Reference no: EM133277762

John is a 55 year-old accountant that was referred for an outpatient evaluation by his family doctor following a recent emergency room visit. In the last year, he has presented to the emergency room twice times with complaints of shortness of breath and heart palpitations. He expressed concern that he had a medical condition that was underlying his physical symptoms.

John grew up in Alberta and moved to the Kingston area for university. He reports a normal birth and that he met all developmental milestones on time. John has Type II diabetes that was diagnosed five years ago. He has faced a number of complications due to his diabetes, including admission to hospital for unmanaged diabetes. In the last two years, John has had spells of heart palpitations and shortness of breath that can last for hours at a time. They happen mostly outside of the house, and he could not identify a trigger to the onset.

John reported that in the past he has experienced periods of lower mood and that he has a tendency to worry. He has no history of diagnosed mental health conditions. Following the start of the Covid-19 pandemic, John has moved to remote work and no longer goes into an office. When asked about current stressors, John stated that he has some concerns about his health, the health of his friends and family, finances, his friendships, and his work. He said that these worries do not consume his day and don't typically affect his ability to complete work projects. Upon further prompting, John acknowledged that he tends to feel most anxious when at the grocery store, travelling on the bus, and in other crowded settings. He often avoids these activities because of this and sometimes will have very little food available to him which has led him to order takeout frequently (up to 6 days a week). His family physician stated that if he continues to consume fast food, he will worsen his unmanaged diabetes. John attributes anxiety in these settings to concerns about contracting Covid-19.

John's mother died at a young age and she reports that she had depression and anxiety. He reported no other family history of mental health conditions in his family.

Upon examination, John appeared to be anxious and preoccupied with worries of something being wrong with his health. He denied psychotic symptoms. His cognition was intact and he had no psychomotor slowing or agitation.

CASE SUMMARY

Provide information and empirical evidence to assist in making diagnostic, etiological, and treatment decisions

What symptoms is the patient currently exhibiting and what diagnostic symptom clusters do these belong to?

What is the most accurate DSM V diagnosis for these symptoms? What led you to rule out other possible diagnoses?

What information (if any) is still needed to strengthen the diagnosis? How will you obtain this information?

What factors may have contributed to the onset/etiology of the disorder?

What current factors might be maintaining the disorder?