Alexandra Katsaros iHuman Case Study

Alexandra Katsaros is a 22-year-old female presenting to the emergency department with overwhelming emotional distress following a witnessed consumption of alcohol, alprazolam, and acetaminophen with diphenhydramine. She reports feeling “overwhelmed” due to relationship stressors and exhibits symptoms consistent with adjustment disorder and substance use concerns.

In this comprehensive guide, we’ll walk you through how to approach her case, from initial psychiatric assessment through mental status examination to the final diagnosis of Adjustment Disorder with Mixed Anxiety and Depressed Mood. You’ll learn the key clinical reasoning steps for young adult psychiatric emergencies, what the iHuman grading rubric expects, and a complete step-by-step solution to help you confidently navigate this complex psychiatric case simulation involving substance use and mental health crisis intervention.

Alexandra Katsaros iHuman Case Overview (Doorway Information)

Patient Overview: Alexandra Katsaros is a 22-year-old female presenting with chief complaint of feeling “overwhelmed” following a witnessed consumption of multiple substances including alcohol, alprazolam, and acetaminophen with diphenhydramine. She was brought to the emergency department by her ex-boyfriend after the incident occurred during a relationship conflict.

Key Background Information:

• Age/Gender: 22-year-old female
• Chief Complaint: “I was feeling overwhelmed”
• Duration: Recent onset following relationship stressor
• Substance Use: Witnessed consumption of alcohol, alprazolam, and acetaminophen with diphenhydramine preceded by marijuana, beer, and hard liquor use
• Presenting Situation: Emergency department presentation via ex-boyfriend
• Associated Symptoms: Anxiety, insomnia, headaches, poor concentration, and muscle tension affecting school and work performance
• Significant History: Past medical history of hypothyroidism, previous depression in high school without pharmacological support
• Current Stressors: Recent breakup with inability to secure separate living accommodations
• Risk Factors: Young adult female, relationship stressors, substance use history
• Psychiatric Symptoms: Denies suicidal ideation and homicidal ideation but reports overwhelming emotional distress

The patient appears alert and cooperative during assessment, with notable psychiatric findings including mood disturbance, anxiety symptoms, and recent polysubstance use in context of psychosocial stressors. Her presentation is consistent with adjustment disorder with co-occurring substance use, making this an excellent case for learning systematic young adult psychiatric assessment and crisis intervention skills.

Alexandra Katsaros (22 y/o female) – Psychiatric Emergency Assessment

• CC: “I was feeling overwhelmed”
• MSAP: Adjustment disorder with mixed anxiety and depressed mood following relationship stressor, complicated by polysubstance use including alcohol, prescription medications, and over-the-counter drugs
• Associated symptoms: Anxiety, insomnia, headaches, poor concentration, muscle tension, functional impairment in academic and occupational settings
• History: Previous mental health history includes depression in high school, current hypothyroidism, prescribed alprazolam for insomnia
• High-risk factors: Young adult female, relationship stressors, substance use, social instability

History Questions:

• How can I help you today, Ms. Katsaros?
• Can you tell me more about feeling overwhelmed?
• When did these feelings start, and what triggered them?
• Tell me about the substances you used today – walk me through what happened
• Have you ever used these medications together before?
• Were you trying to hurt yourself or just trying to feel better/sleep?
• Can you describe your current living situation and recent relationship changes?
• How has this stress been affecting your daily life, school, and work?
• Tell me about your sleep patterns and any recent changes
• Have you been experiencing anxiety or panic symptoms?
• Any thoughts of wanting to harm yourself or others?
• Tell me about your concentration and memory lately
• How are you coping with stress typically?
• Tell me about your current medications for hypothyroidism and any psychiatric medications
• Have you used alcohol or other substances recently?
• Is there any family history of mental health conditions or substance use?
• Have you sought counseling or psychiatric care since high school?
• Any recent changes in appetite, weight, or energy levels?
• Tell me about your support system and social connections
• Have you experienced any trauma or significant losses recently?

