Differential Diagnosis
Based on the provided information, the following differential diagnoses are considered:
- Single most likely diagnosis
- Anxiety Disorder: The patient's history of health anxiety, agoraphobia, and excessive reassurance seeking behavior are all consistent with an anxiety disorder. The patient's symptoms of emotional distress, torment, weepiness, and dark terrifying emotions are also typical of anxiety disorders.
- Other Likely diagnoses
- Adjustment Disorder: The patient's symptoms of emotional distress and anxiety began after a series of stressful events, including COVID-19 infection, moving to a new apartment, and starting a new relationship. Adjustment disorder is a possible diagnosis, as the patient's symptoms may be a response to these stressors.
- Depressive Disorder: Although the psychiatrist ruled out depression, the patient's symptoms of emotional distress, weepiness, and dark thoughts could be consistent with a depressive disorder. However, the lack of other typical depressive symptoms, such as changes in appetite or sleep, makes this diagnosis less likely.
- Trauma- and Stressor-Related Disorder: The patient's history of trauma, including living in a stressful environment with barking dogs, and their excessive reassurance seeking behavior, could be consistent with a trauma- and stressor-related disorder.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Panic Disorder: The patient's symptoms of panic attacks, agoraphobia, and excessive reassurance seeking behavior could be consistent with a panic disorder. Although the patient's symptoms are not typical of panic disorder, it is essential to consider this diagnosis due to the potential severity of the condition.
- Cardiovascular Disease: The patient's history of chest pain and breathlessness, although investigated and found to be non-cardiac, warrants consideration of cardiovascular disease. The patient's excessive reassurance seeking behavior and health anxiety may be masking underlying cardiovascular symptoms.
- Rare diagnoses
- Mitochondrial Disease: The patient's symptoms of emotional distress, fatigue (although not reported), and impaired folate and BH4 cycles (MTHFR TT) could be consistent with a mitochondrial disease. However, this diagnosis is rare and would require further investigation.
- Neurotransmitter Disorder: The patient's symptoms of emotional distress, anxiety, and impaired neurotransmitter breakdown (COMT CT, MAOA TT, MAOB GG) could be consistent with a neurotransmitter disorder. However, this diagnosis is rare and would require further investigation.
Each of these diagnoses is considered based on the patient's symptoms, medical history, and laboratory results. A comprehensive evaluation, including a thorough medical history, physical examination, and laboratory tests, is necessary to determine the underlying cause of the patient's symptoms.