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Suggest treatment for social anxiety, depression and low self confidence

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Posted on Fri, 15 May 2015
Question: Please help advice about person with the following symptoms:

- Think people are looking at me
- Can become obsessive about certain things
- Social anxiety
- Think people could be watching my PC through the screen
- Depression
- Anxiety
- Avoid most social situations
- Just going out the house is hard sometimes:
- Mowing the lawn would feel impossible (what if people are looking at me)
- Low self confidence
- High confidence on at times
- Can’t make friends (can’t get in those situations due to anxiety)
- Only visit family
- Feel bad self-shame
- Don’t feel much empathy
- Feel negative
- Find it hard to get any work done
- No big plans

- Never any relationship (wouldn't be able to cope more than a day)
- Get obsessive when a close friend isn’t available after a period of time (thinking why and going round in circles)

Has a parent with OCD and another parent with a self-identity problem. Mental problems are also apparent with the wider family too.

Not sure which mental issue this could be? Please advise.
doctor
Answered by Dr. Shubham Mehta (3 hours later)
Brief Answer:
cluster c personality disorder is a possibility.

Detailed Answer:
Hello
Welcome to HCM.

I have read the symptom details thoroughly.

Keeping the given details in mind, In my opinion, this person can have following differential diagnosis for his symptoms (in the following order):

1. Cluster C personality disorder, which includes avoidant, dependent personality. The patient is always anxious, fearful, cannot bear criticisms and has fear of negative evaluation in social situation.
Obsessive personality features are also persent in such patients.

2. Social anxiety disorder.

3. Depression.

I think a detailed clinical examination by a psychiatrist is needed.

For treatment, these people are good candidates for cognitive behaviour therapy.
If needed, antidepressant and antianxiety drugs can also be given.

Hope this helps.

Feel free to ask further.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shubham Mehta (3 days later)
Thanks for your reply. I do drink every weekend 25 beers. Would this be causing many of the symptoms or would this be unrelated?

doctor
Answered by Dr. Shubham Mehta (5 hours later)
Brief Answer:
alcohol can lead to depression and anxiety.

Detailed Answer:
You are most welcome :).

Alcohol abuse can be a co-morbidity with disorders having such symptoms.

Alcohol can sometime lead to anxiety and depressive symptoms but not personality disorder.

Hope this answers your query satisfactorily.

Kindly close the discussion if you have no more queries and give your valuable feedback.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shubham Mehta (53 minutes later)
Thanks for your reply. Do you think that amount of alcohol could cause the symptoms I listed?
doctor
Answered by Dr. Shubham Mehta (14 minutes later)
Brief Answer:
could cause some symptoms

Detailed Answer:
I donot think that amount of alcohol could cause all of these symptoms.

Yes, some symptoms like negative thoughts, anxiety, feeling that people are watching at me, depression can be caused by such amount of alcohol.

Hipe this helps.
Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shubham Mehta (21 minutes later)
Thanks for your reply.

I wondered if I could have cushings disease?
doctor
Answered by Dr. Shubham Mehta (1 hour later)
Brief Answer:
physical signs and symptoms of cushing disease.

Detailed Answer:
Cushings disease mainly has physical signs and symptoms which may include:
high blood pressure,
abdominal obesity but with thin arms and legs, reddish stretch marks,
a round red face,
a fat lump between the shoulders,
weak muscles, weak bones,
acne, and fragile skin that heals poorly.

Occasionally there may psychological symptoms which include changes in mood, headaches, and a chronic feeling of tiredness

Do you have these physical signs and symptoms?

An endocrinologist opinion would be needed if you have these symptoms.

You are welcome for more queries.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shubham Mehta (14 hours later)
Hi,

I used to be obese and had still have acne out breaks. Would say my skin can bruise quite easily, always had. No fat lump. I have normal weight now. I dont get head aches any more. I do feel tired a lot.

Cortisol was checked and was outside the range at CORTISOL * 622 nmol/l
DHEA was slightly raised.

Please advise.
doctor
Answered by Dr. Shubham Mehta (17 hours later)
Brief Answer:
lifestyle modifications; endocrinologist

Detailed Answer:
Hi again.

Sorry for the delayed response.

The symptoms which you have mentioned does match with those of cushing disease.

But, I would suggest you to consult your local endocrinologist for proper diagnosis and treatment.

I can suggest you some lifestyle modifications which anyway, will help you:
1. Drink plenty of water.
2. Practice relaxation exercises like deep breathing and meditation.
3. Eat green vegetables and fruits.
4. You can also take some multivitamin supplements.

Get your platelet count checked for symptom of easy bruising.

Since this is not in my speciality, the best person for you would be an endocrinologist.

Hope this helps.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shubham Mehta (5 hours later)
Thanks for reply. already had blood test, here are the results:

PLATELET COUNT 219 x10^9/L 150 - 400
MPV 12.2 fL 7 - 13
doctor
Answered by Dr. Shubham Mehta (6 minutes later)
Brief Answer:
results normal

Detailed Answer:
You are most welcome :)

The results are well within normal range.

With this backdrop, I think you must consult an endocrinologist to rule out cushing disease.

Kindly follow the lifestyle modifications as I suggested earlier, as far as possible.

I wish you good health.

Take care.
Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shubham Mehta (12 minutes later)
Do you need to be obese to have Cushings? Also, Im thinking about taking another cortisol test, which is best? Saliva or Urine?

Thanks
doctor
Answered by Dr. Shubham Mehta (10 hours later)
Brief Answer:
salivary cortisol test is more sensitive.

Detailed Answer:
Obesity is one of the central feature of cushings syndrome.

Both urine and saliva measure free cortisol levels.

24-hour urinary free cortisol (UFC) and nocturnal salivary cortisol(NSC) are both screening tests for cushings.

I think nocturnal salivary cortisol is more sensitive.

However, neither of the tests are confirmatory for diagnosis of cushings.

If these tests are positive, you should go for dexamethasone suppression test under your doctor's guidence.

Hope this helps.

Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Dr. Shubham Mehta

Psychiatrist

Practicing since :2008

Answered : 2134 Questions

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Suggest treatment for social anxiety, depression and low self confidence

Brief Answer: cluster c personality disorder is a possibility. Detailed Answer: Hello Welcome to HCM. I have read the symptom details thoroughly. Keeping the given details in mind, In my opinion, this person can have following differential diagnosis for his symptoms (in the following order): 1. Cluster C personality disorder, which includes avoidant, dependent personality. The patient is always anxious, fearful, cannot bear criticisms and has fear of negative evaluation in social situation. Obsessive personality features are also persent in such patients. 2. Social anxiety disorder. 3. Depression. I think a detailed clinical examination by a psychiatrist is needed. For treatment, these people are good candidates for cognitive behaviour therapy. If needed, antidepressant and antianxiety drugs can also be given. Hope this helps. Feel free to ask further. Thanks.