Anxiety/adjustment disorder

Question 1

11yo F recently moved from WA 3m ago presented with 6 week history of of sleeping difficulties, refusing to go to school and doing homework. She reported headache and stomach ache, both been checked by GP with no medical concerns. Started off missing a couple days per week, now completely stopped going.

Answer 1

Impression
Recent move = significant life stressor within 3 months of the symptom onset. Concerned about adjustment disorder/anxiety given >6 weeks sx of withdrawal, ?psychosomatic sx and sleep difficulties.

Ddx
1- adjustment disorder
2- anxiety disorder
3- depression

Question 2

Adjustment disorder - History

Answer 2

History:

• PC: characterise sx more explicitly:
• adjustment disorder: life stressor, functional impairment, distress,
• depression screen: anhedonia, worthlessness, withdrawal, appetite/weight/sleep changes, suicidality
• anxiety screen: fear of negative evaluation, fear of panic attacks, presence of panic attacks, etc
• mania screen
• psychosis screen
• Then the rest of the psychiatric history

Question 3

Adjustment disorder - Examination

Answer 3

Examination

• General observation + vital signs
• MSE

Question 4

Adjustment disorder - Investigations

Answer 4

Investigations:

• rule out organic causes
• bedside:
• bloods:
• imaging

Question 5

Adjustment disorder - Management

Answer 5

Management
- primary mode of treatment, particularly in paediatric patients is to address the triggering psychosocial stressor, if possible. Otherwise, a number of psychosocial interventions may be of utility:

• psychoeducation
• counselling
• de-arousal strategies
• CBT
• problem-solving and stress management
• psychodynamic therapy
• family counselling