Differential Diagnosis
- Single most likely diagnosis
- Adjustment Disorder: The patient's symptoms of anxiety, agitation, and emotional distress began after a specific event (the CBT session) and have persisted for months. The absence of depressive symptoms like anhedonia, guilt, or shame, and the presence of extreme anxiety and emotional reactivity, support this diagnosis.
- Other Likely diagnoses
- Anxiety Disorder (Generalized Anxiety or Panic Disorder): The patient's history of agoraphobia, extreme health anxiety, and frequent ECGs suggest a chronic anxiety disorder. The CBT session may have triggered an exacerbation of these symptoms.
- Post-Traumatic Stress Disorder (PTSD): Although the CBT session is not typically considered a traumatic event, the patient's intense emotional response could be indicative of PTSD, especially if the session triggered unresolved issues or past traumas.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Thyroid Storm or Hyperthyroidism: The patient's symptoms of anxiety, agitation, and emotional distress could be indicative of a thyroid disorder. The rash on the back could be a sign of thyroid-related skin changes.
- Pheochromocytoma: This rare tumor can cause episodic anxiety, panic, and emotional distress, often accompanied by cardiovascular symptoms. The frequent ECGs and extreme health anxiety may be related to this condition.
- Rare diagnoses
- Somatization Disorder: The patient's multiple physical complaints (rash, anxiety, frequent ECGs) and emotional distress could be indicative of a somatization disorder, although this diagnosis is less likely given the absence of other somatic symptoms.
- Factitious Disorder: The patient's extreme health anxiety and frequent medical tests could be indicative of a factitious disorder, although this diagnosis would require further evaluation and evidence of fabricated or induced illness.