Examkin

Soru

Zorluk: KolayAnxiety, OCD, and Trauma-Related Disorders

During a routine wellness check, a 42-year-old male executive reports feeling constantly "on edge" and exhausted. Upon further questioning, he reveals that for the past 8 months, he has been overwhelmingly worried about various issues including his company's performance, his children's academic success, and his mortgage. He states, "I just can't turn my brain off." He also notes frequent neck stiffness and difficulty falling asleep. He denies any depressed mood, sudden rushes of fear, or repetitive rituals. He drinks one cup of coffee daily and does not use illicit substances. Vital signs are within normal limits. Physical examination shows tense trapezius muscles but is otherwise unremarkable. Thyroid-stimulating hormone (TSH) level is normal. Which of the following is the most likely diagnosis?

  1. A
    Panic disorder
  2. B
    Adjustment disorder with anxiety
  3. Generalized anxiety disorderCevap
  4. D
    Caffeine-induced anxiety disorder
  5. E
    Primary hyperthyroidism

Cevap

Generalized anxiety disorder
The correct diagnosis is Generalized anxiety disorder because the patient describes excessive, persistent, and uncontrollable worry about various aspects of life (work, family, finances) occurring more days than not for at least 6 months. Additionally, he exhibits the required somatic symptoms, specifically fatigue, muscle tension, and sleep disturbance. The normal physical exam, normal TSH, and lack of significant substance use effectively rule out secondary causes.

Adım Adım Çözüm

1
Analyze the temporal characteristics of the patient's anxiety symptoms.
The patient has experienced constant worry for 8 months, which exceeds the 6-month threshold required for chronic anxiety conditions.
Duration of symptoms is a key differentiator between acute stress, adjustment disorders, and generalized anxiety.
2
Assess the nature and focus of the patient's worry.
The worry is excessive, uncontrollable, and spans multiple domains (work, family, finances), accompanied by somatic symptoms like muscle tension and insomnia.
This confirms the 'generalized' nature of the anxiety, ruling out specific phobias, panic attacks, or single-stressor conditions.
3
Rule out medical and substance-induced etiologies.
A normal TSH rules out hyperthyroidism; minimal caffeine intake and no illicit drug use make substance-induced anxiety highly unlikely.
Psychiatric diagnoses are diagnoses of exclusion regarding underlying physiological or substance-related causes.

Anahtar Kavram

Diagnosis of Generalized Anxiety Disorder (GAD)
Bu soruyu puanla

Konular

Anxiety, OCD, and Trauma-Related Disorders

Bu konudan daha fazla soru