Physical Exam:

• Vitals: Temperature, pulse, blood pressure, respirations, oxygen saturation, pain scale
• General appearance: Level of consciousness, cooperation with exam, apparent distress, hygiene
• Mental Status Examination:
  • Appearance and behavior
  • Speech patterns and rate
  • Mood and affect assessment
  • Thought process and content
  • Perceptual disturbances
  • Cognitive assessment (orientation, memory, concentration)
  • Insight and judgment evaluation
• Psychiatric Risk Assessment:
  • Suicide risk evaluation
  • Homicide risk assessment
  • Substance use assessment
  • Safety planning needs
• Neurological examination: Basic cognitive testing, coordination, reflexes
• Cardiovascular examination: Heart sounds, rhythm assessment
• Respiratory examination: Lung sounds, respiratory effort
• Toxicology considerations: Signs of intoxication or withdrawal

Assessment Note: A.K. is a 22-year-old female presenting with acute emotional distress and polysubstance use following relationship stressors. Mental status exam notable for anxious and depressed mood, good reality testing, denial of suicidal ideation, and functional impairment related to psychosocial stressors. Recent polysubstance use in context of adjustment difficulties in a young adult with prior depression history.

Diagnostic Testing: Comprehensive metabolic panel, toxicology screen, psychiatric screening tools, thyroid function tests

Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood, complicated by substance use

Plan:

• Psychiatric consultation for comprehensive evaluation
• Toxicology screening and medical clearance
• Safety assessment and crisis intervention
• Substance use counseling and brief intervention
• Case management for housing and social support
• Follow-up psychiatric care arrangement
• Patient education about adjustment disorders and healthy coping strategies

Alexandra Katsaros SOAP Note

Patient: Alexandra Katsaros

Subjective Data

CC: 22-year-old female presents with “I was feeling overwhelmed”

HPI: 22-year-old female presents to emergency department via ex-boyfriend following witnessed polysubstance consumption including alcohol, alprazolam, and acetaminophen with diphenhydramine. Episode occurred during argument about recent relationship breakup. Prior to medication ingestion, patient had been using marijuana, beer, and hard liquor. She initially took four acetaminophen with diphenhydramine tablets followed by two 1mg alprazolam tablets, stating she was trying to go to sleep.

Patient denies suicidal or homicidal ideation, stating she felt overwhelmed due to relationship stressors and inability to secure separate living accommodations. She reports ongoing symptoms of anxiety, insomnia, headaches, poor concentration, and muscle tension that have been affecting her academic and work performance. The patient has a valid prescription for alprazolam for insomnia as needed.

Medications: Alprazolam as needed for insomnia, medications for hypothyroidism management

Allergies: No known drug, food, or environmental allergies reported

PMH: History of hypothyroidism currently managed with medication

Psychiatric History: Previous depression in high school without psychopharmacologic treatment. Possible undiagnosed ADHD based on instructor observation. Denies history of physical, verbal, or sexual abuse. Reports avoiding social activities.

Family History: No significant family psychiatric history reported

Social History: 22-year-old college student living with ex-boyfriend until recent breakup. Current housing instability. Reports recent substance use including alcohol, marijuana, and prescription medications.

Review of Systems: Notable for anxiety symptoms, insomnia, concentration difficulties, headaches, muscle tension, and functional impairment. Denies fever, nausea, vomiting, or other acute medical symptoms.

Objective Data

General: Alert, cooperative 22-year-old female appearing stated age. Mild emotional distress noted during assessment. No acute physical distress observed.

