Clinical case: summary
A 25-year-old male is seeking medical help because he is struggling with his job as a consultant due to social anxiety. He experiences difficulty giving presentations and has passed up opportunities for promotion because of fear of embarrassing himself and being judged by his peers. He is otherwise comfortable interacting with small groups and friends in non-work settings.
The patient’s Problem based on Priority
1. Social anxiety: The patient's primary concern is hisdifficulty giving presentations at work due to fear of embarrassment and hispeers' judgment.
2. Career frustration: The patient is frustrated withbeing unable to take on leadership roles and potential promotions because ofhis social anxiety.
3. Self-esteem: The patient may be experiencing decreasedself-esteem due to his inability to perform at work.
Based on the symptoms described, a possible diagnosis for this patient is Social Anxiety Disorder (SAD), also known as Social Phobia. SAD is characterized by intense fear and avoidance of social situations due to fear of embarrassment, judgment, or negative evaluation from others (Schneier & Goldmark, 2015). The patient's difficulty in giving presentations and passing up opportunities for promotion due to fear of being put on the spot is consistent with symptoms of SAD.
In this case, the rationale for considering a diagnosis of Social Anxiety Disorder (SAD) is based on the patient's presenting symptoms. The patient reports experiencing intense fear and avoidance of social situations, specifically giving presentations at work, due to fear of embarrassment, judgment, or negative evaluation from others. This is consistent with the key symptoms of SAD, which include intense fear or anxiety in social situations and significant avoidance behaviors (Schneier & Goldmark, 2015). Additionally, the patient's reported frustration with being unable to take on leadership roles and potential promotions due to this fear is consistent with SAD's impact on a person's daily life and functioning.
In addition to Social Anxiety Disorder (SAD), several other conditions should be considered differential diagnoses in this case:
1. Generalized Anxiety Disorder (GAD). It ischaracterized by excessive and persistent anxiety and worry that is notspecific to social situations (Terlizzi & Villarroel, 2020).
2. Panic Disorder. It is characterized by recurrent andunexpected panic attacks and persistent concern about having additional panicattacks (Craske et al., 2010).
3. Specific Phobia: It is an intense fear or avoidance ofspecific objects or situations, such as speaking in public, that is not limitedto social situations (Eaton, Bienvenu & Miloyan, 2018).
4. Adjustment Disorder: It is a condition that candevelop in response to a significant life stressor, such as starting a new job,and is characterized by emotional or behavioral symptoms (Carta et al., 2009).
Test and Screening tools
Several tests and screening tools can help identify the correct diagnosis in this case. For example, a thorough clinical interview with the patient can help gather information about the patient's symptoms, medical history, and personal and family history. Shankman et al. (2018) suggest that a Structured Clinical Interview for DSM-5 (SCID) is a standardized diagnostic interview that can be used to diagnose various psychiatric disorders, including Social Anxiety Disorder (SAD). A therapist can also use a Social Phobia Inventory (SPIN). It is a 17-item self-report questionnaire that assesses the severity of social anxiety symptoms. In this case, the therapist providing health care services to the patient can use a Beck Depression Inventory (BDI). It is a widely used self-report questionnaire that assesses the presence and severity of symptoms of depression. The therapist can also use Generalized Anxiety Disorder 7 (GAD-7). It is a 7-item self-report questionnaire that assesses the severity of generalized anxiety symptoms. All these tests and screening tools can be used to gather additional information and help support or rule out a diagnosis of SAD and other differential diagnoses that have been considered. However, it is important to note that no test or screening tool can accurately diagnose a condition. A comprehensive evaluation by a mental health professional is necessary before providing a definitive diagnosis.
In general, treatment for Social Anxiety Disorder (SAD) often involves a combination of psychotherapy and medication. Treatment choice depends on several factors, including the severity of symptoms, comorbid conditions, and the patient's preferences and treatment history. The best treatment for the patient is psychotherapy, specifically, Cognitive-behavioral therapy. Cognitive-behavioral therapy (CBT) is the most widely researched and effective psychotherapy for SAD (Kaczkurkin & Foa, 2022). CBT teaches patients to identify and challenge negative thoughts and beliefs about themselves and social situations and gradually expose themselves to feared social situations in a controlled and safe environment. Although other treatments, such as selective serotonin reuptake inhibitors, can be considered, I would recommend CBT because it is a nonpharmacological treatment that reduces the risk of side effects and can negatively impact the patient's health.
