Question

A 25 year old lady presented with sadness, palpitation, loss of appetite and insomnia. There is no complaint of hopelessness or suicidal thought, and there is no past history of any precipitating event. She is remarkably well in other areas of life. She is doing her office job normally and her social life is also normal. What is the probable diagnosis in this case?

• A. Generalised anxiety disorder (GAD)
• B. Mixed anxiety and depression
• C. Adjustment disorder
• D. Mild depressive episode

Hint:

Autonomic arousal, no precipitant, no hopelessness or suicidal ideas, function intact.

Answer 1

The Correct Option is A

Step 1: List the symptoms. She has palpitation, insomnia, poor appetite and a low mood, but crucially no hopelessness and no suicidal thoughts, and her work and social functioning are intact.
Step 2: Weigh depression. Core depression needs persistent low mood plus features such as hopelessness, loss of interest, guilt or suicidal ideas, usually with impaired functioning. She lacks the cognitive and functional markers of depression, so a depressive episode is a poor fit.
Step 3: Weigh adjustment disorder. Adjustment disorder requires an identifiable stressor or precipitating event; the stem specifically says there is none, so this is excluded.
Step 4: Recognise the anxiety pattern. Palpitations, insomnia and appetite loss are prominent autonomic and arousal symptoms. With largely intact functioning and no clear depressive cognition or precipitant, this best fits generalised anxiety disorder, where free-floating anxiety drives somatic and autonomic complaints. The sadness here is a secondary affective colouring rather than true depression.
Step 5: Mixed anxiety and depression is reserved for when neither anxiety nor depression dominates and both are subthreshold; here the anxiety and autonomic picture is the dominant theme, so GAD is preferred per the recalled key.
Answer: Generalised anxiety disorder (GAD).