Mental Status Examination:

• Appearance: Appropriate dress and hygiene, cooperative with examination
• Behavior: Calm, no psychomotor agitation or retardation
• Speech: Normal rate, rhythm, and volume
• Mood: Reports feeling “overwhelmed” and anxious
• Affect: Anxious and dysthymic, congruent with stated mood
• Thought Process: Linear and goal-directed
• Thought Content: Denies suicidal or homicidal ideation, preoccupied with relationship stressors
• Perceptions: No hallucinations or delusions reported
• Cognition: Alert and oriented to person, place, and time
• Insight: Fair insight into current situation and stressors
• Judgment: Impaired as evidenced by polysubstance use

Cardiovascular: Regular rate and rhythm, no murmurs, rubs, or gallops

Respiratory: Clear lung sounds bilaterally, no respiratory distress

Neurological: Grossly intact, appropriate cognitive function for age

Toxicological: Assessment for substance intoxication and withdrawal potential

Vital Signs: Within normal limits for age, stable throughout assessment

Assessment

Primary Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23)

Secondary Concerns:

• Substance use related to maladaptive coping with adjustment stressor
• History of depression with current symptom recurrence
• Housing instability and psychosocial stressors

Differential Diagnoses

Adjustment Disorder with Mixed Anxiety and Depressed Mood: The patient presents with emotional and behavioral symptoms developing within three months of a clearly identifiable stressor (relationship breakup). Symptoms include both anxious and depressive features with functional impairment.

Major Depressive Episode: Given history of depression in high school and current mood symptoms, major depression should be considered. However, clear temporal relationship to recent stressor and symptom pattern more consistent with adjustment disorder.

Substance Use Disorder: Recent polysubstance use as maladaptive coping mechanism requires assessment for substance use disorder, though appears situational rather than meeting criteria for substance dependence.

Anxiety Disorders: Patient reports significant anxiety symptoms, but these appear directly related to current life stressor rather than representing generalized anxiety disorder or panic disorder.

Acute Stress Reaction: Consider acute stress reaction, though symptoms have persisted beyond immediate stressor and show mixed anxiety-depression pattern more consistent with adjustment disorder.

Most Likely Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood evidenced by the development of emotional symptoms within three months of relationship stressor, with both anxious and depressive features causing functional impairment.

Plan

Health Promotion: ✓ Young Adult Health Maintenance – Age-appropriate preventive care including reproductive health, substance use screening, and mental health maintenance ✓ Mental Health Education – Comprehensive education about adjustment disorders, healthy coping strategies, and stress management techniques ✓ Substance Use Prevention – Education about risks of using substances as coping mechanisms and alternative stress management approaches ✓ Crisis Safety Planning – Development of safety plan and coping strategies for future stressors

Screening: ✓ Mental Health Monitoring – Regular psychiatric assessment using standardized screening tools for depression and anxiety ✓ Substance Use Assessment – Ongoing screening for substance use patterns and intervention as needed ✓ Functional Assessment – Monitoring of academic and occupational functioning

Interventions: ✓ Crisis Intervention – Immediate safety assessment and crisis counseling ✓ Psychiatric Referral – Referral to mental health professional for ongoing therapy and possible medication management ✓ Case Management – Assistance with housing stability and social support resources ✓ Brief Intervention – Substance use brief intervention and motivational interviewing

Complete Step-by-Step Guide to Writing the Alexandra Katsaros iHuman Case Study

Completing the Alexandra Katsaros iHuman case requires a systematic approach focused on young adult psychiatric emergency assessment and adjustment disorders. This comprehensive guide will walk you through each section of the simulation, providing specific strategies and key points to ensure you achieve the required 70% score.

Step 1: Pre-Case Preparation and Initial Approach

Before diving into the case, take a moment to review the doorway information and formulate your initial clinical approach.

Key Information to Note:

• 22-year-old female with acute emotional distress
• Polysubstance use in context of relationship stressor
• Consider adjustment disorders and substance-related concerns

Initial Clinical Mindset: Approach this case with adjustment disorders as your primary consideration. The age, recent stressor, and symptom pattern immediately suggest potential adjustment disorder with co-occurring substance use, making this a high-priority assessment requiring systematic psychiatric evaluation.

