Differential Diagnosis

• Single most likely diagnosis
  • Obsessive-compulsive disorder (OCD): The patient's repetitive thoughts about accidentally killing someone and his compulsive behaviors, such as driving around the block multiple times and constantly looking around to ensure he hasn't done something wrong, are characteristic of OCD. His anxiety and avoidance of certain situations also support this diagnosis.
• Other Likely diagnoses
  • Generalized anxiety disorder: The patient's excessive worry about everyday things, such as driving and bumping into people, and his physical symptoms, like a racing heart and diaphoresis, could also suggest generalized anxiety disorder. However, the presence of specific obsessive thoughts and compulsive behaviors makes OCD a more likely diagnosis.
  • Adjustment disorder: The patient's anxiety and avoidance behaviors could be related to a specific stressor, such as his fear of losing his job. However, the complexity and specificity of his symptoms suggest a more nuanced diagnosis like OCD.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Delusional disorder: Although the patient's thoughts seem to be obsessive rather than delusional, it's essential to consider delusional disorder, especially if his beliefs become more fixed and detached from reality. Missing this diagnosis could lead to inadequate treatment and potentially severe consequences.
  • Substance-induced anxiety disorder: The patient's daily wine consumption could be contributing to his anxiety symptoms. While it's unlikely to be the primary cause, it's crucial to assess and address any potential substance-related issues.
• Rare diagnoses
  • Traumatic brain injury or other neurological conditions: Although unlikely, it's possible that the patient's symptoms could be related to an underlying neurological condition. A thorough medical evaluation and history would be necessary to rule out such conditions.
  • Psychotic disorder: The patient's symptoms do not strongly suggest a psychotic disorder, but it's essential to maintain a broad differential diagnosis and consider all possibilities, especially if his symptoms evolve or worsen over time.