Generalized Anxiety Disorder

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of increased anxiety

Symptoms described as ‍worryfeeling on edgerestlessnessirritabilitytension

Recent source of stress: ‍, ‍work-related issues, ‍personal relationship issues, ‍social issues

Severity is ‍mildmoderateseveredebilitating, ‍causingwithout causing significant distress

Negative impact on ‍daily activitiessocial lifeworkfamilypersonal relationship

Anxiety is ‍persistentintermittent

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



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

‍excessive worry

‍restlessness

‍fatigue

‍depressed mood

‍difficulty concentrating

‍irritability

‍muscle tension

‍sleep disturbances

‍racing thoughts

‍sweating

‍nausea

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

‍hallucinations



Contributing factors:

‍substance abuse

‍cannabis use

‍caffeine

‍past traumatic event

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

no use of: ‍levothyroxine, ‍stimulants, ‍new medication

no family history of: ‍anxiety disorders



Smoking: ‍neversmokerformer smoker, ‍ pack-years

Alcohol: ‍nonesociallyexcessive, ‍ drinks per ‍dayweek

Recreational drugs: ‍none ‍cannabis, ‍IVDU





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

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:

‍Anxiety ‍likelysuspectedpossible

DDx: situational anxiety, adjustment disorder, anxiety disorder, generalized anxiety disorder, panic disorder, social anxiety disorder, specific phobias, agoraphobia, obsessive-compulsive disorder, acute stress disorder, post-traumatic stress disorder, depression, bipolar disorder, hyperthyroidism, cardiac arrhythmias, substance-induced anxiety disorder (e.g., caffeine, alcohol, drugs), medication side effects, personality disorders, neurocognitive disorders, pheochromocytoma





PLAN:

Investigations:

- Blood work: ‍CBC, ‍TSH

- Urine toxicology screen

Treatments:

- Psychoeducation about anxiety

- Stress management techniques

- Relaxation techniques

- Regular exercise

- Healthy diet

- Sleep hygiene

- Avoidance of alcohol and drugs

- ‍Antidepressants

- ‍Anxiolytics/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