For the assessment and treatment of the patient, I would typically use different standard guidelines. For example, I would use the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5), the Evidence-Based Practices (EBPs), and Clinical Practice Guidelines (Bockian, Smith & Berghuis, 2016). These standard guidelines will ensure that I maintain consistency and conduct effective assessment and treatment of the patient in this case. They will help ensure that I provide the highest quality of care to the patient. For example, I would use the DSM-5 to identify the professional criteria for diagnosing the patient's mental condition. I would also use clinical practice guidelines to identify the best assessment and treatment of specific mental health conditions.
Top of Form
The 25-year-old male is struggling in his new consulting firm job. He struggles to give presentations as he fears embarrassing himself and being judged by his peers. This fear has resulted in him passing up multiple leadership roles and potential promotions. He reports no difficulty interacting with peers in small groups or social settings. This case presents a fear of public speaking and potential social anxiety in the work setting. The patient's fear of public humiliation should be addressed to help him improve his work performance and reach his career goals.
The diagnosis that should be considered for this case is Social Anxiety Disorder (SAD) or Social Phobia (Koyuncu et al., 2019). This diagnosis is characterized by an intense fear of being judged or humiliated in social or performance situations.
The rationale for considering Social Anxiety Disorder (SAD) or Social Phobia as a diagnosis for the 25-year-old male is based on his presenting symptoms. He is exhibiting fear of public speaking and of being judged or humiliated in social or performance situations, which are hallmark symptoms of SAD (Koyuncu et al., 2019). Additionally, his fear is preventing him from taking on leadership roles and potential promotions in his job, which can further impair his work performance and career development. Therefore, further assessment of his symptoms is necessary to determine if he meets the criteria for diagnosis, and treatment should be provided if necessary.
When considering the differential diagnosis for this case, it is essential to consider other diagnoses, such as Generalized Anxiety Disorder (GAD), Panic Disorder, and Adjustment Disorder. While the primary diagnosis is Social Anxiety Disorder (SAD), it is essential to consider other mental health conditions influencing the patient's symptoms (Koyuncu et al., 2019). GAD is characterized by excessive worry (DeMartini et al., 2019), while Panic Disorder is characterized by sudden and intense fear (Efron & Wootton, 2021). Adjustment Disorder is characterized by emotional and behavioral symptoms responding to a stressful event (O’Donnell et al., 2019). It is essential to consider all of these diagnoses to provide the most effective treatment for the patient.
It is crucial to use both test and screening tools to help identify the correct diagnosis in this case,. One of the most commonly used tools is the Mini International Neuropsychiatric Interview (MINI), a structured clinical interview used to assess a patient's mental health status and identify potential diagnoses (Wu et al., 2020). Additionally, the Social Phobia Inventory (SPIN) is a self-report questionnaire used to measure the severity of social anxiety symptoms. These tools can help provide a more comprehensive assessment of the patient's symptoms and help identify the correct diagnosis.
Given the patient's presentation, it is crucial to consider both psychopharmacology and psychotherapy for treatment. Medication such as SSRIs and SNRIs can help reduce anxiety symptoms and improve functioning (Zolnoori et al., 2019). Cognitive behavioral therapy (CBT) is an effective psychotherapeutic treatment for Social Anxiety Disorder. CBT focuses on identifying and challenging negative thought patterns and replacing them with more adaptive ones (Arnfred et al., 2022). It is also vital to provide psychoeducation to the patient to help them better understand their condition and develop coping strategies. Referrals to a psychiatrist and other medical professionals may also be necessary to provide the most effective treatment.
When assessing and treating this patient, it is essential to use standard guidelines. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides criteria for diagnosing mental health conditions (Sarmiento & Lau, 2020), and the American Psychiatric Association (APA) has guidelines for treating mental health disorders. Additionally, the American Academy of Child and Adolescent Psychiatry (AACAP) has guidelines for assessing and treating mental health conditions in children and adolescents (Nunez & Danielson, 2023). These guidelines provide a framework for assessing and treating mental health conditions and are essential for providing evidence-based care for this patient.
