Differential Diagnosis
The patient's complex presentation of anxiety, agoraphobia, and disturbing emotions warrants a comprehensive differential diagnosis. The following categories outline potential diagnoses:
- Single most likely diagnosis
- Anxiety Disorder, specifically Health Anxiety: The patient's excessive worry about COVID, long COVID, heart health, and other medical conditions, despite negative test results and reassurance, suggests health anxiety. The frequent reassurance-seeking behavior from chatbots and excessive self-research also support this diagnosis.
- Other Likely diagnoses
- Obsessive-Compulsive Disorder (OCD): The patient's repetitive and intrusive thoughts about health concerns, as well as their compulsive behavior of seeking reassurance, may indicate OCD.
- Panic Disorder: The patient's experience of intense anxiety, chest pains, and breathlessness, which led to multiple ECGs and a hospital visit, could be indicative of panic disorder.
- Adjustment Disorder: The patient's significant distress and impairment in social and occupational functioning following the COVID infection and subsequent health concerns may suggest an adjustment disorder.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cardiovascular Disease: Although the patient's tests have been negative, it is essential to rule out underlying cardiovascular disease, given their symptoms of chest pain and breathlessness.
- Neurological Disorders (e.g., Multiple Sclerosis, Neuropathy): The patient's rash and itching, which resolved with topical treatment, may be unrelated to their primary concerns, but it is crucial to consider potential neurological conditions.
- Thyroid Dysfunction: Thyroid disorders can cause anxiety, mood disturbances, and other symptoms presented by the patient, making it essential to rule out thyroid dysfunction.
- Rare diagnoses
- Somatization Disorder: The patient's multiple, recurring physical complaints (e.g., chest pain, breathlessness, rash) without a clear medical explanation may suggest somatization disorder.
- Factitious Disorder: The patient's excessive focus on their health concerns and repeated seeking of medical attention, despite negative test results, may raise concerns about factitious disorder.
- Dissociative Disorder: The patient's experience of disturbing emotions, including feelings of being "drunk" and "sad," could be indicative of a dissociative disorder, although this would be a less likely diagnosis given the patient's overall presentation.