Differential Diagnosis
Single Most Likely Diagnosis
- Adjustment Disorder with Mixed Emotional Features: This diagnosis is considered the most likely due to the sudden onset of symptoms after a therapy session, which was preceded by weeks of chronic stress. The patient's symptoms, including emotional distress, weepiness, and dark thoughts, are consistent with an adjustment disorder. The fact that the patient's symptoms improved for two weeks in February and then returned suggests a possible trigger-related condition.
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.
- Trauma- and Stressor-Related Disorder, Unspecified: Although the patient does not report any traumatic events, the chronic stress and anxiety related to their health concerns and relationship issues could be contributing to their symptoms.
- Serotonin Syndrome or SSRI-Induced Syndrome: The patient's symptoms, including emotional distress and agitation, could be related to the use of 5-HTP or Sertraline, although the symptoms persisted after stopping the medication.
Do Not Miss Diagnoses
- Pheochromocytoma or Other Catecholamine-Related Disorders: The patient's symptoms, including palpitations, anxiety, and emotional distress, could be indicative of a catecholamine-related disorder. Although the patient's blood pressure and other tests are normal, this diagnosis should not be missed due to its potential severity.
- Neuroendocrine Disorders, such as Cushing's Syndrome or Addison's Disease: The patient's symptoms, including emotional distress and fatigue, could be related to a neuroendocrine disorder. Although the patient's cortisol levels are normal, other tests may be necessary to rule out these conditions.
Rare Diagnoses
- Mitochondrial Disorders or Other Metabolic Conditions: The patient's symptoms, including emotional distress and fatigue, could be related to a mitochondrial disorder or other metabolic condition. Although the patient's tests are mostly normal, further evaluation may be necessary to rule out these conditions.
- Autoimmune or Inflammatory Disorders, such as Lupus or Rheumatoid Arthritis: The patient's symptoms, including emotional distress and joint pain (not reported but possible), could be indicative of an autoimmune or inflammatory disorder. Although the patient's tests are mostly normal, further evaluation may be necessary to rule out these conditions.
It is essential to note that a comprehensive diagnostic evaluation, including a thorough medical history, physical examination, and laboratory tests, is necessary to determine the underlying cause of the patient's symptoms. A mental health professional should be consulted to further evaluate the patient's condition and develop an appropriate treatment plan.