He had been placed in the gifted program while in middle school, but Carlos believed that he always underperformed academically (despite never receiving less than a B in school) and described having had to work harder than his classmates to obtain his grades. Although there were no objective signs of significant academic or occupational dysfunction throughout his life, Carlos described a chronic pattern of “struggling to stay on top” of his assignments. In reviewing his remote history, Carlos admitted that this was not the first time that he had difficulty managing the demands of work or school. He became increasingly anxious and mildly depressed regarding his job security. After missing two deadlines, he had a meeting with the company’s CFO who questioned whether he was under excessive stress and warned that he might be placed on probation and some of his projects reassigned to a different team. He found himself procrastinating with increased frequency. If interrupted while completing a specific task, he had difficulty resuming the initial the task and it would be left undone. In obtaining detailed history regarding onset and emergence of symptoms, Carlos described that shortly after he transitioned to working from home, he began having difficulty with focus, distractibility, and staying on task. He had been married for 10 years and lived with his wife and two children, ages 8 and 6. He obtained a master’s degree in information systems and had been with the same healthcare organization for 12 years. Psychosocial history revealed that Carlos had been born and raised in the US to parents who had emigrated here from Latin America. Family medical and psychiatric history indicated cerebrovascular disease in father and ADHD in son he denied any incidence of familial mood or anxiety disorders. Psychiatric history was negative for episodes of anxiety, depression, or mania/hypomania, and he denied prior psychotropic or psychotherapeutic treatment history. He denied tobacco, excessive alcohol, or recreational drug use. Current medications were vitamins and fish oil. Neither he, his wife nor his two children had contracted COVID-19 during that time.Ĭarlos’ medical history indicated borderline hypercholesterolemia, controlled with diet and exercise. Early into the pandemic, Carlos transitioned to working remotely from home, which made him feel more at ease regarding exposure to COVID-19. Carlos reported overseeing IT operations for a large healthcare organization (as it would turn out, activity at work remained steady and constant throughout the pandemic and the family never experienced financial hardship). He was also concerned regarding the impact the pandemic would have on his job and the family’s financial status. He described stressors and concerns that were experienced by many during that time, primarily centered around maintaining a safe environment for himself, his family, and his elderly parents. His PCP was contemplating initiating antidepressant treatment, concerned that the stress of the pandemic was causing emotional symptoms that were beginning to impact his ability to work, but wanted a comprehensive mental health assessment prior to initiating any therapy.Ĭarlos reported to be in his usual state of health until shortly after the pandemic started. Carlos, a 39-year-old IT systems analyst with no psychiatric history, was referred for mental health assessment by his PCP during the COVID-19 pandemic due to complaints of anxiety, poor focus, trouble staying on task, and increased difficulty in keeping up with his workload.
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