Mental Disorders 3rd year 2nd semester Flashcards
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
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.
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
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
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
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.
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
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.
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
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.
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
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
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.
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.
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
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
GENERALIZED
ANXIETY DISORDER INTRODUCTION
- 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
INTRODUCTION
* 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
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: (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
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: 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.
What is the lifetime prevalence of Major Depressive Disorder (MDD) in Canada?
A) 5%
B) 10% ✅
C) 15%
D) 20%
✅ 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%
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
✅ 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.
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
✅ 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.
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
✅ 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.
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
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
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
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
an 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.
- 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.
- 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.
- 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.
- 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.
- 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.
