| Severity |
Case Example |
| Mild |
- Juan is a 16 year old male who presents to his well visit with 2 episodes over the past few months during which he experienced:
- Sudden significant urge of anxiety and worry accompanied by heart palpitations
- Shortness of breath, dizziness, cold chills, and fears of dying
- Symptoms consistent with panic attack
-
- Severity (Assess Suicidal Ideation (SI), Severity of Psych Symptoms, Co-morbidities, Impairment)
- Since these episodes, he spends much of his time worrying about having future episodes.
- He has missed several basketball practices, he worries he will have an “anxiety attack”
- Worry has impacted his academic functioning, scoring lower on tests during most recent marking period.
- Denies any other psychiatric symptoms.
- Denies any past or present wish for death, suicidal ideation, suicidal behavior, or non-suicidal self-injury.
- Diagnosis: Panic Disorder
- Severity of Symptoms/Avoidance: Mild
- Suicidality: None
- Comorbidities: None
- Level of Distress/Impairment in Functioning: Mild
- (some missed basketball practices, slight decline in grades)
- Initial Treatment
- Supportive Therapy
- Consider Cognitive Behavioral Therapy (CBT)
- Can be treated by PCP or referred to Behavioral Health as needed
|
| Moderate |
- Lauren is a 9 year old female who presents to her well visit. She has experienced significant worry over the past 9 months:
- Worry occurs almost every day of the week
-
| Worries |
About school performance, What her friends think of her, her parent’s marriage
Being sick or something bad happening to her parents |
- Difficult to control her worry
- Difficulties falling asleep and staying asleep, tired during the day, feels irritable when interacting with family, friends
-
- Severity (Assess SI, Severity of Psych Symptoms, Co-morbidities, Impairment)
- Symptoms have led to challenges in her relationships with family and friends, and has contributed to her having failing grades in two classes.
- Lauren completed a SCARED, Total Score = 32, GAD Subscale = 12
- Has established diagnosis of ADHD since 1st grade for which she takes medication.
- Denies any history of wish for death, suicidal ideation, suicidal behavior, or non-suicidal self-injury.
- Diagnosis: General Anxiety Disorder
- Severity of Symptoms/Avoidance: Moderate
- Suicidality: None
- Comorbidities: Yes - ADHD
- Level of Distress/Impairment in Functioning: Moderate
- (failing 2 classes, peer and family difficulties)
- Initial Treatment
- CBT
- Consider 1st line medication
- Family Therapy as indicated
|
| Severe |
- Aniyah, a 17 year old female presents to her well visit w/ hx of:
- Anxiety in social situations, worsened over past 6 mos
- Worries about being negatively judged by others in performance situations,
- i.e. giving presentations, and in social situations. I.e parties, events, asking people for directions, ordering food for herself
- She now avoids social situations, she recently quit track due to persistent worries about being judged about her performance
- She struggles to establish and maintain friendships, she spends much of her time in her room
- Her grades have recently declined, she is failing 3 classes
-
- Severity (Assess SI, Severity of Psych Symptoms, Co-morbidities, Impairment)
- Wish for death daily, history of intermittent SI, at times with method and plan, aborted attempt by hanging 4 mos ago
- At time of visit she endorses wish for death but denies experiencing active SI in the preceding week
- Diagnosed with Major Depression, Single episode, mild, 1 yr ago
- No current treatment despite continued symptoms
- Diagnosis: Social Anxiety Disorder
- Severity of Symptoms/Avoidance: Severe
- Suicidality: Yes
- Comorbidities: Yes - Major Depression
- Level of Distress/Impairment in Functioning/Distress: Severe
- (failing 3 classes, dropped track, peer difficulties, always in room)
- Initial Treatment
- CBT
- Start 1st line medication
- Family Therapy as indicated, consider Intensive Outpatient Program (IOP) or Partial Hospitalization Program (PHP)
|