Irritability (adult)

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍- ‍day history of irritability

Symptoms described as ‍feeling easily annoyed

Recent source of stress: ‍, ‍work-related issues, ‍personal relationship issues, ‍financial concerns, ‍health issues

Impact on daily activities: ‍mildmoderateseveredebilitating, affecting ‍, ‍causingwithout causing significant distress

Irritability is ‍persistentintermittent, ‍cyclical with periods

Worsening factors: ‍none

Alleviating factors or self-treatments: ‍none, ‍effectiveineffective



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

‍restlessness

‍angry outbursts

‍difficulty concentrating

‍physical tension

‍insomnia

‍fatigue

‍anxiety

‍depression

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

‍suicidal plan, ‍specificvague, mean ‍‍undefined, ‍withwithout lethal mean available, place ‍ ‍undefined, time ‍ ‍undefined, ‍withwithout preparations made

‍self-harm



Contributing factors:

‍stressful life events

‍history of trauma or abuse

‍sleep disturbances

‍substance abuse

‍poor coping skills

no history of: ‍mood disorders, ‍anxiety disorders, ‍ADHD, ‍substance use disorders

no use of: ‍antidepressants, ‍new medication

no family history of: ‍mood disorders





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:

‍Mood disorder ‍likelysuspectedpossible

DDx: major depressive disorder, bipolar disorder, anxiety disorders, generalized anxiety disorder, post-traumatic stress disorder, personality disorders, ADHD, chronic stress, sleep disorders, substance abuse, substance withdrawal, medication side effect, thyroid disease, anemia, chronic pain syndrome, premenstrual syndrome, premenstrual dysphoric disorder, neurocognitive disorders, infection, grief reaction, autism spectrum disorder, schizophrenia





PLAN:

Investigations:

- Blood work: ‍CBC, ‍TSH

- Urine toxicology screen

- CT scan of the head

Treatments:

- Psychoeducation about irritability and its causes

- Stress management techniques

- Regular exercise

- Healthy diet

- Sleep hygiene

- Avoidance of alcohol and drugs

- ‍Antidepressants

- ‍Anxiolytics/Sedatives

- Cognitive behavioral therapy

Further care:

- Referral to psychologist

- Referral to psychiatrist

- Follow-up in ‍ ‍weeksmonths

- Return if irritability worsens or if new symptoms develop such as suicidal thoughts, aggression, or significant mood changes