AI-powered analysis designed for real-world psychiatric presentations. When the case is complicated, Diagnoxal helps you think it through.
Diagnoxal applies a structured reasoning pipeline to your clinical vignettes. Every diagnostic consideration is grounded in DSM-5-TR and ICD-11 criteria, with explicit evidence and reasoning visible at each stage.
Patients present with overlapping symptoms and complex histories. The system evaluates multiple diagnostic possibilities simultaneously rather than forcing a single match.
Every conclusion links back to specific clinical features from your vignette. Supporting and opposing evidence is presented for each diagnostic consideration.
Hierarchical rules eliminate diagnoses that cannot coexist. The system distinguishes true comorbidity from overlapping symptom clusters.
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Elena Rodriguez is a 19-year-old Hispanic female undergraduate student who presented to the campus counseling center stating, "I feel like I'm going to explode," and reported frequent episodes of heart palpitations and shortness of breath. She stated these feelings began approximately two months ago, coinciding with mid-term exams, but have not subsided despite the semester ending.
Elena is a nursing major on a full academic scholarship. She is the first in her family to attend college and expressed immense pressure to "make her parents' sacrifices worth it." The onset of her symptoms occurred shortly after she received a 'C' on an Anatomy quiz. Since then, she describes a constant sense of impending doom regarding her academic standing, despite currently holding a 3.8 GPA. She reported difficulty falling asleep (initial insomnia) because she "replays every mistake" she made during the day. She has begun skipping meals to study longer, resulting in a 10-pound weight loss over two months.
Elena works part-time (15 hours/week) as a barista. She admitted to drinking 4–5 cups of coffee daily (up from one). She has stopped attending her bi-weekly dance class, stating she "doesn't deserve to have fun" until her grades improve. She denies feelings of depression or hopelessness but describes herself as "wired and terrified."
Elena grew up in a tight-knit, religious household. No history of trauma or abuse. No past psychiatric treatment. Medically, mild asthma, otherwise healthy. Denies illicit drugs or alcohol.
On examination: appeared her stated age, well-groomed but tired with dark circles. Posture tense, fidgeted with ring throughout interview. Speech rapid and pressured but coherent. Affect anxious and labile; tearful when discussing parents. Denied suicidal or homicidal ideation. Thought process logical but focused on themes of failure and perfectionism. Insight partial.
The patient is Elena Rodriguez, a 19-year-old college student presenting with two months of prominent anxiety, episodic palpitations/shortness of breath, sleep-onset insomnia, social withdrawal (stopped dance class), reduced eating with 10-lb weight loss, and marked preoccupation with academic failure beginning after a poor quiz grade during midterms.
The diagnosis is Adjustment Disorder with Anxiety, acute because symptoms began approximately two months ago in clear temporal relation to an identifiable psychosocial stressor (receipt of a 'C' on an Anatomy quiz during midterms), are predominantly anxiety-focused (constant sense of impending doom, insomnia from "replaying every mistake," autonomic symptoms), represent a marked emotional reaction out of proportion to the single academic event (she holds a 3.8 GPA yet reports pervasive catastrophic worry), and have produced behavioral change (skipping meals, stopping dance class) without evidence of a preexisting chronic anxiety disorder. The time frame is under six months, consistent with an acute adjustment reaction rather than a persistent disorder.
Generalized Anxiety Disorder: Ruled out at this time because duration is under the DSM-required six months and the worry is narrowly tied to an identifiable academic stressor rather than being pervasive across multiple domains; if symptoms persist beyond six months or broaden, GAD should be reconsidered. Panic Disorder: Ruled out because although she endorses panic-like symptoms ("heart palpitations and shortness of breath"), the vignette lacks documentation of recurrent unexpected discrete panic attacks with the required symptom profile. Substance/Medication-Induced Anxiety: Considered but not primary because the temporal/causal link between increased caffeine (from one to 4–5 cups/day) and onset/worsening of anxiety is not clearly established. Major Depressive Disorder: Ruled out because the patient denies depressed mood or hopelessness.
Applicable specifiers: 'With anxiety' — symptoms are primarily anxious and manifested by worry, autonomic symptoms, and sleep disturbance. 'Acute' — symptom duration is approximately two months (less than six months). Severity: best characterized as moderate because there is substantial subjective distress and observable behavioral change (10-lb weight loss, stopping a valued activity) but preserved core role functioning (maintains a 3.8 GPA and part-time work).
Recommendations: (1) Clarify timing and quantity of caffeine increase relative to symptom onset. (2) Characterize the reported panic-like episodes: onset, peak timing, number of symptoms per episode. (3) Monitor symptom course over the next months to determine persistence beyond six months. (4) Screen for emergent suicidal ideation if mood or hopelessness appears.
