Differential Diagnosis

The patient's symptoms of anxiety, intrusive thoughts, and fear of making mistakes suggest several possible diagnoses. Here is a differential diagnosis organized into categories:

• Single most likely diagnosis
  • Generalized Anxiety Disorder (GAD): The patient's symptoms of excessive worry, nervousness, and anxiety about everyday things, such as her schedule, are consistent with GAD. The fact that she has no compulsive symptoms to relieve her anxiety also supports this diagnosis.
• Other Likely diagnoses
  • Obsessive-Compulsive Disorder (OCD): Although the patient denies having compulsive symptoms, her intrusive thoughts about doing things in a certain way and fear of making mistakes could be indicative of OCD. However, the lack of compulsive behaviors makes this diagnosis less likely.
  • Major Depressive Disorder (MDD): The patient reports feeling depressed, fatigued, and having feelings of guilt, which are all symptoms of MDD. However, the primary symptoms reported are anxiety-related, making GAD a more likely diagnosis.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Bipolar Disorder: Although the patient denies any history of psychiatric diagnosis, it's essential to consider bipolar disorder, as anxiety and depressive symptoms can be present in the depressive or anxious phases of the illness.
  • Post-Traumatic Stress Disorder (PTSD): The patient's symptoms of anxiety and intrusive thoughts could be related to a traumatic event, which she may not have disclosed. It's crucial to ask about any traumatic experiences.
  • Thyroid Disorders: Hyperthyroidism can cause anxiety, nervousness, and fatigue, making it essential to rule out any underlying medical conditions.
• Rare diagnoses
  • Anxiety Disorder due to a Medical Condition: Although rare, it's possible that the patient's anxiety symptoms are caused by an underlying medical condition, such as a neurodegenerative disorder or a chronic illness.
  • Neurodevelopmental Disorders: Conditions like autism spectrum disorder or attention deficit hyperactivity disorder (ADHD) can present with anxiety symptoms, although this would be less likely given the patient's age and lack of reported developmental delays.