Training Title 37
Name: Mr. Luca Esposito
Gender: male
Age:21 years old
T- 97.4 P- 112 R 22 122/68 Ht 6’1Wt 198lbs
Background: Lives alone in Orlando, FL raised by parents in Buffalo, NY, only child. He is a
full- time student obtaining a degree for graphic design. works part-time as Uber driver. Has a
girlfriend from high school. No previous psychiatric history. No medical illnesses; no history of
psychiatric treatment; denied drugs or alcohol; Allergies: NKDA; sleeps 6 hrs.; appetite eats 3
meals/day, likes to keep a routine schedule.
Symptom Media. (Producer). (2016). Training title 37 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-37

1. Introduction
Patient: Mr. Luca Esposito, 21‑year‑old male.

Context: Case study from Symptom Media video (2016).

Clinical Focus: Anxiety disorders in young adults, diagnostic reasoning, treatment planning.

Importance: Young adults often present with new‑onset anxiety symptoms triggered by academic, occupational, and relational stressors. Early recognition is critical to prevent chronicity.

2. Demographics and Background
Age: 21 years old.

Gender: Male.

Vitals: T 97.4, P 112 (tachycardia), R 22 (tachypnea), BP 122/68 (normal).

Height/Weight: 6’1”, 198 lbs (BMI ~26.1 → overweight).

Family: Only child, raised in Buffalo, NY by parents.

Residence: Lives alone in Orlando, FL.

Education/Occupation: Full‑time student in graphic design; part‑time Uber driver.

Relationship Status: Has girlfriend from high school.

Medical History: No medical illnesses.

Psychiatric History: None prior to current episode.

Substance Use: Denies drugs or alcohol.

Allergies: NKDA.

Lifestyle: Sleeps 6 hours/night, eats 3 meals/day, prefers routine schedule.

3. Psychosocial Stressors
Academic Stress: Full‑time graphic design program, workload, deadlines.

Occupational Stress: Uber driving, irregular hours, financial pressure.

Social Stress: Maintaining long‑distance relationship with girlfriend.

Isolation: Living alone, limited family support nearby.

Transition Stress: Young adult navigating independence, education, and work simultaneously.

4. Clinical Presentation (Anxiety Features)
Reported Symptoms (likely from case context):

Tachycardia (P 112).

Tachypnea (R 22).

Restlessness, irritability.

Difficulty concentrating.

Excessive worry about school, finances, relationships.

Somatic symptoms: sweating, muscle tension, GI upset possible.

Risk Factors:

Young age, limited coping skills.

Academic and occupational stress.

Social isolation.

No prior psychiatric treatment.

5. Mental Status Examination (MSE)
Appearance: Appropriate grooming, overweight.

Behavior: Cooperative, anxious demeanor.

Speech: Normal rate/volume, may be pressured when discussing stressors.

Mood: Reports anxiety, worry.

Affect: Constricted, tense.

Thought Process: Logical, coherent.

Thought Content: Preoccupation with academic and occupational stress.

Cognition: Alert, oriented ×3.

Insight/Judgment: Fair, recognizes anxiety but limited coping strategies.

6. Differential Diagnosis
Generalized Anxiety Disorder (GAD): Excessive worry for ≥6 months, difficult to control.

Adjustment Disorder with Anxiety: Symptoms linked to identifiable stressors (school, work).

Panic Disorder: Must rule out recurrent unexpected panic attacks.

Obsessive‑Compulsive Disorder (OCD): No compulsions or obsessions reported.

PTSD: No trauma exposure reported.

Medical Causes: Thyroid dysfunction, arrhythmia (tachycardia present, but vitals otherwise stable).

7. Diagnostic Considerations (DSM‑5)
GAD Criteria: Persistent worry ≥6 months, difficult to control, associated with restlessness, fatigue, irritability, muscle tension, sleep disturbance.

Adjustment Disorder with Anxiety: Emotional/behavioral symptoms within 3 months of stressor, disproportionate distress.