Step 2: Conducting the History of Present Illness (HPI)

The HPI is crucial for establishing the foundation of your psychiatric diagnosis. Use systematic questioning while keeping young adult mental health considerations in mind:

Onset: Ask about when symptoms started and relationship to stressors

• Key points to elicit: Timeline relative to breakup and housing concerns

Location: Determine emotional, physical, and social impact

• Target response: Anxiety, depression, and functional impairment

Duration: How long symptoms have persisted since stressor

• Important detail: Within three months of stressor onset

Character: Detailed description of emotional and behavioral symptoms

• Critical descriptors: Overwhelmed feelings, anxiety, depression, concentration problems

Aggravating factors: What makes symptoms worse

• Essential findings: Relationship conflicts, housing instability

Relieving factors: What provides relief or coping attempts

• Key response: Attempted relief through substance use (maladaptive coping)

Timing: Pattern and relationship to stressors

• Important pattern: Directly following relationship breakup

Severity: Impact on daily functioning

• Typical response: Significant functional impairment affecting school and work performance

Associated Symptoms:

• Ask specifically about: Sleep disturbance, concentration problems, anxiety symptoms, mood changes
• Key findings: Physical tension, headaches, insomnia

Step 3: Review of Systems (ROS)

Conduct a thorough but focused ROS, paying special attention to psychiatric and substance use systems:

Psychiatric:

• Mood changes, anxiety symptoms, concentration difficulties
• Sleep disturbances and appetite changes
• Suicidal and homicidal ideation assessment
• History of mental health treatment

Substance Use:

• Patterns of alcohol, prescription, and illicit drug use
• Tolerance, withdrawal, and loss of control
• Use of substances as coping mechanisms

General:

• Energy levels, fatigue, and physical symptoms
• Social and occupational functioning
• Academic performance changes

Medical:

• Thyroid-related symptoms and medication compliance
• Any physical health concerns

Step 4: Past Medical History, Social History, and Family History

Past Medical History:

• Previous episodes of depression or anxiety
• Current management of hypothyroidism
• Any psychiatric hospitalizations or treatment

Social History:

• Current living situation and housing instability
• Academic and occupational status
• Substance use patterns and social context
• Support systems and social connections

Family History:

• Family history of mental health conditions
• Substance use in family members
• Family dynamics and support

Step 5: Mental Status Examination Strategy

Perform a comprehensive psychiatric mental status exam:

Appearance and Behavior:

• Expected findings: Cooperative, appropriate appearance, possible mild distress

Speech:

• Critical component: Normal rate and rhythm, assess for pressured or slow speech

Mood and Affect:

• Look for: Anxious and depressed mood, congruent affect

Thought Process and Content:

• Comprehensive assessment including suicidal/homicidal ideation
• Preoccupation with relationship stressors
• Reality testing and perceptual disturbances

Cognitive Assessment:

• Orientation, memory, and concentration testing
• Impact of anxiety and depression on cognitive function

Risk Assessment:

• Comprehensive suicide and violence risk evaluation
• Substance use risk assessment

Step 6: Developing Differential Diagnoses

Propose at least 3-4 appropriate differentials with rationales:

Primary Consideration: Adjustment Disorder with Mixed Anxiety and Depressed Mood

• Supporting evidence: Clear stressor, temporal relationship, mixed symptoms

Secondary Considerations:

• Major Depressive Episode: Given prior depression history and current mood symptoms
• Substance Use Disorder: Pattern of substance use as coping mechanism
• Anxiety Disorders: Consider generalized anxiety or panic disorder

Step 7: Diagnostic Test Interpretation

Interpret provided test results to support your diagnosis:

Expected Key Findings:

• Toxicology screen: Evidence of recent polysubstance use
• Psychiatric screening tools: Elevated anxiety and depression scores
• Medical clearance: Rule out organic causes

Step 8: Final Diagnosis and Most Significant Active Problem (MSAP)

Primary Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood

Justification:

• Development of symptoms within three months of identifiable stressor
• Both anxious and depressive symptoms present
• Functional impairment in academic and occupational domains
• Young adult demographic consistent with adjustment disorders

MSAP Selection: Choose “Adjustment Disorder with Mixed Anxiety and Depressed Mood” as your Most Significant Active Problem, as this represents the primary condition requiring immediate intervention and follow-up care.

