Differential Diagnosis
Single most likely diagnosis
- Anxiety Disorder, specifically Health Anxiety: The patient's history of excessive worry about their health, frequent reassurance seeking, and preoccupation with the possibility of having a serious illness (e.g., long COVID, heart conditions) are all consistent with health anxiety. The patient's symptoms of agitation, distress, and torment may be manifestations of this anxiety.
Other Likely diagnoses
- Adjustment Disorder: The patient's symptoms of emotional distress, anxiety, and depression may be related to significant life changes, such as moving to a new apartment, starting a new relationship, and experiencing a traumatic event (e.g., the hospital trip).
- Panic Disorder: The patient's history of panic attacks, agoraphobia, and avoidance behaviors are consistent with panic disorder.
- Depressive Disorder, NOS (Not Otherwise Specified): Although the psychiatrist ruled out depression, the patient's symptoms of emotional distress, weepiness, and dark thoughts may be indicative of a depressive 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 continue monitoring their cardiovascular health, given their history of chest pain and heart palpitations.
- Neurological Disorders (e.g., Multiple Sclerosis, Parkinson's Disease): Although the patient does not have any obvious neurological symptoms, it is crucial to consider these conditions, given their potential severity and impact on quality of life.
Rare diagnoses
- Mitochondrial Disease: The patient's history of fatigue, nausea, and vomiting, although not currently present, may be indicative of a mitochondrial disorder.
- Mast Cell Activation Syndrome: The patient's history of rash, itching, and anxiety may be related to mast cell activation syndrome, although this is a rare condition.
- Postural Orthostatic Tachycardia Syndrome (POTS): The patient's history of heart palpitations, anxiety, and avoidance behaviors may be indicative of POTS, although this is a rare condition.
Relevance of the therapy session
The therapy session may have triggered the patient's emotional distress, as they reported feeling a "dark cloud" wash over them after the session. This could be related to the patient's health anxiety and fear of losing control.
Is this Agitated Depression?
While the patient's symptoms of emotional distress, anxiety, and depression are consistent with agitated depression, the lack of clear depressive symptoms (e.g., anhedonia, changes in appetite or sleep) and the presence of prominent anxiety symptoms make this diagnosis less likely. However, it is essential to consider agitated depression as a possible diagnosis, given the patient's significant emotional distress and impairment in daily life.