Silas Vane is a 29-year-old Caucasian male employed as a journeyman electrician, referred for a "Fitness for Duty" psychiatric evaluation by the Safety Compliance Office of a large industrial contracting firm. Mr. Vane had been employed for three weeks. During his hiring orientation, he appeared charismatic and knowledgeable, presenting a resume detailing extensive experience with high-voltage systems. However, in his short tenure, site foremen reported that Mr. Vane was frequently tardy, often disappeared for long breaks, and refused to wear mandatory protective gear, labeling it "safety theater for wimps."
The referral was precipitated by a critical incident: Mr. Vane allegedly bypassed a safety lockout on a live circuit breaker to finish a job faster, resulting in a minor explosion that singed an apprentice's eyebrows. When confronted, Mr. Vane reportedly laughed and told the apprentice, "That'll teach you to keep your head on a swivel," and blamed the equipment manufacturers for making "over-sensitive junk."
When the project manager attempted to terminate his contract for gross negligence, Mr. Vane immediately threatened legal action. He claimed he suffered from Post-Traumatic Stress Disorder (PTSD) and Intermittent Explosive Disorder, stating that the stress of the job site triggered his condition. He insisted that firing him would be a violation of the Americans with Disabilities Act (ADA) and demanded a forensic evaluation to prove his "disability status" and secure paid leave.
During the evaluation, Mr. Vane spent the majority of the time detailing his intellectual superiority over his supervisors, whom he described as "clipboard warriors who wouldn't know a neutral wire if it strangled them." He has a four-year-old daughter he has never met; he stated he refuses to pay child support because "the kid is probably not mine, and even if she is, I'm not funding her mother's shopping addiction."
A review of school records and juvenile court documents revealed a diagnosis of Conduct Disorder with onset at age 11. He had a history of initiating physical fights, was caught twice setting small fires in neighbors' mailboxes, and was suspended for stealing prescription medications from the school nurse's office. Notably, a school counselor's note described an incident where Silas killed a stray cat.
Mr. Vane admitted to heavy alcohol use, drinking a "12-pack or so" on weekends and "a few shots" before work to "steady the hands." He also admitted to purchasing oxycodone off the street for "old back injuries." A background check revealed that Mr. Vane's electrician license number actually belonged to a retired worker in a different state. He had been fired from two previous jobs: one for stealing copper wire from a job site to sell for scrap, and another for slashing the tires of a foreman who criticized his work. He is currently awaiting trial for an assault charge related to a bar fight, a detail he omitted during the interview.
The patient is a 29-year-old male journeyman electrician referred for a fitness-for-duty forensic evaluation after workplace safety violations culminating in bypassing a lockout that caused a minor explosion. History, collateral records, and observed behavior demonstrate longstanding pattern of rule-breaking, deceit, aggression, lack of remorse, grandiosity, and current instrumental symptom presentation.
The diagnosis is Antisocial Personality Disorder (documented Conduct Disorder with onset before age 15) because history and collateral documentation meet the developmental and adult-phase requirements. History reveals a documented Conduct Disorder beginning in adolescence (onset age 11) with repeated early aggressive and rule‑breaking acts (physical fights, arson of mailboxes, theft from the school nurse, and cruelty to animals). Adult behavior demonstrates pervasive antisocial features: repeated illegal acts (theft of copper wire; awaiting trial for assault), deceit and misrepresentation (using another electrician's license number), reckless and impulsive endangerment of others (bypassing a safety lockout leading to an explosion that injured an apprentice), aggressiveness (slashing a foreman's tires), and apparent lack of remorse (laughing after the incident and blaming equipment manufacturers).
Narcissistic Personality Disorder: Ruled in as a comorbid personality disorder because the patient reports pervasive grandiosity, entitlement, exploitative interpersonal style, and lack of empathy (e.g., repeated statements of intellectual superiority, describing ex-partners as "parasites," boasting of hacking the school system). Malingering: Confirmed as present because the patient has clear external incentives (avoiding termination, obtaining ADA protections, acquiring controlled medications), provided inconsistent/vague symptom reports for PTSD, and falsified credentials and omitted criminal charges on interview. PTSD and Intermittent Explosive Disorder: Ruled out as primary explanations because the patient fails to endorse core trauma-related symptoms and aggressive acts are longstanding and instrumentally motivated rather than episodic explosive outbursts.
Recommendations: (1) Forensic clarification: Obtain standardized symptom and performance validity testing. (2) Substance evaluation: Obtain urine toxicology and focused assessment for Opioid/Alcohol Use Disorder. (3) Collateral/documentation: Maintain records documenting Conduct Disorder and prior employment findings. (4) Occupational recommendation: Not fit for safety-sensitive duties pending remediation.
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