Hypothetical Patient:

• Patient: 16-year-old female, “Sarah”
• Presenting Concern: Persistent low mood, social withdrawal, and declining academic performance.

Clinical Presentation:

Sarah presents to the clinic accompanied by her mother. Her mother expresses concern about Sarah’s recent changes in behavior. She reports that Sarah, who was previously a bright and engaged student, has become increasingly withdrawn and irritable over the past few months. Sarah spends most of her time in her room, avoids social interactions with friends, and has shown a noticeable decline in her grades.

Specific Symptoms:

• Persistent low mood, described by Sarah as “feeling sad all the time.”
• Loss of interest in previously enjoyed activities (e.g., playing the guitar, spending time with friends).
• Social withdrawal and isolation.
• Decreased energy and fatigue.
• Changes in sleep patterns (difficulty falling asleep and staying asleep).
• Decline in academic performance.
• Feelings of worthlessness and hopelessness.
• Increased irritability and occasional outbursts of anger.
• Reports of feeling overwhelmed.

Relevant History:

• No known history of mental health disorders.
• No current medical conditions.
• No known substance use.
• Family history of depression (maternal aunt).
• Reports of increased academic pressure.

Initial Assessment:

• Mental status examination: Sarah appears sad and withdrawn. Her affect is constricted, and her speech is slow. She denies suicidal ideation but expresses feelings of hopelessness.
• Physical examination: Within normal limits.
• Review of school records.

Potential Differential Diagnoses:

• Major depressive disorder.
• Adjustment disorder with depressed mood.
• Generalized anxiety disorder.
• Social anxiety disorder.
• Substance use disorder (rule out).
• Situational depression due to academic pressure.

Next Steps:

• Conduct a thorough psychosocial assessment, including a detailed history of Sarah’s symptoms, family history, and social support.
• Administer standardized screening tools for depression and anxiety (e.g., Beck Depression Inventory, Generalized Anxiety Disorder 7-item scale).
• Consider laboratory tests to rule out medical causes of her symptoms.
• Provide psychoeducation to Sarah and her mother about depression and anxiety.
• Develop a treatment plan that may include:
  • Individual therapy (e.g., cognitive behavioral therapy, interpersonal therapy).
  • Family therapy.
  • Consideration of medication (e.g., selective serotonin reuptake inhibitors) if indicated.
  • Collaboration with the school counselor.
• Schedule follow-up appointments to monitor Sarah’s progress.

This hypothetical case illustrates the importance of a comprehensive assessment and a multidisciplinary approach to addressing mental health concerns in adolescents.