Burnout

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍anxietydepressed moodinsomnia

Symptoms appeared in response to: ‍ ‍changes at workend of a relationshiphealth issues

Severity is ‍mildmoderateseveredebilitating, ‍causingwithout causing significant distress

Negative impact on ‍daily activitiessocial lifeworkfamilypersonal relationships

Reaction to stressors is more intense or longer-lasting than would normally be expected

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍feeling sad or hopeless

‍anxiety or worry

‍difficulty concentrating

‍feeling overwhelmed

‍withdrawal from social supports

‍insomnia

‍hypersomnia

‍decreased performance at work/school

‍loss of appetite

‍increased appetite

‍impulsive or risky behaviors

‍suicidal thoughts, ‍persistentintermittent, ‍withwithout a plan, ‍withwithout intent to act

‍hallucinations



Contributing factors:

‍social isolation

‍past traumatic event

‍family history of mental health issues

no history of: ‍adjustment disorders, ‍anxiety disorders, ‍major depression, ‍suicidal attempts, ‍substance use disorders, ‍schizophrenia

no use of: ‍new medication



Smoking: ‍neversmokerformer smoker, ‍ pack-years

Alcohol: ‍nonesociallyexcessive, ‍ drinks per ‍dayweek

Recreational drugs: ‍none ‍cannabis, ‍IVDU





EXAM:

Mental Status:

Appearance: ‍well-dressed, ‍well-groomed, ‍goodpoor eye contact, appears ‍age-appropriate

Behavior: ‍cooperativenon-cooperative

Psychomotor activity: ‍normalretardedagitated

Speech: ‍clear, ‍slowrapid, ‍monotonoustalkative

Mood: ‍euthymicdysthymic, ‍anxious, ‍

Affect: ‍euthymic, ‍reactivenon-reactive, ‍full range, ‍appropriate to situation, ‍congruent with mood

Thought process: ‍organizeddisorganized, ‍coherentincoherent, ‍logicalillogical, ‍

Thought content: ‍normalpreoccupationshopelessness, ‍delusions, ‍suicidal ideations, ‍homicidal ideations

Perception: ‍normal, ‍hallucinations, ‍illusions

Cognition: ‍alert, oriented to ‍3 spheres, disoriented to ‍, attention ‍intactdistractible, memory ‍intactimpaired

Judgment: ‍goodmoderatepoor

Insight: ‍goodmoderatepoor into condition

Reliability: ‍goodmoderatepoor





ASSESSMENT:

‍Adjustment disorder ‍likelysuspectedpossible

DDx: depressive disorder, anxiety disorders, acute stress disorder, post-traumatic stress disorder, personality disorders, bipolar disorder, situational crisis, substance-induced mood disorder, mood disorder due to medical condition, normal bereavement





PLAN:

Investigations:

- Blood work: ‍CBC, ‍TSH

Treatments:

- Psychoeducation about adjustment disorder

- Stress management techniques

- Relaxation techniques

- Regular exercise

- Healthy diet

- Sleep hygiene

- Avoidance of alcohol and drugs

- ‍Antidepressants

- ‍Sedatives

- ‍Atypical antipsychotics

- Cognitive behavioral therapy

Further care:

- Referral to psychologist

- Referral to social worker

- Referral to psychiatrist

- Follow-up in ‍ ‍weeksmonths

- Return if condition worsen or if new symptoms develop such as suicidal thoughts