The current case study describes a patient with various symptoms, majorly psychological but also physical those do not unite in one pathological mechanism or can be explained by science, except for the slight herniation of L4-L5. The patient has almost no deviations in diagnostics except for the mild increase in ALT, ACT, and total bilirubin. The latter can be interpreted as mild liver and other cell damage and cannot be clinically relevant to any of the patient’s complaints. Ms. B has tachycardia and fatigue that, with normal hormone outcomes, do not refer to the pathology of the thyroid gland. Fatigue and weight loss are not likely to refer to malignant processes as the weight loss is not substantial, and the patient’s age is young. Thus, the provisional and differential diagnoses will be connected with psychologic and psychiatric areas.
The most likely diagnosis for Ms. B is tension headaches, frequent episodic type. The latter is explained by the duration of the symptoms of more than 15 days per month and the total duration of the condition less than three months (Ailani et al., 2021). The patient has headaches that by description mostly refer to this nosology. Ms. B stated that the headache felt as her skin was too tight for her skin, and such characteristics along with relief from non-steroid anti-inflammatory tablets are standing for the proposed primary diagnosis. Despite the spread of the disorder and the frequent diagnostics of it in the ambulatory chain, the trigger factors are not yet known. Some state the condition is psychogenic, others believe it has a neurobiological basis. Diagnostics of the disorder are based on clinical data, and other instrumental tests might be negligible (Burch, 2018). Tension headaches are oftentimes misdiagnosed with non-aura migraines and should be taken under control by a physician.
As an additional diagnosis, Ms. B might have a major depressive episode which relates to most of the patient’s symptoms. Conditions signalizing the major depressive episode are anhedonia for at least two weeks, weight loss, sleep disruptions, fatigue, struggles with decision-making (Halverson, 2020). The absence of the symptoms connected with substance use also argues for the disorder. However, the patient has headaches and lower back pain that are relieved after one tablet of Tylenol. Aches might occur in the framework of major depressive disorders; however, they are not included in DSM-V criteria and if happen, are resistant to painkillers. Moreover, the patient does not have significant weight change or appetite disturbance, did not have any thoughts of death and suicide that also refer to this nosology (Halverson, 2020). Even though the psychological sphere allows deviations, two out of three patients’ chief complaints are not relevant to a major depressive episode.
The other additional diagnosis is somatization disorder which refers to recurrent complaints about various somatic symptoms. Depressive and anxious backgrounds can lead to actual physical conditions, and bother patients for long periods (Cao et al., 2020). The patient indeed has two symptoms significantly impacting her daily activities which are headache and lower back pain. The patients usually overreact to their symptoms and deny any psychological or psychiatric roots of the issue which is evident in Ms. B’s behavior. In the framework of somatization disorder, the symptoms of the patient also do not gather in a medical explanation with clear pathogenesis.
References
Ailani, J., Burch, R. C., & Robbins, M. S. (2021). The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache: The Journal of Head and Face Pain, 61(7), 1021–1039. Web.
Burch, R. (2018). Migraine and tension-type headache.Medical Clinics of North America, 103(2), 215-233. Web.
Cao, L., Luo, G., Cao, L., Sheng, C., & Ou, J. (2020). Somatization disorder mediates the association of depression and anxiety with functional impairment in patients with heart failure. Psychology, Health & Medicine, 26(7), 911-916. Web.
Halverson, J. L. (2020). What are the DSM-5 criteria for diagnosis of major depressive disorder (clinical depression)?Medscape. Web.