Step 9: Comprehensive Management Plan

Develop a multi-faceted treatment approach:

Immediate Management:

• Crisis assessment and safety planning
• Medical clearance and toxicology evaluation
• Psychiatric consultation for comprehensive evaluation

Short-term Management:

• Brief intervention for substance use
• Crisis counseling and coping skills development
• Case management for housing stability

Long-term Management:

• Psychotherapy referral for individual counseling
• Stress management and adaptive coping strategies
• Academic and occupational support services

Patient Education:

• Adjustment disorder education and prognosis
• Substance use risks and alternative coping mechanisms
• Support group resources and peer support

Follow-up Plan:

• Regular mental health follow-up
• Substance use monitoring and support
• Academic and social functioning assessment

Step 10: Documentation and Submission Tips

Writing Your Summary:

• Create a concise 350-word summary explaining your clinical reasoning for young adult psychiatric emergencies
• Include how you arrived at the problem list with consideration of adjustment disorders
• Cite specific assessment findings and risk factor correlations
• Use professional psychiatric terminology appropriate for emergency mental health

Key Documentation Elements:

• Assessment Statement: Brief patient summary with key psychiatric findings
• Clinical Reasoning: Explain diagnostic thought process for adjustment disorders
• Risk Assessment: Link symptoms to safety concerns and substance use
• Management Rationale: Justify treatment choices and referral needs

Final Submission Checklist:

• ✓ Complete psychiatric history with systematic mental health questioning
• ✓ Comprehensive mental status examination including risk assessment
• ✓ Appropriate differential diagnoses with young adult considerations
• ✓ Correct final diagnosis and MSAP
• ✓ Evidence-based management plan including crisis intervention
• ✓ Professional documentation with proper psychiatric terminology

Alexandra Katsaros iHuman Case Summary

Grading Criteria

The Alexandra Katsaros iHuman case will evaluate you across several critical domains to ensure comprehensive young adult psychiatric emergency assessment skills. Here’s what you need to focus on to maximize your score:

(1) History Taking (Major Points): You must ask targeted questions about psychiatric symptoms and psychosocial stressors to get full credit. Essential questions include: temporal relationship between stressor and symptoms, substance use patterns, suicidal ideation assessment, functional impairment documentation. Don’t miss asking about: prior mental health treatment, family psychiatric history, current medication compliance. The rubric specifically rewards students who ask about stressor-symptom relationships and coping mechanisms.

(2) Mental Status Examination (High Weight): Focus your exam on systematic psychiatric assessment and risk evaluation. Must-do components: comprehensive mental status examination, suicide risk assessment, substance use evaluation, cognitive testing. Pro tip: The rubric awards points for thorough risk assessment and documentation of insight and judgment – key components that relate directly to adjustment disorder diagnosis.

(3) Differential Diagnosis (Critical for Scoring): You need to propose at least 3 appropriate differentials with brief rationales. Expected differentials include: Adjustment Disorder with Mixed Anxiety and Depressed Mood, Major Depressive Episode, Substance Use Disorder, and anxiety disorders. Scoring secret: The rubric rewards students who can distinguish between adjustment disorders and major mental illness based on stressor relationship and symptom timeline.

(4) Final Diagnosis & MSAP: You must correctly identify Adjustment Disorder with Mixed Anxiety and Depressed Mood as your Most Significant Active Problem (MSAP). Justification is key – cite the temporal relationship to stressor, mixed symptom presentation, and functional impairment as supporting evidence.

(5) Management Plan (Heavily Weighted): The rubric expects comprehensive crisis intervention including: appropriate psychiatric referrals, risk management strategies, substance use intervention, and case management. High-scoring responses mention: emergency psychiatric consultation, toxicology evaluation, substance use counseling, and social support services.

(6) Patient Communication: Demonstrate appropriate communication for young adult patients in crisis. Bonus points for: explaining the diagnosis in age-appropriate terms, discussing healthy coping strategies, addressing immediate safety concerns, and providing resources for ongoing support.

Example of a High-Scoring Clinical Summary

Here’s how a top-performing student might document this case:

Patient Summary – Alexandra Katsaros

Situation: 22-year-old female presenting with acute emotional distress and polysubstance use following relationship breakup and housing instability.