In conclusion, the 25-year-old male exhibits symptoms of Social Anxiety Disorder (SAD), characterized by a fear of public speaking and of being judged or humiliated in social or performance situations. It is essential to use both test and screening tools to assess his symptoms and to consider both psychopharmacology and psychotherapy for treatment. Additionally, standard guidelines should be used to assess and treat this patient to provide evidence-based care.
Case Discussion on Anxiety
Summary of Clinical Case
A 25-year-old man who is having trouble in his new work makes a clinic visit. He works for a consulting firm and has admitted that he finds delivering presentations tough because he worries that he will look foolish in front of his peers. He has also complained that his fear of being put on the spot prevents him from accepting major roles and potential promotions.
Problems & Priorities
1. Anxiety in the workplace
2. Fear of presentation
3. Fear of being put on the spot
4. Difficulty taking on lead roles and potential promotions
The diagnosis for this patient is Generalized Anxiety Disorder related to work performance as evidenced by his fear of being put on the spot and his avoidance of lead roles and potential promotion due to fear of embarrassment (Abramowitz & Blakey, 2020).
The patient is displaying symptoms of Generalized Anxiety Disorder such as fear of presentation and fear of being put on the spot. He is also displaying avoidance behaviors such as not taking on leadership roles and potential promotions due to his fear. These symptoms and behaviors are indicative of Anxiety Disorder.
Other diagnoses that should be considered include Major Depressive Disorder, Agoraphobia, Post-traumatic Stress Disorder, and Social Anxiety Disorder. Major Depressive Disorder should be considered due to the symptoms of low mood and difficulty functioning in the workplace. Agoraphobia should be considered due to the fear of being in public settings and the fear of being embarrassed in public (Abramowitz & Blakey, 2020). Post-traumatic Stress Disorder should be considered due to the possibility of a past traumatic experience that is causing the current anxiety. And Social Anxiety Disorder should be considered due to the fear of interacting with peers and the fear of being judged by them.
Testing & Screening
A physical exam should be conducted to assess the patient's physical health and rule out any physical ailments that could be contributing to his symptoms. The clinician should also review the patient's medical history to gain a better understanding of his mental health, including any history of mental health issues, family history of mental health issues, and any medications or treatments he has been prescribed. A psychological evaluation should be conducted to assess the patient's symptoms and determine the underlying cause of his anxiety (Terlizzi & Villarroel, 2020). This evaluation should include a review of the patient's current symptoms, as well as any past experiences that may be contributing to his current symptoms. In addition, the clinician should consider the use of standardized psychological tests such as the Beck Depression Inventory and the Hamilton Anxiety Rating Scale to assess the severity of the patient's symptoms. These tests can provide the clinician with a better understanding of the patient's anxiety and help them to develop an evidence-based plan of care.
The treatment plan should include a combination of psychopharmacology, psychotherapy, and psychoeducation. The patient should be prescribed medications such as SSRIs or benzodiazepines to help reduce the symptoms of anxiety (DeMartini et al., 2019). In addition, the patient should be referred for psychotherapy such as cognitive-behavioral therapy, which can help the patient to manage his anxiety. The patient should also be provided with psychoeducation on the symptoms and treatment of Anxiety Disorder.
The treatment plan should be based on the guidelines provided by the American Psychiatric Association and the American Psychological Association. These guidelines include the use of medications, psychotherapy, and psychoeducation as well as the use of standardized psychological tests (DeMartini et al., 2019). The plan should also be tailored to the individual needs of the patient.
Yordanis Santana Soayero
21 hours ago, at 8:58 PM
Top of Form
Summarize the clinical case.
The patient has issues performing duties in his job. He is afraid of embarrassing himself when making presentations to peers and that they will belittle him. Besides, the client has turned down several promotions for fear of being in the lead role and a subject for target by the employer's on-duty performance. However, the client finds no difficulty in interacting with a small group of colleagues.
Create a list of the patient’s problems and prioritize them.
The client is suffering from any of the following three psychological disorders; social anxiety disorder, atychiphobia, or atelophobia. Social anxiety disorder (SAD) is a mental health condition where an individual is afraid of people judging him, scrutiny, or being embarrassed in public. Atychiphobia, is simply referred to as fear of failure where an individual may become depressed, anxious, or develop poor self-esteem. Atelophobia on the other hand is the fear of imperfection or making mistakes which has similar effects as atychiphobia.
