Psychiatry and Behavioral Health Rotation

Patient will present as → a 21-year-old female complaining of poor school performance.  She is concerned about her performance despite reassurance from her professors. She tells you that her symptoms occur daily, consisting of sleep disturbances, difficulty concentrating, and irritability. She reports her symptoms started around age 16 but have worsened.

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Key Points:

• Generalized anxiety disorder (GAD) involves persistent and excessive worry pertaining to multiple events or domains that continues for > 6 months
• Anxiety is not related to a specific focus, but rather is generalized to most issues
• GAD is the most common psychiatric illness seen by primary care providers.

DSM-5 Diagnostic Criteria

• Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
• The individual finds it difficult to control the worry.
• The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months): Note: Only one item is required in children.
  • Restlessness or feeling keyed up or on edge.
  • Being easily fatigued.
  • Difficulty concentrating or mind going blank.
  • Irritability.
  • Muscle tension
  • Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
• The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of
• The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).
• The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

To be considered generalized anxiety disorder, symptoms must occur for more than 6 months

• Patients with GAD might show psychological signs, physical signs, or somatic signs. At times, they might show similar symptoms of a myocardial infarction. A quick ECG, along with Troponin levels and CK-MB, should rule out an MI
• Rule out medical disorders such as substance abuse, thyroid dysfunction, or ETOH withdrawal