What observable signs during the MSE would suggest an acute panic attack or severe anxiety state?

• A. Slow speech and flat affect.
• B. Chronic memory loss.
• C. Visible agitation, tachycardia, diaphoresis, tachypnea, distractibility, and inability to maintain attention; frantic or hypervigilant behavior.
• D. Delusions of grandeur with preserved anxiety.

Answer: (C)

Acute panic or severe anxiety shows a state of marked autonomic arousal and heightened behavioral activation. In the exam you’d look for clear signs of distress and frantic energy: visible agitation or restlessness, possibly pacing or inability to settle, and a rapid, unsettled demeanor. Autonomic symptoms cluster as well, including a fast heart rate and sweating, along with rapid breathing. Cognitive impact shows up as distractibility and trouble maintaining attention because high arousal overloads processing and focus. This combination—agitation with autonomic activation and disrupted attention—fits an acute panic or severe anxiety state.

Other patterns don’t fit as well: slow speech with flat affect points to depression or withdrawal; chronic memory loss suggests a neurocognitive issue; delusions of grandeur with preserved anxiety implies a psychotic or manic presentation rather than an acute anxiety state.