The stress of Transitioning to college

History of Present Illness: Onset: Following move to out-of-town college, worsening over the past 3 months of being away from home and the stress of transitioning to college.

Chief Complaint: Katie Adams is a 19-year-old Caucasian female here and states, “I worry about everything all the time.” “I can’t ever sleep, and I feel anxious and nervous at school and work.” “I cry often for no reason.”

Location:Heart races, shortness of breath, sweating, headaches, dizzy.

Duration:Daily, lasts 2 to 4 hours then subsides, begins around 10 a.m. before first class starts at 10:30 a.m.

Characteristics: Worsens with attending large size classes, peers and roommates pressure to go out socially and drink, difficulty sleeping, avoids some classes, chest tightness often and shortness of breath.

Aggravating: With increased stress, crowds, when worrying about completing assignments or making good grades.

Relieving: Reading fiction, marijuana, sometimes a beer (1-2), staying in room alone when roommates go out.

Temporal: Worse in morning before classes and worse before bedtime.

Severity: I hate how I feel, it’s horrible.

Questions:

1. Differentials: List the three most likely differential diagnoses based on her objective findings with cited rationale.

2. What is the etiology/pathophysiology associated with each diagnosis?

3. What is the prevalence of each of these diagnoses?

4. Develop a plan of care for each of the three differential diagnoses including the following:

i. Diagnostic testing

ii. Pharmacologic interventions, including dosage, route, and frequency

iii. Nonpharmacologic interventions, including modality, and frequency

iv. Education, including health promotion, maintenance, and psychosocial needs

v. Safety Plan

vi. Referrals required

vii. Follow-up, including return to the clinic (RTC) in what time frame and reason, including any labs that are needed for the next visit