Home: • The patient resides at 123 Maple Street, Suburbia, with her parents and younger sister • Recent changes include moving to a new school district 6 months ago • Reports increased stress due to academic pressure and making new friends • Spends approximately 4 hours daily on social media and gaming Education & Employment: • Currently enrolled as a junior at Suburbia High School • Maintains a B average but struggling in mathematics • Part-time job at local grocery store (10 hours/week) • Plans to apply to state universities next year Eating & Exercise: • Weight: 65 kg, height: 165 cm • Skips breakfast regularly, tends to snack late at night • Participates in school soccer team, practices 3 times/week • Menstrual cycles regular, every 28-30 days Activities: • Member of school drama club, rehearsals twice weekly • Plays guitar as a hobby, self-taught • Screen time averages 6 hours daily (including homework) Drugs & Alcohol: • Denies personal use of alcohol or drugs • Reports some friends experimenting with marijuana at parties • No known substance use in immediate family Sexuality & Gender: • Identifies as female, uses she/her pronouns • Currently in a 6-month relationship with male classmate • Sexually active, uses condoms for contraception • No history of pregnancies or STIs Suicide, Depression & Self-Harm: • Reports feeling overwhelmed and sad occasionally • Sleep disturbances: difficulty falling asleep, averages 6 hours/night • Denies self-harm behaviors or suicidal ideation • No history of diagnosed mental health conditions Safety: • No serious injuries in past year • Reports being cautious about online privacy • No exposure to domestic violence or abuse • No involvement in criminal activities

Interview Context: I met with Sarah Johnson and her husband, Tom. Sarah expressed concern about her increasing anxiety levels and their impact on her daily life. Tom provided additional context and observations regarding Sarah's symptoms. Profile: Sarah Johnson is a 35-year-old married woman living in suburban Melbourne. She works as a primary school teacher and enjoys gardening and yoga in her free time. Presenting Complaint: Sarah is seeking help for worsening anxiety symptoms that are interfering with her work and personal life. History of Presenting Complaint: Anxiety symptoms began six months ago, gradually intensifying. Sarah experiences frequent worry about work performance, health, and family matters. Difficulty controlling these thoughts, often leading to physical symptoms. Anxiety symptoms: Excessive worry about various aspects of life. Racing thoughts, difficulty concentrating. Physical symptoms include rapid heartbeat, sweating, and trembling. Avoids social gatherings and public speaking at work. Mood symptoms: Low mood accompanying anxiety episodes. Feelings of worthlessness and guilt, particularly related to work performance. No significant changes in appetite or weight. Vegetative features: Insomnia, taking 1-2 hours to fall asleep. Wakes multiple times during night. Fatigue throughout the day, affecting work performance. Concentration difficulties, especially during anxious periods. No significant diurnal mood variation. Manic or Psychotic features: No manic symptoms or episodes reported. No hallucinations, delusions, or other psychotic features observed or reported. Risks: No current suicidal ideation or intent. No history of self-harm or suicide attempts. No homicidal ideation or aggressive behavior. Recent stressors: Increased workload at school. Mother-in-law diagnosed with cancer three months ago. Financial concerns due to recent home renovation. Attributes anxiety to work stress and family health worries. Overall functioning impaired, particularly in work and social domains. Past History: - Mild depressive episode at age 25. - Appendectomy at age 18. - Asthma diagnosed in childhood, well-controlled. Medication: - Salbutamol inhaler PRN for asthma - Trial of sertraline 50mg daily for 2 months (discontinued due to side effects) Alcohol / Substance Use: - Alcohol: 1-2 glasses of wine per week, socially - No illicit substance use - No smoking Family History: - Mother: Generalized Anxiety Disorder. - Father: Type 2 Diabetes. - Maternal grandmother: Depression. Developmental History: - Unremarkable pregnancy and delivery - Met developmental milestones appropriately - Described as a shy child, difficulty making friends in primary school - Parents divorced when patient was 14, experienced adjustment difficulties - Excelled academically throughout schooling Mental State Examination: Appropriately dressed, well-groomed woman appearing stated age. Mild psychomotor agitation, fidgeting with hands. Speech normal in rate and volume. Affect anxious, mood congruent. No perceptual disturbances. Thought process logical and coherent. No evidence of thought disorder or delusions. Cognition intact, oriented to time, place, and person. Good rapport established. Partial insight into condition. Judgment unimpaired. Impression: Sarah presents with symptoms consistent with Generalized Anxiety Disorder (GAD) as per DSM-5 criteria. Biological factors include genetic predisposition (family history of anxiety). Psychological factors involve perfectionist tendencies and negative self-talk. Social stressors include work pressure and family illness. Precipitating factors: increased work responsibilities and mother-in-law's cancer diagnosis. Maintaining factors: avoidance behaviors and rumination. Protective factors include supportive spouse and engagement in yoga. No immediate risk to self or others identified. Differential diagnosis includes Adjustment Disorder with Anxiety. Plan: - Commence cognitive-behavioral therapy (CBT) for anxiety management - Consider trial of SSRI (e.g., escitalopram 10mg daily) for symptom relief - Encourage continuation of yoga and introduction of mindfulness practices - Provide psychoeducation on anxiety and sleep hygiene - Review in 4 weeks to assess progress and medication response if initiated - Liaise with GP for ongoing physical health monitoring

Patient Assessment – Mental Health - Persistent low mood for 3 months - Difficulty sleeping, averaging 4-5 hours per night - Loss of interest in previously enjoyed activities - Fatigue and low energy levels throughout the day - Poor concentration affecting work performance - Occasional suicidal thoughts without plan or intent - Expresses feelings of worthlessness, stating "I feel like I'm failing at everything" Mental Health History - No previous mental health diagnoses - Brief counseling during university for stress management (5 years ago) - No history of psychiatric medications - Never seen a psychiatrist Social/Family History - Single, living alone in a rented apartment - Full-time employment as an accountant - Limited social support network - Mother diagnosed with depression in her 40s - No other known family history of mental health issues Mental Status Examination - Appearance: Adequately groomed, slightly disheveled - Behavior: Slow movements, slumped posture - Speech: Slow rate, low volume - Mood: Depressed - Affect: Flat, congruent with mood - Thought Process: Linear, goal-directed - Thought Content: No delusions or hallucinations - Insight: Partial - Judgment: Intact Outcome Measurement Tool K10: 32 Risk Assessment - Passive suicidal ideation without plan or intent - No history of self-harm - No risk to others Provisional Diagnosis - Major Depressive Disorder, single episode, moderate Issues/problems - Persistent depressive symptoms impacting daily functioning - Sleep disturbance contributing to daytime fatigue - Social isolation exacerbating low mood - Work performance affected by poor concentration Goals - Improve mood and reduce depressive symptoms - Establish healthy sleep patterns - Increase social engagement and support network - Enhance work productivity through improved concentration Actions for patient - Commence antidepressant medication as prescribed - Attend weekly psychological therapy sessions - Implement sleep hygiene techniques - Gradually increase physical activity, starting with daily 15-minute walks - Reconnect with one friend or family member each week Plan for Crisis Intervention and/or for Relapse Prevention: - Identify early warning signs of worsening mood - Develop a list of coping strategies for managing low mood - Create a safety plan for managing suicidal thoughts - Schedule regular check-ins with GP to monitor progress - Engage in regular physical activity to maintain mood stability Emergency care: Lifeline 13 11 14 : Mental Health Access Line 1800 011 511 Psycho-education performed: Yes Patient agreement to goals: Yes Copy of plan given to patient: Yes