Which diagnosis should be considered and what rationale
The possible diagnosis for the patient is social anxiety disorder. The rationale for choosing this condition is the symptoms the patient presents with. For instance, the client is afraid of making presentations before people view that he will be judged or might embarrass himself. The symptoms rhyme with those of individuals with SAD. According to Jefferies & Ungar (2020), SAD is a social issue where individuals find it difficult to give presentations before others or socialize with other people. They feel worried that other people may view them as being less intelligent or competent in what they do and thus lead to rejection. These issues are present in our patients.
What differential diagnosis should be considered
A differential diagnosis is atychiphobia. The reason for the possible diagnosis is that atychiphobia is characterized by the fear of trying new things or taking risks and embracing growth for fear of failing. The patient has occasionally rejected job promotions or leading in various roles because he is afraid he might fail and be the subject of ridicule by the supervisors.
What test or screening tools should be considered to help identify the correct diagnosis
Three tools are used in diagnosing people with SAD. The tools are Liebowitz Social Anxiety Scale (LSAS), the Social Phobia Inventory (SPIN), and the Brief Social Phobia Scale (BSPS). LSAS measures the intensity of fear and avoidance of people. SPIN evaluates fear by assessing symptoms like blushing, tremor, or palpitations. BSPS is administered by clinicians to identify any symptoms of SAD among patients. The tools are effective and will establish any fear as a result of suffering from SAD.
What treatment would you prescribe and what is the rationale
SAD is treatable through psychotherapy and psychopharmacology. Psychotherapy mostly utilizes cognitive behavioral therapy (CBT). In CBT, individuals are exposed to situations they fear most. For our client, this could be encouraging him to approach large gatherings and make presentations. In the process, they gain confidence and coping skills (Otte, 2022).
Psychopharmacology involves the use of drugs that reduce the secretion of serotonin and norepinephrine hormones responsible for triggering fear responses. Examples of commonly used drugs are selective serotonin uptake inhibitors, paroxetine, and sertraline. These drugs are effective in reducing symptoms associated with SAD.
What standard guidelines would you use to assess or treat this patient?
Individuals with SAD may not be aware of their condition or at least the condition is treatable. Like the case of the patient, the individual may feel that social anxiety is a personal flaw and blame themselves for what they go through. Such patients are subject to stigmatization and therefore clinicians should ensure data protection and privacy in handling the patient. They should not be discriminated against in the course of the treatment.
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Yolanda Morgado de Romero
Discussion Topic: Anxiety
The patient is a 25 year-old male that has recently changed his job, that comes to consultation in regards to his difficulties related to job’s performance. He states that he fears giving presentations because he thinks he will not be efficient and his colleagues are going to underestimate him. He also states that this fear is preventing him to escalate in his job and he has not accepted higher position jobs for which he is qualified in order to prevent shame during presentations, not getting the promotions he deserve. He denies otherwise having problems with interactions out of this context with peers or small groups.
The patient problems are related to anxiety as described by him by avoiding situations that are seen as potentially embarrassing that provokes him frustration and negative thoughts. Low self esteem can also be a concern. To delineate appropriately the patients problems, further evaluation will be needed with a complete psychiatric interview including mental status examination and any other psychological or medical tests deemed to be applicable to the patient and his situation.
The diagnosis of Social Anxiety Disorder (SAD) with the specifier Performance only should be first considered. The client present fear or anxiety related to presentations at his work, feels he is going to be scrutinized and negatively evaluated by his coworkers. This fear is always present and out of proportions and has led him to avoid leading positions and prevented him to be promoted at his job causing him to take positions below his level where he feels more confident. Client currently meets the DSM5-TR criteria A, B, C, D, E, and G for Social Anxiety Disorder-Performance only (American Psychiatric Association, 2022).
Differential diagnoses to be considered for this patient include Generalized Anxiety Disorder (GAD) where the anxiety and worry is related to several events or activities and the individual has trouble controlling the anticipatory worry, the recurring thoughts interfere with the attention and concentration, and may be accompanied by restlessness, irritability, disturbed sleep, being easily fatigued, and muscle tension (American Psychiatric Association, 2022).