Background: Significant risk factors including young adult female, prior depression history, current psychosocial stressors. Recent onset of mixed anxiety and depressive symptoms with functional impairment. Past medical history significant for hypothyroidism and previous untreated depression.

Assessment: Mental status examination notable for anxious and depressed mood, good reality testing, denial of suicidal ideation, and impaired judgment evidenced by polysubstance use as maladaptive coping mechanism.

Primary Diagnosis: Adjustment Disorder with Mixed Anxiety and Depressed Mood

Recommendation:

• Immediate psychiatric consultation for comprehensive mental health evaluation
• Medical clearance and toxicology screening
• Substance use brief intervention and counseling referral
• Crisis safety planning and coping skills development
• Case management for housing stability and social support
• Patient education regarding adjustment disorders and healthy stress management

Patient and Family Education Provided: Explained adjustment disorder diagnosis and expected course, discussed healthy coping strategies and stress management techniques, emphasized importance of mental health follow-up, and provided information about crisis resources and support groups for young adults experiencing life transitions.

Conclusion

By following this comprehensive approach to the Alexandra Katsaros case, you’ll demonstrate the young adult psychiatric emergency assessment skills that iHuman evaluates. Remember, success in psychiatric emergency cases requires understanding crisis intervention principles: gather detailed psychiatric history about stressor-symptom relationships, perform systematic mental status examination with thorough risk assessment, consider adjustment disorders in young adults with clear stressors, and develop crisis-centered management plans addressing both mental health and substance use concerns. The key is treating each iHuman simulation as you would a real psychiatric emergency – be thorough, consider the complexity of young adult mental health, and always prioritize safety assessment and crisis intervention. With this guide, you’re well-prepared to excel in this challenging but important psychiatric emergency case simulation.

Frequently Asked Questions

Q1: What is the correct diagnosis for Alexandra Katsaros’s psychiatric presentation?

Alexandra Katsaros’s primary diagnosis is Adjustment Disorder with Mixed Anxiety and Depressed Mood. The key distinguishing features that point to this diagnosis include the clear temporal relationship between the relationship breakup stressor and symptom onset, the presence of both anxious and depressive symptoms, and functional impairment in academic and work settings. Students often struggle between adjustment disorders and major depression, but remember that adjustment disorders typically show a clear relationship to an identifiable stressor and develop within three months of the stressor, whereas major depression may occur independently of life events.

Q2: What are the critical mental status exam components I need to perform to score well?

Essential mental status exam elements include comprehensive psychiatric assessment with mood and affect evaluation, thought process and content assessment, cognitive testing, and thorough risk evaluation. Many students miss points by inadequately performing suicide risk assessment, which is crucial for identifying safety concerns in psychiatric emergencies. Don’t forget to assess insight and judgment, particularly regarding the patient’s use of substances as coping mechanisms, and evaluate the patient’s understanding of their current situation.

Q3: How do I pass the Alexandra Katsaros case and meet the 70% requirement?

You must score a cumulative 70% on the iHuman assessments to successfully complete the required lab component. To achieve this score, focus on thorough psychiatric history-taking using systematic mental health questioning, complete all recommended mental status exam components with attention to young adult considerations, propose appropriate differential diagnoses (including adjustment disorders, major depression, and substance use concerns), and develop a comprehensive crisis management plan that includes psychiatric referrals, substance use intervention, and safety planning. The key is being systematic and remembering that psychiatric emergency cases require crisis-centered care approaches.

Q4: What management interventions should I include in my treatment plan?

The comprehensive management plan should address both immediate safety needs and long-term mental health care. Include psychiatric consultation for comprehensive evaluation, medical clearance and toxicology screening, crisis safety planning, substance use brief intervention and counseling referral, case management for housing stability, and arrangement for ongoing mental health follow-up. Students often forget to address the psychosocial aspects including stress management education, coping skills development, and support resources, which are crucial components for managing adjustment disorders and can impact your overall score.