CASE NO : 5

F41.1 GENERALIZED ANXIETY

SOCIODEMOGRAPHIC DATA

1. Name : JK

2. Age : 35

3. Sex : Female

4. Marital Status : Divorced

5. Education : Master’s Degree

6. Location of residence : Urban

7. Occupation : Software Engineer

8. Socio-economic Status : Upper Middle Class

Informant: Patient

Reliability: Reliable

Adequacy: Adequate

Presenting Complaints:

 Persistent feelings of anxiety, restlessness, and unease.

 Excessive worry and fear about various aspects of life.

 Difficulty controlling worrying thoughts.

 Physical symptoms such as headaches, muscle tension, and fatigue.

 Avoidance of situations that trigger anxiety.

 Sleep disturbances, including difficulty falling asleep and frequent nightmares.

The patient was presented with persistent symptoms of generalized anxiety. She reported

feeling anxious, restless, and on edge for the past year. Her parents and close friend noticed

her increased worry and fear about various aspects of life, including her work, relationships,

and personal safety, therefore they suggested to consult a psychologist. She mentioned that

she had a stressful work environment, including high work demands and a competitive

atmosphere, and that it contributed to her anxiety. Additionally, the recent breakup of her

long-term relationship intensified her feelings of unease. She was reluctant in talking about

the relationship.

She described having difficulty controlling her worrying thoughts, which would often

spiral into worst-case scenarios. Physical symptoms such as headaches, muscle tension, and

fatigue were common for her. She also mentioned that she avoided situations that triggered

her anxiety, such as crowded places or social events. Sleep disturbances, including difficulty

falling asleep and frequent nightmares, further impacted her daily functioning.

Onset of illness: Insidious

Course of illness: Fluctuating

Precipitating factors: Stressful work environment, recent breakup of a long-term

relationship

Duration: One year

Negative History:

No h\o of fever, diabetes, cholesterol, thyroid, hypertension.

No h\o of wandering tendency, posturing, increased religiosity.

Treatment History:

The patient sought therapy for her anxiety symptoms and has been attending regular

counselling sessions for the past six months.

Past psychiatric history:

There are no significant medical conditions or illnesses in her past medical history.

Medical History:

No history of substance abuse or addiction.

Family History:

The patient’s father is a business man and his mother is a homemaker. The patient was

married but later got divorced. Her mother has a history of anxiety disorder.

Personal History:

1. Birth and early development: The pregnancy was expected and there were no

prenatal complications. Delivery and birth cry was normal. There was no
 complications within the first two weeks and all the developmental milestones were

achieved within normal limits.

2. Behaviour during childhood: She maintained a good relation with his parents,

peers.

3. Physical illness: Absent.

4. Educational history: She started schooling at the age of 4 and completed till 12 th in

a Government School. Later she joined Aluva Queen Mother College to do her degree

and completed her Master’s too there. She was studious and had excellent scholastic

performance. She maintained a good relationship with his teachers and friends.

5. Occupational history: She started working at the age of 23 as a software engineer.

Her job satisfaction was moderate and her future ambition is to advance in her career

and achieve work-life balance.

6. Marital and social history: The patient was divorced because of communication

issues, incompatibility with her ex-spouse. She has limited close friends and her

engagement in social activities gradually decreased due to anxiety.

7. History of substance use: Occasional social drinking, no illicit drug use.

Premorbid Personality:

The patient is generally known as a conscientious and organized individual. She strives for

perfection and sets high standards for herself. She is driven and ambitious, always seeking

personal and professional growth. However, she tends to be self-critical and has a strong need

for control. She is introverted and values her alone time, but also cherishes meaningful

connections with a few close friends. She has a tendency to overthink and worry about

potential negative outcomes.

social.

 Attitude to self: She was an introvert and values her alone time.

 Social relations: She cherishes meaningful conversation with a few close friends.

 Mood: Her mood used to change very quickly.

 Leisure activity and interest: She likes to read books and watch movies.

 Habits: Occasional social drinking, no illicit drug use.

