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PS7.1,PS8.1 | Anxiety Spectrum Disorders — Assignment

CLINICAL SCENARIO

You are a final-year MBBS student posted in a primary care clinic. A patient presents with significant emotional distress following a recent life event. Your task is to work through the case systematically — distinguishing an anxiety disorder from a stress-related disorder, justifying your diagnosis using ICD-11/DSM-5 criteria, proposing an evidence-based management plan, and identifying whether referral is warranted.

Instructions

Read the clinical vignette below carefully, then respond to each section in the order given. Your response must be written in continuous paragraphs under each heading — do NOT use bullet points or tables in your answers. Use appropriate clinical language.

Vignette:
Mr. Arjun Rao, a 31-year-old software project manager, presents to your primary care clinic 5 weeks after being denied a promotion he had been working towards for 3 years. He reports persistent low mood, inability to concentrate at work, disturbed sleep (initial insomnia), and tension headaches on most days. He describes excessive worry — not only about his career but also about his family's finances and his parents' health — which he says he has 'always been a worrier' about, well before the promotion decision. He denies any traumatic event. He is not anhedonic, has no suicidal ideation, and thyroid function tests are normal. He drinks alcohol socially and denies substance misuse.

Address each of the following sections in your written response.

Length: 600-900 words

What to Submit

Section 1: Diagnostic Reasoning

Identify the two most likely diagnoses to consider in this case and explain — using DSM-5 or ICD-11 criteria (state which you are using) — why each fits or does not fit this presentation. Clearly state which diagnosis you favour and provide your primary justification. Pay particular attention to the 6-month duration criterion, the nature of the stressor, and whether the worry is reactive or pre-existing.

Section 2: Differential Diagnosis — Ruling Out Other Conditions

Discuss at least TWO other conditions that must be excluded in this presentation (e.g., depressive disorder, adjustment disorder, or a medical mimic such as hyperthyroidism). For each, state the key feature present or absent that allows you to include or exclude it. Reference at least one relevant clinical criterion.

Section 3: Management Plan

Outline a structured management plan for your favoured diagnosis. Include: (a) non-pharmacological approaches (psychoeducation, lifestyle, and psychological therapy — name the specific therapy and its mechanism); (b) first-line pharmacological treatment (drug class, example agent, dose range, duration, and monitoring parameters); (c) what you would do if first-line pharmacotherapy fails at 12 weeks. Address the role of benzodiazepines explicitly, stating when — if ever — they are appropriate in this patient.

Section 4: Referral Decision

State whether you would refer this patient to a psychiatrist or specialist mental health service at this point, and justify your decision. Describe at least THREE clinical features that, if present, would change your decision and necessitate urgent referral. Reflect briefly on how the referral decision would differ if this patient were presenting with PTSD rather than GAD.

Section 5: Reflection — Diagnostic Pitfalls

Identify ONE common diagnostic pitfall that you could have fallen into in this case (e.g., conflating adjustment disorder onset with GAD, or missing a medical mimic). Describe how you would have recognised and corrected this error in your clinical reasoning.

Grading Rubric — Anxiety Spectrum Disorders Assignment Rubric

Criterion	Points	Full-marks descriptor
Diagnostic accuracy and application of ICD-11/DSM-5 criteria	10 pts	Correct diagnosis with clear, specific reference to ICD-11/DSM-5 criteria (states which system); accurately identifies duration, pervasiveness, and reactive vs pre-existing worry; competing diagnoses handled precisely with criterion-level justification.
Quality and completeness of management plan	10 pts	Comprehensive plan covering psychoeducation, specific named psychological therapy (CBT) with mechanism, first-line SSRI with dose/duration/monitoring, clear step-up for non-response, and an explicitly justified benzodiazepine position (short-term adjunct only).
Referral decision — clinical reasoning and criterion identification	10 pts	Justified decision not to refer at this point with evidence-based reasoning; correctly identifies ≥3 referral-triggering features (suicidality, psychosis, failed primary care treatment, PTSD transition, severe impairment); PTSD contrast handled accurately.
Differential diagnosis reasoning — ruling out other conditions	10 pts	At least two differential diagnoses addressed with specific inclusion/exclusion criteria applied to case detail; at least one medical mimic discussed; language is precise and clinically grounded.
Clinical reflection — identification and correction of diagnostic pitfalls	10 pts	Identifies a genuine, specific pitfall relevant to this case (e.g., misclassifying as adjustment disorder, anchoring bias on the stressor, missing pre-existing GAD) with a precise corrective step that demonstrates metacognitive awareness.

PEER REVIEW

You will review one peer's submission. Your feedback should be constructive, specific, and grounded in the clinical content — not just general writing quality. For each of the five rubric criteria: (1) identify one specific strength in your peer's response; (2) identify one specific gap, error, or missed nuance (e.g., an incorrect criterion, a missing referral trigger, an unsupported benzodiazepine recommendation); (3) suggest one concrete improvement. Your review must be ≥200 words and reference specific clinical details from their submission. Avoid vague praise such as 'good job' — aim to give feedback that would genuinely help a colleague improve their clinical reasoning.