Differential Diagnosis

The patient's symptoms of anxiety, nervousness, and intrusive thoughts about making mistakes and doing things in a certain way, along with worry about future plans and feelings of depression and fatigue, suggest several potential diagnoses. Here is a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Generalized Anxiety Disorder (GAD): This diagnosis is the most likely due to the patient's excessive and persistent worry about everyday things, even when there's no apparent reason to worry. The worry is also causing significant distress and impairment in social, occupational, and other areas of functioning, which aligns with GAD criteria. The patient's symptoms of feeling nervous, anxious, and always second-guessing herself, along with the fear of not making mistakes, are classic presentations of GAD.

• Other Likely Diagnoses

  • Obsessive-Compulsive Disorder (OCD): Although the patient denies compulsive symptoms that relieve anxiety, the presence of intrusive thoughts about doing things in a certain way could suggest OCD. However, the lack of compulsions and the broader worry pattern make GAD more likely.
  • Major Depressive Disorder (MDD): The patient reports sometimes feeling depressed and fatigued, and has thoughts of letting herself and her family down, which could indicate depressive episodes. However, the primary complaint is anxiety, suggesting that depression might be secondary or part of a broader anxiety disorder.
  • Adjustment Disorder with Anxiety: This could be considered if the anxiety symptoms are directly related to a specific stressor (e.g., a significant life change or stressor that occurred last year). However, the information provided does not clearly link the onset of symptoms to a specific stressor.

• Do Not Miss Diagnoses

  • Bipolar Disorder: Although less likely given the information, bipolar disorder can present with anxiety and depressive symptoms. It's crucial to ask about manic or hypomanic episodes, even though the patient denies psychotic symptoms and previous psychiatric diagnoses.
  • Thyroid Disorders: Thyroid dysfunction, particularly hyperthyroidism, can cause anxiety, nervousness, and fatigue. A physical examination and thyroid function tests could help rule out this condition.
  • Anxiety Disorder Due to Another Medical Condition: Various medical conditions can cause or exacerbate anxiety symptoms. A thorough medical history and physical examination are necessary to identify any underlying medical conditions that could be contributing to the patient's symptoms.

• Rare Diagnoses

  • Neurodegenerative Disorders: Rarely, anxiety can be an early symptom of neurodegenerative diseases. However, given the patient's age and the absence of other neurological symptoms, this is less likely.
  • Psychotic Disorders with Prominent Anxiety Symptoms: Although the patient denies psychotic symptoms, in some cases, anxiety can be a prominent feature of psychotic disorders. This would be unusual without other psychotic symptoms, but it should be considered if the clinical picture changes.