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 visit).
- Panic Disorder: The patient's experience 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 low mood, anhedonia, and suicidal ideation may suggest 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's symptoms do not strongly suggest a neurological disorder, it is crucial to consider these possibilities, given the potential for severe consequences if left undiagnosed.
Rare diagnoses
- Mitochondrial Myopathies: The patient's symptoms of fatigue, anxiety, and depression, combined with their history of COVID-19, may suggest a mitochondrial myopathy, although this is a rare and unlikely diagnosis.
- Postural Orthostatic Tachycardia Syndrome (POTS): The patient's symptoms of anxiety, palpitations, and orthostatic intolerance may be consistent with POTS, although this diagnosis would require further evaluation.
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 agitation, anxiety, and depression are consistent with agitated depression, the psychiatrist's evaluation suggested that the patient's symptoms were more consistent with a state of emotional angst rather than depression. However, it is possible that the patient's symptoms could be related to a depressive disorder, and further evaluation would be necessary to determine the underlying cause of their symptoms.