Adjustment disorders — structured clinical viva

This is not a trivial "situational" case. There is a clear stressor within 3 months, mixed anxious-depressive symptoms, functional impact, alcohol, diverted benzodiazepine overdose-equivalent behaviour, and passive/ambiguous suicidality — so risk and substance issues dominate the opening minutes.^[1][2]

Diagnosis working view. Adjustment disorder with mixed anxiety and depressed mood is plausible if full MDE and other syndromes are excluded after careful history. Re-check MDD criteria carefully after a self-harm act; substances may inflate or mask symptoms. Do not refuse AD language if criteria fit, but never use it to minimise risk.^[1][4]

Immediate management. Same-day risk assessment; collateral; means restriction (medications, alcohol); consider crisis team or inpatient if intent, plan, ongoing intoxication risk, or inadequate supports; least-restrictive legal framework under local statute. No further unsupervised benzodiazepines.^[2]

Therapy plan. Motivational engagement for psychology: problem-solving around housing/relationship practicalities, brief CBT for hopeless appraisals, alcohol reduction, behavioural activation. Evidence supports brief psychological approaches as preferred active treatment domain despite overall limited AD-specific trial quality.^[3][4]

Medication. Not first-line solely because of breakup. If severe depression emerges or psychology cannot start and distress remains high with risk, consider SSRI with tight early review (e.g. sertraline 25–50 mg orally daily) — explain activation risk after recent self-harm. Avoid replacing alcohol with chronic diazepam.^[3][4]

ICD-11 pearl if asked. Preoccupation + failure to adapt.^[5]