Generate a primary and differential diagnosis using the DSM-5 criteria
J.T. is a patient seeking care following feelings of depression and a significant amount of stress about school. Based on the patient’s explanation, he feels depressed, and stressed, has difficulties identifying what is enjoyable on a typical day, and fears negative evaluation. J.T has hard time interacting with peers, interacting with teachers, turns down invitations, and is uncomfortable with authority figures.
The primary diagnosis for J.T is social anxiety disorder. A person with this condition feels symptoms of fear in situations where they may be judged or scrutinized by others (Hyett & McEvoy, 2018). Students may have challenges answering questions in class, doing daily tasks in front of others, and interacting with friends. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the criteria for diagnosis of social anxiety disorder involves persistent, intense fear of specific social situations (American Psychiatric Association, 2013). The individual develops fear because they believe they may be judged negatively, embarrassed, or humiliated. Secondly, the individual avoids anxiety-producing social situations, and if present, they endure them with intense fear. Additionally, these individuals have excessive fear that is out of proportion and their anxiety interferes with daily living (Hyett & McEvoy, 2018). J.T presents with anxiety, depression, ruminations, and social anxiety symptoms that indicate he has a social anxiety disorder.
The differential diagnoses for J.T include depression, generalized anxiety disorder, and avoidant personality disorder. Depression is a mood disorder characterized by persistent feelings of sadness and hopelessness. Affected individuals lose interest in pleasurable activities, feel unworthy, and have diminished ability to think (American Psychiatric Association, 2013). J.T has problems with concentration, stays alone in his room, and skips classes indicating a possibility of depression. Generalized anxiety disorder is a condition observed to produce fear, worry, and a constant feeling of being overwhelmed. Affected individuals persistently and excessively worry about everyday things, have difficulty controlling the worry, have difficulty concentrating and their mind goes blank sometimes. Regarding avoidant personality disorder, the affected individuals avoid any work that requires social contact because of fear that they will be criticized 9American Psychiatric Association, 2013). They may have restrained close relationships, low self-esteem, and withdrawal behavior. J.T’s symptoms of turning down invitations, ignoring phone calls, skipping classes, and isolation is an indication of avoidant personality disorder.
Develop a biopsychosocial plan of care for this client.
The initial plan of care for the patient will involve establishing the correct diagnosis using social anxiety screening tools like the Social Phobia Inventory (SPIN). SPIN is a 17-item questionnaire that is proven effective for measuring the severity of social anxiety disorder (Hyett & McEvoy, 2018). A score of 21-30 will indicate mild social phobia, 31-40 moderate 41-50 severe, and above 50 very severe social phobia.
Upon establishing the diagnosis, the second approach will involve treatment with medication and psychotherapy. The first choice of medication for social anxiety is selective serotonin reuptake inhibitors (SSRIs). For example, Zoloft (Sertraline) is FDA approved for the treatment of social anxiety disorder (Bernik et al., 2018). The drug has a high success rate with a dosage of 50 mg orally daily observed to produce tremendous results. The patient should be reviewed for improvement of symptoms after four weeks and the dosage may be increased by 25 mg weekly to a maximum of 200 mg/day (Bernik et al., 2018). The second approach will involve the use of cognitive behavioral therapy (CBT) to ensure the patient works to face the fears gradually through exposure therapy. The patient may benefit from CBT and improve confidence to deal with anxiety-inducing situations.
American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders. American psychiatric Association Press, Washington, DC.
Bernik, M., Corregiari, F., Savoia, M. G., Barros Neto, T. P., Pinheiro, C., & Neto, F. L. (2018). Concomitant treatment with sertraline and social skills training improves social skills acquisition in social anxiety disorder: A double-blind, randomized controlled trial. PloS One, 13(10), e0205809.
Hyett, M. P., & McEvoy, P. M. (2018). Social anxiety disorder: looking back and moving forward. Psychological Medicine, 48(12), 1937-1944.
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