Differential Diagnosis
- Single most likely diagnosis
- Posttraumatic Stress Disorder (PTSD): The patient's symptoms began after a life-threatening event (the mugging), and he exhibits classic symptoms of PTSD, including flashbacks (episodes of chest discomfort, shortness of breath, and fear of dying), avoidance of discussing the incident, and memory lapses about the event.
- Other Likely diagnoses
- Acute Stress Disorder: Similar to PTSD, but the time frame since the incident is shorter. The patient's symptoms have been present for 3 weeks, which could still fit within the timeframe for acute stress disorder.
- Generalized Anxiety Disorder: The patient's symptoms of anxiety and fear could be indicative of generalized anxiety disorder, but the specific trigger of the mugging and the presence of memory lapses and avoidance behaviors make PTSD a more likely diagnosis.
- Do Not Miss
- Factitious Disorder: Although less likely, factitious disorder should be considered, especially given the patient's refusal to discuss the incident and the severity of his symptoms. However, the presence of a clear traumatic event and the patient's symptoms aligning closely with PTSD make this less likely.
- Cardiac Conditions: Despite an unremarkable cardiac workup, cardiac conditions should always be considered in cases of chest pain, as they can be life-threatening. Further evaluation may be necessary to rule out cardiac causes entirely.
- Rare diagnoses
- Obsessive-Compulsive Disorder: While the patient's symptoms could be interpreted as obsessive (fear of dying) and compulsive (avoidance behaviors), the direct link to a traumatic event and the nature of his symptoms make OCD a less likely diagnosis in this case.
- Other Psychiatric Conditions: Other psychiatric conditions, such as panic disorder or conversion disorder, could be considered but are less likely given the specific context of the patient's symptoms following a traumatic event.