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. The fact that the patient's symptoms improved with 5-HTP, a serotonin precursor, and then worsened after a hangover and vomiting, suggests a possible link between serotonin levels and the patient's symptoms.
Other Likely diagnoses
- Adjustment Disorder: The patient's symptoms of emotional distress and anxiety began after a series of stressful events, including contracting COVID-19, moving to a new apartment, and starting a new relationship. The patient's symptoms may be a response to these stressors, which is consistent with an adjustment disorder.
- Depressive Disorder: Although the patient's psychiatrist ruled out depression, the patient's symptoms of emotional distress, weepiness, and dark terrifying emotions could be consistent with a depressive disorder. The patient's improved mood in the evenings, especially when their partner is present, may suggest a link between their mood and their relationship.
- Trauma- and Stressor-Related Disorder: The patient's history of trauma, including living in a noisy and stressful environment for six years, and their excessive reassurance seeking behavior, may 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 palpitations, anxiety, and emotional distress could be consistent with a pheochromocytoma, a rare tumor of the adrenal gland that can cause excessive catecholamine production.
- Thyroid Disorder: Although the patient's thyroid tests were normal, thyroid disorders can sometimes cause anxiety, emotional distress, and other symptoms that the patient is experiencing.
- Neurological Disorder: The patient's symptoms of emotional distress, anxiety, and intrusive thoughts could be consistent with a neurological disorder, such as a brain tumor or multiple sclerosis.
Rare diagnoses
- Mitochondrial Disorder: The patient's symptoms of emotional distress, anxiety, and fatigue could be consistent with a mitochondrial disorder, such as mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS).
- Autonomic Dysfunction: The patient's symptoms of palpitations, anxiety, and emotional distress could be consistent with autonomic dysfunction, a rare disorder that affects the autonomic nervous system.
- Mast Cell Activation Syndrome: The patient's symptoms of anxiety, emotional distress, and gastrointestinal symptoms could be consistent with mast cell activation syndrome, a rare disorder that affects the mast cells in the body.
The therapy session may have been relevant in that it may have triggered a emotional response in the patient, which could have contributed to their symptoms. The patient's methylation report showing impaired folate and BH4 cycles, moderate methionine cycle efficiency, and slow breakdown of neurotransmitters may also be relevant, as these impairments could contribute to the patient's symptoms. The patient's normal libido and sleep suggest that their symptoms are not related to a hormonal or sleep disorder.