Differential Diagnosis
Single Most Likely Diagnosis
- Adjustment Disorder with Mixed Emotional Features: This diagnosis is considered the most likely due to the patient's history of chronic stress, significant life changes (e.g., moving, new relationship, health anxiety), and the sudden onset of emotional distress after a therapy session. The patient's symptoms, such as emotional pain, weepiness, and dark thoughts, are consistent with this diagnosis. The fact that the patient's symptoms improved for two weeks in February and then returned suggests a possible trigger-related pattern.
Other Likely Diagnoses
- Anxiety Disorder, Not Otherwise Specified: The patient's history of health anxiety, agoraphobia, and current symptoms of emotional distress and intrusive thoughts could be indicative of an anxiety disorder.
- Depressive Disorder, Not Otherwise Specified: Although the patient does not exhibit typical symptoms of major depressive disorder, such as anhedonia, low libido, or changes in appetite, the presence of emotional distress, weepiness, and dark thoughts could suggest a depressive disorder.
- Trauma- and Stressor-Related Disorder: The patient's history of chronic stress, health anxiety, and significant life changes could be contributing to their current symptoms, which may be related to a trauma- and stressor-related disorder.
Do Not Miss Diagnoses
- Panic Disorder: The patient's history of panic attacks and agoraphobia suggests the possibility of panic disorder, which could be contributing to their current symptoms.
- Post-Traumatic Stress Disorder (PTSD): Although the patient does not report typical symptoms of PTSD, such as flashbacks or nightmares, their history of chronic stress and significant life changes could be contributing to their current symptoms, which may be related to PTSD.
- Neurological Disorder: The patient's symptoms, such as emotional distress and intrusive thoughts, could be indicative of a neurological disorder, such as a seizure disorder or a movement disorder.
Rare Diagnoses
- Wilson's Disease: This rare genetic disorder can cause psychiatric symptoms, such as anxiety, depression, and emotional distress, and should be considered in the differential diagnosis.
- Mitochondrial Disease: The patient's history of chronic fatigue and emotional distress could be indicative of a mitochondrial disease, such as mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS).
- Autoimmune Encephalitis: This rare condition can cause psychiatric symptoms, such as anxiety, depression, and emotional distress, and should be considered in the differential diagnosis.
It is essential to note that a comprehensive diagnostic evaluation, including a thorough medical and psychiatric history, physical examination, laboratory tests, and imaging studies, is necessary to determine the underlying cause of the patient's symptoms. A mental health professional, such as a psychologist or psychiatrist, should be consulted to provide a definitive diagnosis and develop an effective treatment plan.