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Psych Scene

Psych Scene

@psychscene.bsky.social

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We provide psychiatry education for Psychiatrists, GPs & Mental Health Practitioners.

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Psych Scene @psychscene.bsky.social · 1d

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Psych Scene @psychscene.bsky.social · 1d

Summary of Assessment Approach

Is it Anxiety?

Is the Anxiety Severe?

Is it an Anxiety Disorder?

Does it meet the criteria for GAD, PD, or SAD?

Use Clinical Practice Guidelines to plan treatment.

Consider other diagnoses and appropriate referral when necessary.

Psych Scene @psychscene.bsky.social · 1d

Medical Contributors to Rule Out

Substance-induced (intoxication, withdrawal, caffeine)

Medical Conditions (hyperthyroidism, seizures, hypoglycaemia)

Psych Scene @psychscene.bsky.social · 1d

Differentiate from MDD

MDD: primary low mood/anhedonia with past-oriented rumination (“Why did I…”) plus hopelessness.

GAD: primary anxiety with future-oriented “what if…”, prominent muscle tension, and secondary low mood.

Psych Scene @psychscene.bsky.social · 1d

Differentiate from OCD

OCD has circumscribed, unwanted intrusive thoughts with compulsions and harm/contamination themes; thoughts feel alien and are ritual-neutralised.

GAD worries are internally congruent, everyday, predominantly verbal, and not ritual-driven.

Psych Scene @psychscene.bsky.social · 1d

GAD-7 Self-Assessment

This diagnostic tool detects a patient’s latent anxiety.

These items are answered by frequency (not at all, most days, etc.)

[Spitzer et al., 2006]

Psych Scene @psychscene.bsky.social · 1d

Diagnostic Interview

“Are you a worrier?”
“How long each day do worries occupy you?”
“What do you worry about?””

Probe tension headaches/neck tightness, sleep onset/maintenance, concentration, avoidance, and functional impact.

Psych Scene @psychscene.bsky.social · 1d

DSM-5 anchors you can count.

Excessive worry more days than not for ≥6 months about multiple domains, difficult to control.

Plus ≥3 of restlessness, fatigue, poor concentration/mind blank, irritability, muscle tension, and sleep disturbance.

Psych Scene @psychscene.bsky.social · 1d

Nature of Anxiety.

Worry is frequent, excessive, hard to switch off, and out of keeping with threat, often without a trigger.

It persists even when things are going well and becomes the problem, not the topic [Andrews et al., 2018].

Psych Scene @psychscene.bsky.social · 1d

Chelsea, 20, says she’s “going mad with anxiety.”

Onset with VCE exams; now pervasive worry, decision paralysis, and no depressive features.

You suspect GAD.

What would you do to confirm this? 👇

Psych Scene @psychscene.bsky.social · 3d

Want to go deeper into the diagnosis and complexities of ADHD?

Join Dr. Sanil Rege for the ADHD Masterclass: From Neurobiology to Clinical Practice on the 29th of November:

ADHD Masterclass Live Curriculum for Clinicians | Psych Scene

learn.psychscene.com

Psych Scene @psychscene.bsky.social · 3d

Psych Scene Tip

When assessing females:

• Ask beyond classroom disruption, explore internal experiences.
• Adapt rating scales (e.g., “excessive giggling/talking” vs. aggression).
• Screen for comorbidities and masking behaviours.

(Young et al., 2020)

Psych Scene @psychscene.bsky.social · 3d

Underdiagnosis may lead to higher risks of:

• Depression and anxiety
• Eating disorders
• Substance use
• Relationship and occupational impairment

Early recognition changes lifelong trajectories.

Psych Scene @psychscene.bsky.social · 3d

Females with ADHD may present with:

• Inattention, disorganisation, overwhelm
• Emotional dysregulation
• Fatigue and low motivation
• Co-occurring anxiety or mood disorders

Hyperactivity is less visible but often internal, restlessness, racing thoughts, impulsive decisions

Psych Scene @psychscene.bsky.social · 3d

Hormonal Influences

Hormones modulate dopamine and serotonin systems.

Oestrogen increases dopamine receptor density, improving focus, while low-oestrogen phases (premenstrual, postpartum, menopause) can exacerbate ADHD symptoms.

Psych Scene @psychscene.bsky.social · 3d

The Female Protective Effect

Females may require a higher threshold of genetic or environmental stressors for ADHD to manifest.

This “protective effect” delays recognition, until academic or social transitions reveal underlying difficulties.

Psych Scene @psychscene.bsky.social · 3d

Neurodevelopmental Differences

Brain maturation differs between sexes.

Females reach total cerebral volume ~4 years earlier (Lenroot et al., 2007), influencing symptom timing and diagnosis.

Cross-sectional studies may misinterpret these developmental differences as absence of pathology.

Psych Scene @psychscene.bsky.social · 3d

Compared to boys, girls with ADHD show:

• More emotional lability
• Higher anxiety and mood symptoms
• Greater risk of being bullied
• Stronger prosocial behaviours

These features often hide underlying ADHD. (Nøvik et al., 2006)

Psych Scene @psychscene.bsky.social · 3d

Girls tend to compensate through compliance, social adaptability, and resilience.

They internalise distress rather than externalising it, leading to misdiagnosis as anxiety, depression, or personality disorders.

Psych Scene @psychscene.bsky.social · 3d

Girls often present with inattentive rather than disruptive symptoms.

They may appear dreamy, disorganised, or emotionally sensitive, not “hyperactive.”

These traits are less likely to trigger referral or concern.

Psych Scene @psychscene.bsky.social · 3d

ADHD is diagnosed far more often in males than females.

Early studies show teachers are more likely to refer boys for assessment, even when girls show identical symptoms. (Young et al., 2020)

Psych Scene @psychscene.bsky.social · 3d

Females with ADHD are often underdiagnosed and undertreated, forming a silent minority.

Research shows a significant male-to-female diagnosis gap (Berry et al., 1985).

Let’s explore why ADHD presents differently in females.

Psych Scene @psychscene.bsky.social · 3d

Want to go deeper into the diagnosis and complexities of ADHD?

Join Dr. Sanil Rege for the ADHD Masterclass: From Neurobiology to Clinical Practice on the 29th of November:

ADHD Masterclass Live Curriculum for Clinicians | Psych Scene

learn.psychscene.com

Psych Scene @psychscene.bsky.social · 3d

Psych Scene Tip

When assessing females:

• Ask beyond classroom disruption, explore internal experiences.
• Adapt rating scales (e.g., “excessive giggling/talking” vs. aggression).
• Screen for comorbidities and masking behaviours.

(Young et al., 2020)

Psych Scene @psychscene.bsky.social · 3d

Underdiagnosis may lead to higher risks of:

• Depression and anxiety
• Eating disorders
• Substance use
• Relationship and occupational impairment

Early recognition changes lifelong trajectories.