Differential Diagnosis for Marissa
Based on the case history, the following differential diagnoses are considered:
- Single Most Likely Diagnosis
- Panic Disorder: Marissa's symptoms of sudden episodes of dyspnea, palpitations, sweating, feelings of choking, and chest pains that last for 15-20 minutes are consistent with panic attacks. Her fear of dying or losing control during these episodes and avoidance of activities due to fear of having an attack also support this diagnosis.
- Other Likely Diagnoses
- Generalized Anxiety Disorder (GAD): Marissa's excessive worry about her health, work, and relationships, as well as her difficulty falling asleep due to anxiety, are consistent with GAD.
- Major Depressive Disorder (MDD): Marissa's history of MDD, current feelings of hopelessness, and loss of interest in activities she previously enjoyed suggest that she may be experiencing a depressive episode.
- Do Not Miss Diagnoses
- Cardiac Conditions (e.g., myocardial infarction, arrhythmias): Although Marissa's ECG and office spirometry results are normal, it is essential to rule out cardiac conditions that could be causing her symptoms, as they can be life-threatening if missed.
- Asthma Exacerbation: Marissa's history of asthma and increased use of her inhaler suggest that she may be experiencing an asthma exacerbation, which could be contributing to her symptoms.
- Rare Diagnoses
- Hypothyroidism-Related Anxiety: Although Marissa's TSH level is within the normal range, it is possible that her hypothyroidism is contributing to her anxiety symptoms.
- Anxiety Disorder Due to Another Medical Condition: Marissa's symptoms could be related to an underlying medical condition, such as anemia or a sleep disorder, which would need to be investigated and ruled out.
Rule-In and Rule-Out Table
| Hypothesis | Rule-In Findings | Rule-Out Findings |
|---|---|---|
| Panic Disorder | Sudden episodes of dyspnea, palpitations, sweating, feelings of choking, and chest pains; fear of dying or losing control | Normal ECG and office spirometry results; no clear precipitating factors |
| Generalized Anxiety Disorder (GAD) | Excessive worry about health, work, and relationships; difficulty falling asleep due to anxiety | No clear evidence of obsessive thoughts or compulsive behaviors |
| Major Depressive Disorder (MDD) | History of MDD; current feelings of hopelessness; loss of interest in activities | No clear evidence of manic or hypomanic episodes |
| Cardiac Conditions | Chest pains; shortness of breath | Normal ECG and office spirometry results; no clear evidence of cardiac disease |
| Asthma Exacerbation | Increased use of inhaler; wheezing | Normal office spirometry results; no clear evidence of asthma exacerbation |
Note: This table is not exhaustive, and additional information may be necessary to fully rule in or rule out each diagnosis.