GENERAL DATA Patient M.A. is a 15-year-old Filipino female, single, Roman Catholic, and currently a Grade 10 student. She presented for psychiatric assessment due to recurrent episodes of anxiety and panic associated with difficulty breathing, chest discomfort, palpitations, and a sensation of her heart squeezing or pounding. SOURCE AND RELIABILITY Patient : 95% CHIEF COMPLAINT Patient: “Makulbaan ko og dili ka ginhawa.” The patient presents with recurrent anxiety and panic episodes associated with difficulty breathing, chest discomfort, and a sensation of heart squeezing/pounding. HISTORY OF PRESENT ILLNESS Patient had been experiencing recurrent episodes of anxiety and panic since Grade 9, characterized by sudden nervousness, intense fear, palpitations, difficulty breathing, chest discomfort, tremors, lightheadedness with a sensation of blacking out, abdominal discomfort, chills, derealization, fear of losing control, and fear of dying. The episodes occurred approximately every other day, usually in the afternoon when tired or exposed to heat, and lasted around 5 minutes. Initially, she was able to calm herself by breathing into a paper bag, but eventually required another person to help calm her. Two months PTC, the patient reportedly continued to experience recurrent panic episodes and began avoiding commuting alone and going outside without someone accompanying her because of fear of experiencing another attack without anyone available to help. She also developed increased fear of being judged, stared at, or making mistakes in front of others, with avoidance of speaking or performing in front of people and crowded places. 3–4 weeks PTC, on July 18, 2026, the patient experienced an episode described as seizure-like, characterized by rigidity, for which she was brought to Juan Dosado Hospital, Sogod, Cebu. She was reportedly given medication for gastritis and a pain reliever. On July 28, 2026, she experienced another episode characterized by finger stiffness, eye-rolling, and foaming at the mouth. Following these episodes, she temporarily stopped attending school. Two weeks PTC, the patient remained at home due to her symptoms and subsequently continued to experience excessive worries regarding her future, financial difficulties, completion of school, and whether her mother would still be present when she graduates. She also reported restlessness, occasional difficulty concentrating, irritability, and muscle tension. One day PTC, the patient returned to school on August 12, 2026, after approximately two weeks of absence. She reported being generally able to concentrate on schoolwork but occasionally becoming distracted by her worries PAST PSYCHIATRIC HISTORY The patient has no formal psychiatric consultation or hospitalization. She experiences recurrent anxiety and panic episodes since Grade 9, which have worsened. She denies manic or hypomanic episodes and auditory hallucinations but reports a visual perceptual experience involving her deceased neighbor.She had suicidal and self-harm thoughts during Grades 8–10, including hanging herself or cutting her wrists. She also had a previous suicide attempt, but the details are unclear. There’s no history of psychiatric medication or psychotherapy. SUBSTANCE USE HISTORY The patient began using alcohol in Grade 8 drinks about seven 500-mL bottles when she feels heavy. She started vaping in Grade 9 and stopped in April 2026. Denies using drugs PAST MEDICAL HISTORY The patient currently takes no medications and has no established medical conditions. The two seizures on July 18 and 28, 2026, characterized by rigidity, finger stiffness, eye-rolling, and foaming at the mouth. FAMILY HISTORY The patient is the youngest of eight siblings. She currently lives with her sister and her sister’s family.She reports poor relationships with her mother and most of her siblings, except for her sister , whom she staying with identifies as a source of support.Her mother has hypertension and diabetes. The father’s medical history is unavailable. No known family history of psychiatric illness, substance-use disorder, or suicide was reported. DEVELOPMENTAL AND SOCIAL HISTORY Prenatal History Prenatal care was reportedly complete. No significant maternal illness or complications during pregnancy were reported. Natal History The patient was born full-term through normal spontaneous vaginal delivery at home, with a birth weight of approximately 3.8 kg. No birth complications or congenital abnormalities were reported, and no NICU admission was required. Postnatal History The patient was breastfed for approximately 7 months. Developmental milestones were reportedly achieved appropriately for age, with no significant postnatal complications reported. Childhood History : The patient was described as obedient and high-achieving during childhood and was previously ranked among the top two students in her class.During Grades 6–7, she experienced bullying related to her weight, including hair pulling and physical altercations.History of sexual abuse was also reported when she was in grade 6 her sister’s husband molested her Adolescent History: The patient reports a generally normal adolescent development. She is a good academic student with satisfactory school performance and is able to maintain focus on her studies. She has participated in activities such as volleyball and dancing. She maintains relationships with family and peers, with no significant behavioral problems reported. MENTAL STATUS EXAMINATION The patient is well-groomed, calm, and cooperative, with good eye contact and normal psychomotor activity. Speech is normal. Mood is euthymic with congruent affect. Thought process is linear and goal-directed, with anxiety-related preoccupations. She reports suicidal thoughts without a specific plan and denies homicidal ideation. Denies auditory hallucinations but reports a visual perceptual experience. Alert and grossly oriented, with fair insight and judgment. PHYSICAL EXAMINATION Vitals: BP: 120/60 mmhg Temp: 35.4 C HR : 80bpm RR: 18 cpm Ht: 159cm Wt : 53kg BMI : 21 kg/m² DIAGNOSIS :- 1. Generalized Anxiety Disorder with panic attacks ; 2.Agoraphobia Differential Diagnosis: 1. Panic Disorder 2.Social Anxiety Disorder 3.Post-Traumatic Stress Disorder (PTSD) PLAN SERTRALINE 50 mg 1 tab,½ tab OD x 6 days then 1 tab OD thereafter Psychotherapy: Supportive Risk reduction strategies : Follow up after 2 weeks on Aug 27,2026 Plan for CBT

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