Differential Diagnosis
Single most likely diagnosis
- Anxiety Disorder (Generalized Anxiety Disorder or Panic 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.
- Somatization Disorder: The patient's history of health anxiety and excessive reassurance seeking behavior, combined with the presence of physical symptoms such as nausea and vomiting, suggests a possible somatization disorder.
- Trauma- and Stressor-Related Disorder: The patient's history of trauma, including living in a noisy and stressful environment for six years, and the patient's symptoms of anxiety and emotional distress, suggest a possible 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, panic, and palpitations, combined with the presence of high noradrenaline levels, suggest a possible pheochromocytoma. Although this diagnosis is unlikely, it is a potentially life-threatening condition that should not be missed.
- Thyroid Storm: The patient's symptoms of anxiety, panic, and palpitations, combined with the presence of high noradrenaline levels, suggest a possible thyroid storm. Although this diagnosis is unlikely, it is a potentially life-threatening condition that should not be missed.
Rare diagnoses
- Mitochondrial Disease: The patient's symptoms of anxiety, panic, and emotional distress, combined with the presence of impaired folate and BH4 cycles, suggest a possible mitochondrial disease. Although this diagnosis is rare, it is a potentially serious condition that should be considered.
- Neurodegenerative Disease: The patient's symptoms of anxiety, panic, and emotional distress, combined with the presence of impaired folate and BH4 cycles, suggest a possible neurodegenerative disease. Although this diagnosis is rare, it is a potentially serious condition that should be considered.
The therapy session may have been relevant in triggering the patient's symptoms, as it may have caused the patient to confront and process their emotions, leading to an increase in anxiety and emotional distress. The patient's normal libido and sleep, and lack of family history of depression, suggest that the patient's symptoms are not typical of a depressive disorder. The patient's anhedonia, or lack of pleasure, is also not typical of a depressive disorder. The relevance of the MTHFR gene mutation and the impaired folate and BH4 cycles is unclear, but may be related to the patient's symptoms of anxiety and emotional distress.