Reference no: EM133451636

Case: Desean, a 40-year-old male was brought to the emergency room by his wife for what they described as a "relapse of chronic Lyme disease." Desean explained to the medical staff that he felt extremely concerned about a sense of fatigued for about two months. He reported feeling too tired, confused, and mentally foggy to give much more detailed information to the emergency room staff and requested that they call his psychiatrist. Upon the team calling Desean's psychiatrist, he stated that he has treated him for nearly 20 years. He first started providing mental health services to Desean after he started having what appeared to be panic attacks; however, this resolved quite quickly. The mental health treatment then shifted focus onto helping Desean cope with his chronic illness (Lyme disease). Around the time Desean started seeing the psychiatrist he was enrolled in an MBA program with an accounting focus. Due to worries about exacerbating his illness, he decided to withdraw from the program.  Desean has been married to his wife for 15 years and she is a registered nurse. His wife has been his primary support in his life. To help out financially, Desean works some small accounting jobs here and there but greatly limits them so as not to let stress affect his health. Overall, Desean reports feeling physically and emotionally stable most of the time. He denied that his feelings of extreme fatigue and concentration problems were impairing his life and that he did not require much treatment for these issues. Desean stated that he was not very open to psychotropic medications and preferred a more natural approach to his disease, such as following a plant-based diet and exercising regularly. If it is absolutely necessary to take medications he usually only takes it in small doses. When Desean was asked about how the psychiatric sessions were going, he stated that he often spends his time talking about concerns related to his Lyme disease. He added that he even joined a Lyme disease support group, which has been helpful for normalizing his experience. Desean's wife noted that his symptoms will occasionally worsen and wax/wane, though this is only once a year or so that he notices changes and that generally, he has no or minimal symptoms.  She added that any exacerbations tend to happen in response to some obvious stressor.  The worst flare up to date was about two years ago when his wife discovered that Desean had an affair. While consulting with the psychiatrist, she hypothesized that similar stress was behind his current symptoms. The psychiatrist communicated regularly with Desean regular doctor, who stated that tests to date for Lyme disease had all been negative. His regular doctor told the psychiatrist that Desean became defensive in response to these tests, pointing to literature suggesting Lyme disease testing is inaccurate. Both the psychiatrist and primary care doctor decided to take a conservative treatment approach regarding the disease. On mental status examination, Desean was a healthy adult male. His affect was anxious and spoke softly with his eyes closed. He ruminated on concerns of what this exacerbation in symptoms means. He was noted to lose his thought frequently but was able to give a detailed history with some encouragement and space.  His self-reported history was consistent with what the psychiatrist noted. Physical examination was unremarkable.

• Evaluate the diagnosis, etiology, and treatment plan presented by the group, then indicate your support or rejection using evidence from this module. Specifically, state evidence supporting or contradicting the group's diagnosis, etiology, and treatment plan.
• What other diagnoses would you consider?
• What other etiological factors would you consider?
• What other treatments are available for the diagnosis?