Major Depressive Disorder (MDD) should also be evaluated, individuals with this disorder may be concerned about being negatively evaluated by others, negative thoughts, or feeling that they are not worthy.
Avoidant Personality Disorder is another diagnose that should be ruled out, in this disorder, the avoidance behavior involves many areas of the individual’s life and produces grater impairment. This could be a differential diagnose or might be a comorbid disorder (Koyuncu et al., 2019).
To further evaluate the patient and discard differential diagnoses, several tests could be applied. Tests with reliability and validity include the seven-item anxiety scale (GAD-7) , the generalized anxiety disorder severity scale (DGSS), the Hamilton Anxiety Scales (HAM-A), the Daily Assessment of Symptoms-Anxiety (DAS-A)
The treatment of the patient should include psychotherapy, medication, and psychoeducation. Individual CBT is considered by some guidelines as the first line psychotherapy for SAD, but interpersonal psychotherapy, virtual therapy, insight-oriented psychotherapy, and supportive psychotherapy using psychodynamic and therapeutic alliance can also be beneficial (Boland et al., 2022).
Education of the patient and family should include lifestyle changes, exercise an yoga, lowering use or no use of alcohol while in psychopharmacotherapy, educational groups among others (Providing Care, 2019).
Pharmacological treatment could begin in a conservative way starting with an SSRI or an SNRI (Garakani et al., 2020). If the symptoms are severe, and the patient requires fast control of the symptoms, benzodiazepines are of great use. Also, beta blockers can be useful for performance anxiety (Boland et al., 2022).
For the assessment of the patient we should use standardized guidelines like the DSM5-TR and the ICD-10, and for the treatment, evidence based recommendations, and APA guidelines (Boland et al, 2022).
Social Anxiety Disorder (SAD): Case
Feb 01, 2023
A male patient presents for consultation, stating that he feels job frustration due to his inability to perform in the new work environment. In this new job, he has had the opportunity to fill new leadership roles, but he has turned down any job promotion because he feels incompetent in interacting with his peers or making presentations to large groups of people. These new situations are causing him deep discomfort since he claims to have a favorable social life because he can interact positively with small groups of people. These new work situations make him feel that he can embarrass his peers, and they can judge him or point him out negatively.
Feelings of shame and social targeting
Difficulty interacting with large groups
Intrusive thoughts about the opinions of others
Avoidance of new roles
Feelings of job incompetence
Social Anxiety Disorder (SAD)
Social Anxiety Disorder (SAD) is the patient's primary diagnosis by DSM-5 guidelines. This is characterized by chronic anxiety about social circumstances where the person may be subjected to scrutiny by others, reports feeling melancholy, and has a lot of stress related to the job (APA, 2017). The patient has avoided contacting his peers to improve his job position because he hardly ever gives presentations. The patient struggles to focus during interactions with strangers because he worries about their reactions, which causes frustration
Panic Attack (Koyuncu et al., 2019)
Social Anxiety Test: 3-Minute Self-Assessment
Liebowitz Social Anxiety Scale
SSRIs and the serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine are the base for the treatment. Clinical experience suggests that SSRI non-responders may benefit from augmentation with benzodiazepines or gabapentin, or from switching to MAOIs, RIMAs, benzodiazepines or gabapentin. Cognitive-behavioural therapy may also be a helpful adjunct or alternative. The effectiveness of cognitive‐behavioural therapy (CBT) in managing SAD with pharmacotherapy and psychotherapy like educational‐supportive group therapy, has a role in the management of this disorder. Interestingly, both CBT and pharmacotherapy are able to normalize functional neuroanatomical abnormalities in SAD. It is important to refer the patient to psychology so that they can access follow-up during non-pharmacological therapy, especially when exposure therapy is included, which is usually effective in cases of SAD (Perrotta et al., 2021).
The National Institute of Mental Health (NIMH, 2021) offers a guide to care for patients diagnosed with SAD. This guide is based on the DSM5 approach. The guide addresses options such as Counseling involving Trusted Source talking; Cognitive behavioral therapy (CBT); Acceptance and commitment therapy (ACT) and Group therapy or a support group.