Differential Diagnosis
Single most likely diagnosis
- Anxiety Disorder: The patient's history of health anxiety, agoraphobia, and excessive reassurance seeking behavior are all consistent with an anxiety disorder. The patient's symptoms of emotional distress, torment, weepiness, and dark terrifying emotions are also typical of anxiety disorders.
Other Likely diagnoses
- Adjustment Disorder: The patient's symptoms of emotional distress and anxiety began after a series of stressful events, including COVID-19 infection, moving to a new apartment, and starting a new relationship. Adjustment disorder is a possible diagnosis, as the patient's symptoms may be a response to these stressors.
- Depressive Disorder: Although the psychiatrist ruled out depression, the patient's symptoms of emotional distress, weepiness, and dark thoughts could be consistent with a depressive disorder. However, the lack of other typical depressive symptoms, such as changes in appetite or sleep, makes this diagnosis less likely.
- Trauma- and Stressor-Related Disorder: The patient's history of trauma, including living in a stressful environment with barking dogs, and their excessive reassurance seeking behavior, could be consistent with a trauma- and stressor-related disorder.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pheochromocytoma: The patient's symptoms of anxiety, palpitations, and sweating could be consistent with a pheochromocytoma, a rare tumor of the adrenal gland that can cause excessive catecholamine production.
- Thyroid Storm: Although the patient's thyroid function tests were normal, thyroid storm is a life-threatening condition that can cause symptoms of anxiety, agitation, and emotional distress.
- Neurological Disorder: The patient's symptoms of emotional distress and anxiety could be consistent with a neurological disorder, such as a brain tumor or multiple sclerosis. Although the patient's neurological examination is normal, it is essential to consider these possibilities.
Rare diagnoses
- Mitochondrial Disease: The patient's symptoms of emotional distress and anxiety, combined with their history of COVID-19 infection and excessive reassurance seeking behavior, could be consistent with a mitochondrial disease, such as mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS).
- Wilson's Disease: The patient's symptoms of emotional distress and anxiety, combined with their history of excessive reassurance seeking behavior, could be consistent with Wilson's disease, a rare genetic disorder that can cause psychiatric symptoms.
The therapy session may have triggered the patient's symptoms of emotional distress and anxiety, as it may have uncovered underlying issues or stressors that the patient was not aware of. The patient's methylation report showing impaired folate and BH4 cycles, moderate methionine cycle efficiency, and slow breakdown of neurotransmitters may also be relevant to their symptoms, as these abnormalities can affect mood and anxiety regulation. The patient's response to 5-HTP, which helped for 3 days before the symptoms returned, may also be relevant, as it suggests that the patient's symptoms may be related to serotonin regulation.