MENTAL STATUS EXAMINATION

GENERAL APPEARANCE AND BEHAVIOUR:

The patient was well kept and tidy. He had sense of surroundings. He was cooperative and

maintained eye contact. But at times he keeps staring for prolonged intervals of time and

might not hear what we have said during at that time. Rapport was easily established.

PSYCHOMOTOR ACTIVITY: Nil

SPEECH:
 1. Relevance: At times he deviates from the topic and responds with non-relevant

answers.

2. Coherence: The patient’s speech was coherent and relevant to the conversation.

3. Volume: Her volume of speech was normal.

4. Tone: There was no change in tone.

5. Tempo: The pace of speech was normal.

6. Reaction time: While most of the time the reaction time was normal.

7. Initiation of speech: Speech was easily initiated.

THOUGHT

1. Form

There is no presence of Formal Thought Disorder.

2. Stream

There is no presence of flight of ideas, retardation of thinking, circumstances or thought

blocking. She was goal directed.

3. Possession

There is no obsession, compulsion or thought alienation.

4. Content

Preoccupations with worry, fear, and worst case scenarios.

MOOD

Subjectively and objectively the patient is anxious. She is incongruent to thought and

inappropriate to situation.

PERCEPTION

1. Illusion

Nil
2. Hallucinations

Nil

3. Other perceptual abnormalities

Nil

CLINICAL ASSESSMENTS COGNITIVE FUNCTIONS:

 ORIENTATION:

To check the Orientation of the patient, some questions were asked.

“What is the time now ?” the patient correctly said that the time is 4.10 pm.

“which is this place ?” the patient correctly said that this is the metro mind hospital. “Who am

I?” the patient answered correctly that I was a psychology Intern.

Hence the orientation of time, place and person is adequate.

 ATTENTION AND CONCENTRATION:

To check attention and concentration of the patient, digit span test and serial

subtraction test were used.

Digit Span Test (forward) Digit Span Test (backward)

6, 1 3, 7

2, 4, 9 4, 8, 6

8, 3, 9, 6 6, 7, 9, 4

6, 4, 9, 3, 1 1, 5, 7, 2, 9

6, 8, 4, 2, 9, 7 3, 6, 1, 8, 4, 9

In this method, the patient recalled 3 digits forward as well as backward. For the serial

subtraction test[100-2] was used. The patient said 5 answers correctly within 1

minute. Hence, attention and concentration could be aroused.

For checking out immediate memory, the digit span method was used. In this method the

patient recalled 2 digits forward and 1 digits backwards.

For checking the recent memory, question was asked to the patient. “what you have done last

24 hours?” she was unable to recover.

For checking the remote memory, certain questions were asked to the patient, “what is your

date of birth?” the patient replied accurately.

Hence her immediate and recent memory is impaired. Her remote memory is adequate.

 INTELLIGENCE:

For the general information, the patient were asked “who is PM of India?” she replied

“Narendra Modi”. Then asked “who is CM of Kerala?” she replied “Pinarayi Vijayan”.

Hence general information is intact.

 ABSTRACTION:

To check about the abstractability level of the patient, certain questions were asked.

When she was asked about the Similarity between apple and orange she replied that

they both are round in shape. When she was asked about the Difference between

apple and orange she replied that they are having different colour. When she was

asked about the proverbs, “A friend in need is a friend indeed” she answered that

those who help us in our hard times are our real friends.

Based on the interview, general fund of information and abstract ability found to be

clinically average.

JUDGEMENT
Personal Judgment of the patient is checked out by asking questions to the patient, “what do

you think about your treatment?” the patient replied that she needed treatment because she

wanted to change .

Social Judgment is checked by asking the question, “what do you do when a guest comes to

your house?” the patient replied that she will treat them properly.

Test Judgment is checked by asking the question, “what would you do when a sealed

envelope is found in street?” the patient replied that she will post them in a post office. Hence

her personal, social, test judgement is preserved.

INSIGHT

Level 2 : Partial awareness of being sick but attributes symptoms to external factors such as

stress and life circumstances.

DIAGNOSIS

According to ICD 10, client is diagnosed with Generalized Anxiety Disorder {GAD}

{F41.1}