A 22-year-old college student comes to the office due to tension headaches and neck pain. He has had these symptoms for many years, but they have increased in frequency over the past 7 months since he started working at a coffee shop. The patient attends college and says that although his grades are passing, he feels overwhelmed and fatigued: "I can't concentrate on my schoolwork and worry that I will flunk out of school and never get a good job." He sleeps very fitfully and frequently worries about his grades, health, and social life. He obsesses about minor comments his friends have made about how "serious" he is, and gets depressed thinking that he is not attractive enough to get a girlfriend. Which of the following is the most likely diagnosis in this patient?

Question

A 22-year-old college student comes to the office due to tension headaches and neck pain.  He has had these symptoms for many years, but they have increased in frequency over the past 7 months since he started working at a coffee shop. The patient attends college and says that although his grades are passing, he feels overwhelmed and fatigued: "I can't concentrate on my schoolwork and worry that I will flunk out of school and never get a good job."  He sleeps very fitfully and frequently worries about his grades, health, and social life.  He obsesses about minor comments his friends have made about how "serious" he is, and gets depressed thinking that he is not attractive enough to get a girlfriend.  Which of the following is the most likely diagnosis in this patient?

Quizplus · Accepted Answer

11ec160b_3628_882b_9249_5d752d636612_MD0001_00 This patient's excessive chronic anxiety, muscle tension (tension headaches, neck pain), sleep disturbance, fatigue, and difficulty concentrating all support a diagnosis of generalized anxiety disorder (GAD). Patients with GAD experience excessive and uncontrollable worry about multiple issues. A symptom duration of ≥6 months is required for diagnosis, but many patients with GAD describe lifelong anxiety. In addition to muscle tension, other somatic symptoms are commonly seen (eg, sweating, gastrointestinal distress) and may prompt the patient to seek medical attention. First-line treatment includes cognitive-behavioral therapy and antidepressants (ie, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors). (Choice A) In adjustment disorder, behavioral symptoms develop within 3 months of an identifiable stressor and do not meet criteria for any other DSM-5 disorder. This patient's symptoms are not the result of a specific inciting factor. (Choice C) Although some symptoms of GAD overlap with depression (ie, sleep disturbance, low energy, poor concentration), this patient is predominantly anxious. His depression is related to his worries about social acceptance; he does not meet the full criteria for a major depressive disorder. (Choice D) Obsessive-compulsive personality disorder is characterized by a need for perfectionism, control, and orderliness. (Choice E) In social anxiety disorder, anxiety occurs exclusively in response to social interactions in which the patient fears negative evaluation by others. In contrast, this patient's concerns extend to multiple situations. (Choice F) Patients with GAD frequently have anxiety about their health but among a range of other concerns. In somatic symptom disorder, the distress is centered on ≥1 somatic symptoms. Educational objective: Generalized anxiety disorder involves excessive uncontrollable worry about multiple issues with a symptom duration of ≥6 months. Associated symptoms include restlessness, muscle tension, fatigue, sleep disturbance, irritability, and difficulty concentrating. __________ References: Diagnosis and management of generalized anxiety disorder and panic disorder in adults. (http://www.ncbi.nlm.nih.gov/pubmed/25955736) Generalized anxiety disorder, subthreshold anxiety and anxiety symptoms in primary headache. (http://www.ncbi.nlm.nih.gov/pubmed/23331287)

A 22-Year-Old College Student Comes to the Office Due to Tension