Generate A Primary And Differential Diagnosis Using The DSM

Generate a primary and differential diagnosis using the DSM-5 criteria. Based on the fact that J.T has verbally stated he feels depressed with many negative thoughts

J.T., a young individual presenting with symptoms of depression and anxiety, requires a comprehensive diagnostic assessment utilizing the DSM-5 criteria to accurately identify primary and differential diagnoses. His symptoms include expressed feelings of depression, pervasive negative thoughts, social withdrawal, skipping classes, and declining social invitations—all aligning with criteria for Major Depressive Disorder (MDD). Simultaneously, he exhibits symptoms consistent with anxiety-related conditions, such as excessive worry, fear of negative evaluation, difficulty concentrating, and episodes of panic that suggest comorbid anxiety disorders. This essay explores the diagnostic criteria, develops a biopsychosocial plan of care, and compares different diagnostic considerations for J.T.

Understanding the Diagnostic Criteria

Major Depressive Disorder (MDD) is characterized by at least five symptoms present during a two-week period, representing a change from previous functioning, with at least one symptom being either depressed mood or loss of interest or pleasure (American Psychiatric Association, 2013). J.T.’s verbal complaints of feeling depressed, negative thoughts, social withdrawal, and declining daily activities are consistent with this diagnosis. His comments about feeling overwhelmed by academic stress and isolating himself align with the MDD criteria, particularly when symptoms cause significant impairment in social, academic, or occupational functioning.

On the other hand, the differential diagnosis includes anxiety disorders such as Generalized Anxiety Disorder (GAD), Social Anxiety Disorder (SAD), and Panic Disorder. GAD involves pervasive worry about various aspects of life, accompanied by physical symptoms like restlessness, fatigue, and difficulty concentrating (Mayo Clinic, 2018). SAD is characterized by persistent fear of social or performance situations where the individual fears negative evaluation, leading to avoidance and distress in social contexts (Hyett & McEvoy, 2018). Panic Disorder entails recurrent, unexpected panic attacks with symptoms of intense fear, palpitations, sweating, and fear of losing control, often accompanied by anticipatory anxiety (Northwestern Medicine, 2020). J.T.’s fears of judgment, social withdrawal, and episodes of panic align most closely with Social Anxiety Disorder, but comorbid depressive symptoms warrant simultaneous consideration of MDD.

Biopsychosocial Plan of Care for J.T.

Biological Interventions

The primary biological intervention involves pharmacotherapy. Selective Serotonin Reuptake Inhibitors (SSRIs), such as sertraline (Zoloft), are first-line treatments for both depression and social anxiety disorder (Bernik et al., 2018). Initiating sertraline at 50 mg daily allows for symptom improvement while monitoring for side effects. Dosage adjustments—incrementally increasing to a maximum of 200 mg/day—should be guided by clinical response and tolerability. Pharmacotherapy aims to elevate mood, reduce anxiety, and diminish social avoidance behaviors, promoting engagement in daily activities. Regular follow-up appointments are essential to assess efficacy, adherence, and adverse effects (Bershad et al., 2020).

Psychological Interventions

Cognitive Behavioral Therapy (CBT) is highly effective for depression and social anxiety. For J.T., CBT sessions should focus on cognitive restructuring to challenge negative thought patterns and behavioral experiments to gradually confront feared social situations (Hofmann et al., 2012). Exposure therapy can help destigmatize social interactions, reducing avoidance behaviors. Techniques such as mindfulness and distraction strategies, including meditation and relaxation exercises, can help manage acute stress and worry (Kabat-Zinn, 2013). Encouraging participation in group therapy with peers experiencing similar challenges fosters social skills development and provides mutual support (Rapee et al., 2017).

Social Interventions & Support

Building a supportive environment is crucial. Collaboration with academic counsellors can facilitate accommodations like flexible deadlines or reduced coursework. Parental or peer support groups can bolster social reintegration. Psychoeducation about mental health normalizes his experiences and reduces stigma. Encouraging routine physical activity and healthy lifestyle habits can also improve mood and overall resilience (Sharma et al., 2017).

Monitoring and Follow-up

Regular assessments using validated tools like the Patient Health Questionnaire-9 (PHQ-9) for depression and the Social Phobia Inventory (SPIN) for social anxiety will inform treatment progress. A multidisciplinary team involving psychiatrists, psychologists, and social workers ensures comprehensive care tailored to J.T.’s evolving needs.

Comparison of Fear, Worry, Anxiety, and Panic

Understanding the distinctions among fear, worry, anxiety, and panic is key in diagnosing and managing mental health conditions. Fear constitutes an immediate, instinctive response to an imminent threat, activating the amygdala and initiating the fight-or-flight reaction (Northwestern Medicine, 2020). It is adaptive when proportionate to the actual danger. Worry involves persistent, repetitive thinking about potential future threats and is a cognitive component of anxiety; it often lacks the physical symptoms associated with fear (Mayo Clinic, 2018). Anxiety is a broader state characterized by a general sense of unease, often rooted in anticipation of adverse events, and may include physiological symptoms like increased heart rate or muscle tension. Chronic anxiety can develop into disorders such as GAD or SAD if persistent and debilitating. Panic, however, is an intense, sudden surge of fear or discomfort often marked by physiological symptoms like palpitations, dizziness, and chest tightness. Panic attacks are discrete episodes that can occur unexpectedly or as part of panic disorder (Northwestern Medicine, 2020). While fear and panic are physiological responses to threats, worry and anxiety reflect ongoing cognitive and emotional processes that can, if unmanaged, impair daily functioning.

Conclusion

J.T.’s presentation with feelings of depression, social avoidance, and episodic panic aligns with a primary diagnosis of Major Depressive Disorder with comorbid Social Anxiety Disorder. Accurate diagnosis using DSM-5 criteria and validated screening tools facilitates targeted intervention strategies. A combined approach incorporating pharmacotherapy and psychotherapy offers the best prospects for symptom relief and functional recovery. Understanding the nuanced differences between fear, worry, anxiety, and panic underpins effective management and patient education. Ultimately, a biopsychosocial model that addresses biological, psychological, and social factors provides a holistic pathway toward improving J.T.’s mental health and overall well-being.

References

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). APA Publishing.
• Bershad, A. K., et al. (2020). Pharmacotherapy for depression: Current approach and future perspective. Journal of Clinical Psychiatry, 81(5), 19-27.
• Bernik, M., et al. (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), e0205338.
• Hofmann, S. G., et al. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440.
• Hyett, M. P., & McEvoy, P. (2018). Social anxiety disorder. In M. J. Kirchhoff (Ed.), Principles of Clinical Psychiatry. Psychiatry Publishing.
• Kabat-Zinn, J. (2013). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Viking Penguin.
• Mayo Foundation for Medical Education and Research. (2018). Anxiety disorders. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/anxiety-disorders/symptoms-causes/syc-20350961
• Northwestern Medicine. (2020). 5 things you never knew about fear. https://northwesternmedicine.org
• Rapee, R. M., et al. (2017). Peer-assisted interventions for social anxiety disorder in adolescents. Clinical Child and Family Psychology Review, 20, 1–21.
• Sharma, M., et al. (2017). Lifestyle modification and mental health. Indian Journal of Psychiatry, 59(3), 263–273.