Panic Disorder: Recurrent unexpected panic attacks, fear of future attacks.

Luca’s Case:

Symptoms duration unclear but recent onset.

Likely Adjustment Disorder with Anxiety, but if persistent beyond 6 months → GAD.

8. Assessment Tools
GAD‑7: Screens for generalized anxiety.

HAM‑A: Hamilton Anxiety Rating Scale.

PHQ‑9: Screens for comorbid depression.

C‑SSRS: Suicide risk assessment (though no self‑harm reported).

Medical Labs: Thyroid function, CBC, metabolic panel to rule out medical causes.

9. Treatment Plan
Pharmacological:

SSRIs (sertraline, escitalopram) → first‑line for anxiety.

SNRIs (venlafaxine, duloxetine).

Buspirone for chronic anxiety.

Benzodiazepines (short‑term, acute relief).

Psychotherapy:

Cognitive Behavioral Therapy (CBT).

Stress management techniques.

Psychoeducation about anxiety and coping.

Lifestyle Interventions:

Exercise, relaxation techniques.

Sleep hygiene (increase from 6 to 7–8 hours).

Mindfulness practices.

Supportive Measures:

Family involvement.

Academic counseling.

Peer support groups.

10. Monitoring and Follow‑Up
Weekly therapy sessions initially.

Medication monitoring every 2–4 weeks.

Suicide risk reassessment.

Collaboration with school counseling services.

11. Challenges
Stigma: Young adults may minimize mental health needs.

Transition Stress: Balancing school, work, and relationships.

Limited Coping Skills: No prior psychiatric history.

Risk of Escalation: Anxiety may worsen into chronic GAD or panic disorder.

12. Ethical and Cultural Considerations
Confidentiality: Respect patient privacy.

Consent: Informed consent for treatment.

Safety: Suicide risk management.

Cultural Sensitivity: Address stigma in young adult populations.

13. Case Summary
Mr. Luca Esposito: 21‑year‑old male with anxiety symptoms triggered by academic, occupational, and relational stressors.

Likely Diagnosis: Adjustment Disorder with Anxiety vs. emerging GAD.

Treatment: Combination of psychotherapy, possible SSRI, lifestyle interventions, academic support.

Outcome Goal: Symptom reduction, improved functioning, resilience building, prevention of escalation to chronic anxiety.

📝 Quiz (15 Questions)
Multiple Choice – Select the best answer.

What is Luca’s age? a) 19 b) 20 c) 21 d) 22

Where does Luca currently live? a) Buffalo, NY b) Orlando, FL c) Miami, FL d) Dallas, TX

What is Luca’s field of study? a) Accounting b) Graphic Design c) Engineering d) Psychology

What part‑time job does Luca hold? a) Construction worker b) Uber driver c) Retail clerk d) Tutor

Which vital sign indicates anxiety? a) BP 122/68 b) P 112 c) T 97.4 d) R 18

Which diagnosis involves excessive worry ≥6 months? a) GAD b) Adjustment Disorder c) Panic Disorder d) PTSD

Which diagnosis involves symptoms linked to a stressor within 3 months? a) Adjustment Disorder with Anxiety b) GAD c) OCD d) PTSD

Which tool screens for generalized anxiety? a) GAD‑7 b) PHQ‑9 c) C‑SSRS d) MDQ

Which therapy targets negative thought patterns? a) CBT b) DBT c) IPT d) Psychoanalysis

Which medication class is first‑line for anxiety? a) SSRIs b) TCAs c) MAOIs d) Benzodiazepines

Which lifestyle intervention is appropriate for Luca? a) Sleep hygiene b) Smoking cessation c) Alcohol detox d) Dialysis

Which risk must be monitored in young adults with anxiety? a) Suicide b) Diabetes c) Asthma d) Cancer

Which lab should be considered for medical causes of anxiety? a) Thyroid function b) Liver enzymes c) Vitamin D d) All of the above