ASSESSING AND DIAGNOSING PATIENTS WITH MOOD DISORDERS
Sample Solution
Case Study: Navigating the Labyrinth of the Mind
Disclaimer: This case study is for educational purposes only and does not constitute a real patient encounter or diagnosis. Please consult with a qualified healthcare professional for any mental health concerns.
Presenting Complaint:
A 35-year-old woman presents to the clinic with a chief complaint of excessive worry and difficulty concentrating, affecting her work and relationships. She reports feeling constantly on edge, with a racing mind that fixates on worst-case scenarios. This has been ongoing for the past six months, significantly impacting her ability to focus at work, maintain intimacy with her partner, and enjoy social activities. Her sleep has become fragmented, and she wakes up feeling exhausted and overwhelmed.
Objective Observations:
During the interview, the patient appears visibly anxious. Her speech is rapid and punctuated by long pauses as she struggles to organize her thoughts. She fidgets with her hands and maintains direct eye contact. Her affect is tense and worried, and she readily expresses feelings of apprehension and helplessness.
Mental Status Examination:
- Alert and oriented to all spheres: The patient is aware of her surroundings, understands the purpose of the interview, and can accurately recall events.
- Thought content: Preoccupied with intrusive thoughts focused on potential financial ruin, relationship failures, and health problems. She reports no suicidal or homicidal ideation.
- Mood: Anxious and apprehensive, with occasional bursts of irritability.
- Perception: No abnormalities in perception noted.
- Psychomotor: Increased psychomotor activity observed, characterized by fidgeting and a rapid speech pattern.
Differential Diagnoses:
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Generalized Anxiety Disorder (GAD): The patient's excessive worry, difficulty concentrating, and physical symptoms like sleep disturbances and restlessness strongly align with the DSM-5-TR criteria for GAD. The lack of specific phobias or situational triggers further supports this diagnosis.
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Major Depressive Disorder (MDD): While the patient presents with anxiety, her sleep difficulties, low energy, and decreased enjoyment of activities could also suggest MDD. However, the absence of key MDD symptoms like sadness, anhedonia, and changes in appetite makes this diagnosis less likely.
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Obsessive-Compulsive Disorder (OCD): Although the patient reports intrusive thoughts, they are not accompanied by compulsive behaviors or rituals, making OCD a less probable diagnosis. Additionally, the focus of her worries is predominantly on future events rather than specific internal or external stimuli.
Critical Thinking Process:
- The primary diagnosis of GAD is supported by the presence of most core symptoms in the DSM-5-TR criteria and the absence of key features for alternative diagnoses like MDD and OCD.
- The patient's worries are excessive, uncontrollable, and interfere with daily functioning, highlighting the severity of her anxiety.
- The duration of symptoms exceeding six months further strengthens the diagnosis of GAD.
Pertinent Positives:
- Excessive worry and difficulty concentrating
- Physical symptoms like sleep disturbances, restlessness, and muscle tension
- Apprehension and irritability
- Racing thoughts and intrusive thoughts focused on future events
Pertinent Negatives:
- No suicidal or homicidal ideation
- No specific phobias or situational triggers
- Absence of key MDD symptoms like sadness, anhedonia, and appetite changes
- No compulsive behaviors or rituals
Reflection Notes:
- Building rapport and validating the patient's emotional distress would be crucial to establishing trust and encouraging open communication.
- Utilizing active listening techniques and open-ended questions could gain a deeper understanding of the specific content and triggers of her anxiety.
- Exploring potential contributing factors like past traumas, stressors at work or home, and substance use would provide a more holistic picture.
Legal/Ethical Considerations:
- Informed consent for assessment and treatment would be obtained at the outset.
- Confidentiality would be maintained throughout the process, with exceptions only for situations involving risk of harm to self or others.