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Self-Assessment Questions

Psychiatry

Evaluation and Treatment of Generalized Anxiety Disorder: Review Questions

William R. Marchand, MD
Dr. Marchand is chief of outpatient mental health services, George E. Wahlen Veterans Affairs Medical Center, and assistant professor of clinical psychiatry, University of Utah, Salt Lake City, UT.
This work is supported in part by the Veterans Administration VISN 19 MIRECC.




Choose the single best answer for each question.

1. A 32-year-old man presents to his primary care physician and reports excessive worry over the past month. He describes frequent concerns about everyday life stressors but denies any unusual stress. He also reports loss of interest in most activities, feelings of worthlessness, low energy, and difficulty sleeping. What is this patient’s most likely diagnosis?
  1. Adjustment disorder with anxiety
  2. Generalized anxiety disorder (GAD)
  3. Major depression
  4. Obsessive-compulsive disorder
  5. Personality disorder not otherwise specified
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2. Which of the following would be the most appropriate first-line treatment for GAD complicated by polysubstance dependence?

  1. Cognitive behavior therapy
  2. Referral to Narcotics Anonymous
  3. Short-term clonazepam therapy
  4. Thiothixene
  5. Valproic acid
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3. A 45-year-old woman previously diagnosed with GAD presents to a psychiatrist for a second opinion. She reports prior treatment with several medications and psychotherapy but has had no improvement in her symptoms. Her medical records indicate that she has failed adequate therapeutic trials of 2 selective serotonin reuptake inhibitors and buspirone. A physical examination and routine laboratory tests, including thyroid function tests, are all unremarkable. Which of the following would be the most appropriate next step in the management of this patient?

  1. Assess caffeine intake
  2. Obtain an electroencephalogram
  3. Obtain a neurology consult
  4. Start haloperidol
  5. Start lithium
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4. A 25-year-old man reports symptoms that meet diagnostic criteria for GAD. He has had a recent physical examination, electrocardiogram, blood chemistry, and thyroid function tests, all of which were normal. He does not take any prescribed medications and does not use illegal drugs, alcohol, or caffeine. Which of the following should be included in the diagnostic evaluation of this patient?
  1. Amobarbital interview
  2. Assess for comorbid psychiatric conditions
  3. Chest radiograph
  4. Dexamethasone suppression test
  5. Neuropsychologic testing
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5. Which of the following is the most appropriate first-line treatment for GAD uncomplicated by any comorbid psychiatric or medical condition?

  1. ß-Adrenergic receptor antagonist
  2. Bupropion
  3. Imipramine
  4. Treatment is not necessary unless symptoms persist for 12 months
  5. Venlafaxine
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