Young Adult with Anxiety and Intrusive Thoughts Seeking Psychiatric Evaluation

Case at a Glance

A 22-year-old male with a history of childhood anxiety presents with escalating intrusive thoughts and fear of developing serious mental illness. He demonstrates good insight and reality testing but experiences significant distress when alone.

Patient's Story

The patient reports having anxiety since childhood, with early worries focused on catastrophic events such as school violence, terrorism, and health concerns. During high school, his anxiety symptoms intensified significantly. Post-graduation, he began experiencing intrusive thoughts consistent with harm OCD, which he recognized as ego-dystonic but found distressing. Currently employed in a flexible sales position that involves significant periods of isolation, he has developed new obsessive thoughts centered around fears of 'going insane' or developing schizophrenia or psychosis. He experiences paranoid-type intrusive thoughts about government surveillance, which he intellectually recognizes as unrealistic but finds emotionally disturbing. The patient reports that symptoms improve when he is occupied or in social situations but worsen during periods of solitude. He maintains good insight into his condition and is scheduled for telepsychiatry consultation.

Initial Assessment

Patient presents with long-standing anxiety disorder with recent emergence of obsessive thoughts about developing severe mental illness. He demonstrates preserved reality testing and good insight. Symptoms appear to be exacerbated by social isolation and improve with activity and social engagement. No evidence of frank psychosis or delusional thinking.

The Diagnostic Journey

The clinical presentation suggests an anxiety spectrum disorder, likely OCD with illness-focused obsessions. Differential diagnosis includes generalized anxiety disorder with obsessive features, health anxiety, or early-stage psychotic disorder. The patient's maintained insight, recognition of thoughts as irrational, and absence of fixed delusions argue against a primary psychotic process.

Final Diagnosis

Obsessive-Compulsive Disorder with illness/mental health obsessions, comorbid with Generalized Anxiety Disorder

Treatment Plan

1. Cognitive Behavioral Therapy (CBT) with emphasis on Exposure and Response Prevention (ERP) for OCD symptoms 2. Psychoeducation about intrusive thoughts and OCD 3. Consider SSRI medication if symptoms persist or worsen 4. Lifestyle modifications including structured daily activities and reduced isolation 5. Mindfulness-based interventions to manage anxiety during alone time

Outcome and Follow-up

Patient engaged well with treatment, demonstrating excellent insight and motivation for recovery. Regular follow-up appointments scheduled to monitor symptom progression and treatment response. Prognosis is favorable given early intervention, good insight, and absence of psychotic features.