shamil

Client reports feeling 'overwhelmed all the time' due to increased work responsibilities from a recent promotion. He states that 'things have been hard' and he is seeking therapy at his wife's suggestion.

Symptoms began approximately six months ago, immediately following a promotion to 'Head of the department'. The client reports a worsening course of symptoms, including constant worry about work performance, initial insomnia, and irritability directed at his wife and children, followed by feelings of guilt. He also endorses anhedonia (loss of interest in playing cricket), low energy, decreased appetite with some weight loss, and difficulty concentrating at work. He has attempted to use whiskey to aid sleep but finds it ineffective. While he has a history of being a 'worrier,' particularly during college exams, he states the current experience is constant and more severe than anything prior.

Client denies any prior psychiatric diagnoses, medications, hospitalizations, or therapy. This is his first time seeking mental health support.

Client denies any known family history of psychiatric illness, but qualifies this by stating, 'We don't really talk about these things. Everyone is supposed to be fine.'

Client is a married man living in Mumbai with his wife of 10 years and their two children (son, 8; daughter, 6). He works in finance and was recently promoted. He describes a cultural and familial context where men are expected to 'be strong' and not show weakness, citing his father as an example. He reports an increase in alcohol use (whiskey, 2-3 times per week) as a coping mechanism for stress and insomnia.

Rohan is a man who appears his stated age, appropriately groomed and cooperative, though initially hesitant to speak. His speech is clear and coherent. He reports a mood of being 'overwhelmed' and anxious, with an affect that is congruent and constricted. His thought process is logical and goal-directed, with content notable for preoccupations with work-related failure and guilt regarding his family interactions. He explicitly denies suicidal ideation. Insight is good, as he connects his symptoms to his recent promotion and understands their impact on his life; judgment is fair.

Client's symptoms of anxiety, worry, insomnia, irritability, and depressed mood are consistent with an Adjustment Disorder with Mixed Anxiety and Depressed Mood, precipitated by a significant work promotion. The symptoms have persisted for six months and are causing significant distress in his professional and personal life. Rule out Generalized Anxiety Disorder and Major Depressive Disorder, pending further assessment.

The Pass 3 initial-assessment brief expands this into a differential with citations.

Agreed to begin weekly psychotherapy sessions to explore stressors and develop coping strategies. Client will complete anxiety and depression screening questionnaires before the next session. Client will schedule the next appointment before leaving.