Case briefing
The working hypothesis is that Shahid is experiencing an Adjustment Disorder with mixed anxiety and depressed mood, triggered by significant financial stressors. This is supported by his reports of stress, anxiety, low mood, insomnia, and poor concentration that appear linked to 'investment issues'. However, more data is needed to rule out a primary depressive or anxiety disorder. The next session should focus on establishing a clear timeline of stressors and symptoms, and conducting a thorough review of symptoms for Major Depressive Disorder and Generalized Anxiety Disorder to determine if his presentation meets criteria for a more pervasive condition.
6B43 Adjustment disorder · working (50%)
Still to find out · 20 (questions to answer at the next visit)
Administer PHQ-9 + GAD-7 to set a baseline
Progress can only be measured against a starting point.
Can you tell me more about when these investment issues started, and when you first began to feel this way?
To establish a timeline and see if symptoms followed the stressor, which is key for diagnosing Adjustment Disorder.
Over the last two weeks, how has your mood been? Can you describe what 'depression' feels like for you?
To move beyond the label and understand the specific quality, pervasiveness, and severity of his low mood for MDD assessment.
You mentioned enjoying family time. Are there other things you used to enjoy that don't bring you pleasure anymore?
To probe more deeply for anhedonia, a core symptom of depression, which seems partially contradicted by his statement.
You said you have anxiety and stress about investments. Do you find yourself worrying a lot about other things as well?
To differentiate between stress-specific worry (Adjustment Disorder) and pervasive, multi-domain worry (GAD).
How has your sleep been affected? Are you having trouble falling asleep, staying asleep, or waking up too early?
To gather specific details about the sleep disturbance, which is a symptom across all differential diagnoses.
Have you noticed any changes in your appetite or your weight recently?
To screen for another common neurovegetative symptom of depression.
In these moments of stress or low mood, have you ever had thoughts that life isn't worth living, or thoughts of harming yourself?
To conduct a direct and essential assessment for suicidal ideation.
Confirm symptom onset is within one month of the financial stressor.
Tests 6B43 Adjustment disorder.
Assess if the distress is markedly out of proportion to the stressor.
Tests 6B43 Adjustment disorder.
Determine the extent of functional impairment beyond the workplace.
Tests 6B43 Adjustment disorder.
Establish that symptoms do not meet criteria for another mental disorder.
Tests 6B43 Adjustment disorder.
Assess for core depressive symptoms: pervasive low mood and anhedonia.
Tests 6A70 Single episode depressive disorder.
Confirm duration of symptoms (at least two weeks).
Tests 6A70 Single episode depressive disorder.
Screen for other symptoms (appetite/weight changes, worthlessness, suicidality).
Tests 6A70 Single episode depressive disorder.
Clarify if he can enjoy family time or if pleasure is diminished overall.
Tests 6A70 Single episode depressive disorder.
Determine if worry is excessive and uncontrollable.
Tests 6B00 Generalized anxiety disorder.
Assess if worry extends to multiple domains beyond the financial issue.
Tests 6B00 Generalized anxiety disorder.
Confirm duration of excessive worry (at least several months).
Tests 6B00 Generalized anxiety disorder.
Screen for physical symptoms of anxiety (e.g., restlessness, muscle tension, fatigue).
Tests 6B00 Generalized anxiety disorder.
Do next
1.Set a baseline — administer PHQ-9 + GAD-7
This sessionAdminister the recommended screeners so every later session measures change.
Why: You can only show progress against a starting point.
Administer now2.Next session — close an open diagnostic question
Next sessionAsk: "Confirm symptom onset is within one month of the financial stressor."
Why: Tests 6B43 Adjustment disorder.
Next session: in ~7 days
Weekly during assessment keeps the differential narrowing.
A structured second opinion when you’re stuck — what’s been tried, what the data shows, options to consider, and questions to bring to supervision. Therapist-facing only.
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