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MEENAKSHI ANANDI KRISHNAN

MBBS/DEG/2010/0060

This case illustrates the importance of managing the anxiety and stress in this patient who
is a student. Name of the patient is M.A, a 19 year old Sri Lankan Muslim boy. He is single. He
is a student living near Kuala Lumpur. He knows Sinhalese, English and Tamil. The language
spoken to the patient was English and Tamil.
The patient was referred by a lecturer where he was doing a diploma course who was
concerned about his academic performance.
He presented with profuse sweating, panting and fidgetiness and tremors in his
hands. He has been experiencing these symptoms from the starting of his O levels. (Mor e
than one and a half years).Angry about his poor performance for the past six months and
stressed about high expectations from the parents. He says he is unable to cope with the
pressure from his parents to get good grades. He is also unable to concentrat e on his studies
and pre-occupied with thoughts about his grades. He is preoccupied about the exams
postponed till October. He gets angry with other people when they dont understand him.
He says he has difficulty in controlling his emotions. He vents out his anger by hitting the
wall. He has used razors to cut his wrist. (In last 6 months). He says he rapid heart rate and
breathing for almost a year. He also has initial insomnia, Muscle tension, headaches and leg
pain.
He migrated to Malaysia one and half years ago. He is currently doing his highschool diploma. He is unable to cope with his pressure from parents to perform well in his
exams and is not-confident of himself.
Usually gets 8 hours of sleep during his school days. But currently he has difficulty to
sleep at night. He sleeps at 3-4am and wakes up at 7am but during weekends he sleeps till 12pm
noon. No loss of appetite. Micturition and bowel movements are normal.
He has four siblings including him. He is not close with his parents. He is closer to
is younger sisters. He has very few friends in Malaysia. No past psychiatric, medical,
surgical history. He is not on any medications is not allergic to any medications or food.
The current mental state examination was done on him, where he was found to be
pre-occupied with thoughts of passing in his exams and scoring good grades. On
performing the tests of cognition, his attention and concentration was found to be poor.
Provisional diagnosis was generalized anxiety disorder. And differential diagnosis
could by hyperthyroidism and adjustment disorder with anxiety.
Anxiolytics and Sedative-hypnotics can be given to help the patient ease his anxiety
and make him sleep better. Benzodiazepine of low dosage can be started which will help
him sleep and relieve him of his anxiety. Interpersonal therapy, Cognitive and behavioral
therapy, Supportive therapy can be done to improve the patients mental state. Family
counselling will also help in reducing his anxiety.