotonin-boosting substances are used together.** ❌ B) Incorrect: Mild cases present with symptoms like anxiety, tremors, and sweating. ❌ C) Incorrect: Severe cases can involve high fever, increased heart rate, and even shock. ❌ D) Incorrect: Excessive serotonin can be dangerous, not beneficial **Serotonin Depressive Syndrome** - If patient is using an SSRI or SNRI need to watch for serotonin syndrome if prescribing St John’s wort or 5 HTP - Mild symptoms – increased heart rate, anxiety, sweating, dilated pupils, tremor or twitching and hyperresponsive reflexes - Moderate elevation- include hyperactive bowel sounds, high blood pressure and fever - Severe symptoms include increases in heart rate and blood pressure that may lead to shock

Question 35

According to ADHD diagnostic criteria, which of the following is NOT a symptom of inattention? A) Often fails to give close attention to details. B) Often loses things necessary for tasks. C) Often interrupts or intrudes on others. D) Often has difficulty organizing tasks

Answer 35

**✅ Correct Answer: C) Often interrupts or intrudes on others. 📌 Explanation: Interrupting or intruding is a symptom of impulsivity, not inattention.** ❌ A, B, D) Incorrect: These are symptoms of inattention. **Attention Deficit hyperactivity disorder (ADHD)– Diagnostic criteria** A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2): 1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities: a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate). b. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading). c. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction). d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked). Attention Deficit hyperactivity disorder (ADHD)– Diagnostic criteria e. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines). f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers). g. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones). h. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts). i. Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments). 2. Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities: Attention Deficit hyperactivity disorder (ADHD)– Diagnostic criteria Impulsivity a. Often fidgets with or taps hands or feet or squirms in seat. b. Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place). c. Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless). d. Often unable to play or take part in leisure activities quietly. e. Is often “on the go” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with). f. Often talks excessively. Attention Deficit hyperactivity disorder (ADHD)– Diagnostic criteria g. Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation). h. Often has trouble waiting his/her turn (e.g., while waiting in line). i. Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing). Attention Deficit hyperactivity disorder (ADHD)– Diagnostic criteria Several inattentive or hyperactive-impulsive symptoms were present before age 12 years. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings, (e.g., at home, school or work; with friends or relatives; in other activities). There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).

Question 36

ASD - Diagnostic Criteria Which of the following is NOT a core symptom of Autism Spectrum Disorder (ASD)? a) Deficits in social-emotional reciprocity b) Impaired coordination and balance c) Restricted, repetitive patterns of behavior d) Deficits in nonverbal communication

Answer 36

Answer: b) Impaired coordination and balance Explanation: While some individuals with ASD may have motor difficulties, they are not part of the core diagnostic criteria. Social and communication deficits (a, d) and repetitive behaviors (c) define ASD. **Autism spectrum disorder (ASD)– Diagnostic criteria** A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text): 1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back- and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions. 2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication. 3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers. Specify current severity: Severity is based on social communication impairments and restricted repetitive patterns of behavior. Autism spectrum disorder (ASD)– Diagnostic criteria B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text): 1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases). 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day). 3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest). 4. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement). Specify current severity: Severity is based on social communication impairments and restricted, repetitive patterns of behavior.

Question 37

Symptoms of ASD must be present: a) Only in adolescence b) Only in adulthood c) In the early developmental period d) Only after age 10

Answer 37

**Answer: c) In the early developmental period** Explanation: ASD symptoms appear early in life, though they may not be fully noticeable initially. Symptoms appearing only in adolescence or adulthood (a, b, d) are inconsistent with ASD. **Autism spectrum disorder (ASD)– Diagnostic criteria** C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities or may be masked by learned strategies in later life). D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning. E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

Question 38

What percentage of children with ASD in a trial showed gluten IgG sensitivity? a) 10% b) 87% c) 50% d) 25%

Answer 38

**b) Correct due to study findings indicating 87% of ASD children had gluten IgG sensitivity.** Answer: c) Incorrect as it underestimates the observed prevalence. d) Incorrect as it does not match the research data.