Every patient might have several differential diagnoses due to the symptoms that may be common in each of the considered cases. Medical workers must be able to see the major differences between several possible illnesses to identify and prescribe appropriate medications and develop an efficient healing course. The following paper will discuss a case of one patient that had a possibility of being ill with one of three differential diagnoses that will be compared and described below.
The patient that will be observed in the given analysis paper is a thirty-two years old female. The woman has a Hispanic ethnic background. She is also a representative of the lower middle class. Moreover, the client raises and lives with her children without a husband.
When the patient was asked to explain what was her chief complaint and the main reason why she sought help, the woman answered that she had a tremendous lack of energy, self-esteem, and was nervous in many recent life situations. Perhaps, the client has such emotional stresses because of her social status and unrealized professional potential in her career. Also, her health conditions might lead to permanent nervousness because she feels responsible for her children and is obligated to support them without anyone’s help.
Three Common Differential Diagnoses
As it was mentioned in the introduction section, certain symptoms might be the signs of different diagnoses that require specific approaches to them. In the case of the thirty-two years old Hispanic woman, there are three possible variants: depression, hypothyroidism, and generalized anxiety disorder. All of these emotional disorders have to be treated carefully. Otherwise, the psychological help provided to the patient might even worsen the situation. Such statements can be made after the first assessment of the client’s chief complaint. Her nervousness and constant stresses point at the diagnoses stated above.
The pathophysiology of depression implies the depletion of certain neurotransmitters. In the discussed case, it might be serotonin, dopamine, or even norepinephrine. However, serotonin is considered to be the most common type of neurotransmitters known and wisely studied in cases of depression (Ruscio et al., 2015). Also, it is necessary to state that the woman seems to be dissatisfied with her life because her face never shows or expresses positive emotions. Perhaps, the client does not discuss her negative thoughts with anyone who could support her in this hard situation.
The diagnoses of depression, hypothyroidism, and generalized anxiety disorder were chosen in this medical case as the patient’s behavior during the interview proved the most common symptoms that can be observed in people with such psychological problems. The client could not be claimed as a confident woman because her behavior was somewhat modest and congested. Also, the woman was not comfortable to have eye contact with other people – she preferred to keep her sight down.
Comparison of Differential Diagnoses
This section is intended to compare the three diagnoses mentioned above and identify how they differ in their occurrences. To begin with, it is necessary to state that major depressive disorder is the most common issue of all others considered in such medical instances. People with this mental issue do not have any mood or positive thoughts. Instead, they are concentrated on the problems that follow them regularly.
In turn, hypothyroidism is a disorder that hurts the human endocrine system and leads to the reduction of energy and permanent tiredness of a person (Jonklaas et al., 2014). It usually develops as a consequence of depression and is considered to be common among patients with their psychological problems. In contrast, generalized anxiety disorder is a more rare form of lowered activity. However, it is characterized by the same symptoms as two other illnesses (but a person might have more worries).
The pathophysiology of major depressive disorder is still unrevealed by scholars. However, the majority of relevant theories in this sphere point at the inappropriate work of the circadian rhythm, monoaminergic systems, and problems with human immunity. Also, it may imply the abnormal functioning of certain emotional circuits. In turn, hypothyroidism is a physical disorder, whereas the other two diagnoses can be only treated by psychologists (Cuijpers et al., 2014). However, it develops due to the lack of thyroid hormone in its system. If some cells do not receive this element, they do not produce proteins and become weaker. The last diagnosis (generalized anxiety disorder) differs from others by its specific location and negative influence on the human amygdala. Unlike other disorders, it affects the increased feeling of fear related to certain experiences or memories.
Patients with major depression disorders usually do not have any mood, look displeased with everything, and do not pay much attention to what happens around them. In cases when people have hypothyroidism, their thyroid gland enlarges, skin dries, hair falls out, and the rate of pulse slows down (Peirce et al., 2017). If a patient has a generalized anxiety disorder, he or she is likely to worry about something for more than six months, suffer because of restlessness, irritability, insomnia, and muscle tension. As it is possible to see, all of the disorders influence different organs and can be treated only by narrow specialists.
This section will present the relevant testing required to diagnose the severity of the three diagnoses considered in the given study. To differentiate the major depression disorder from other related illnesses, it is necessary to complete both brain imaging and the process of cognitive testing (Bhattacharjee, Oh, Reiman, & Burke, 2017). If there are signs that indicate the presence of hypothyroidism, laboratory examinations of thyroid stimulation hormone indicators will prove or refute the diagnosis. As to the identification of issues related to generalized anxiety disorder, it is necessary to convey a physical medical examination to find various signs or reasons for anxiety. Also, it would be proper to assess the patient’s urine and blood if the diagnosis is likely to be positive.
National Guidelines for Diagnosing and Testing
Depression must be treated immediately as it is one of the most common disorders in the world that lead to various suicidal cases or low living standards. “When depression occurs in the context of medical morbidity, it is associated with increased health care cost, longer duration of hospitalization, poor cooperation in treatment, poor treatment compliance and high rates of morbidity” (Grover, Gautam, Jain, Gautam, & Vahia, 2017, p. 37). In general, the disorder has to be diagnosed immediately, and its treatment process must be completed only by professionals who specialize in the sphere of psychology and have experience in working with such clients.
The client is likely to have the major depressive disorder as she looked stressed during the interview. The main differences between the diagnoses mentioned in the given study (depression, hypothyroidism, and generalized anxiety disorder) are their locations and influences on separate organs. To prove or refute any of the suggested disorders, it is necessary to consult the National Guidelines for it as the treatment process has to be delicate.
Bhattacharjee, S., Oh, Y. M., Reiman, E. M., & Burke, W. J. (2017). Prevalence, patterns, and predictors of depression treatment among community-dwelling elderly individuals with dementia in the United States. The American Journal of Geriatric Psychiatry, 25(7), 803-813. Web.
Cuijpers, P., Sijbrandij, M., Koole, S., Huibers, M., Berking, M., & Andersson, G. (2014). Psychological treatment of generalized anxiety disorder: A meta-analysis. Clinical Psychology Review, 34(2), 130-140. Web.
Grover, S., Gautam, S., Jain, A., Gautam, M., & Vahia, V. (2017). Clinical practice guidelines for the management of depression. Indian Journal of Psychiatry, 59(5), 34-50. Web.
Jonklaas, J., Bianco, A. C., Bauer, A. J., Burman, K. D., Cappola, A. R., Celi, F. S.,… Sawka, A. M. (2014). Guidelines for the treatment of hypothyroidism: Prepared by the American Thyroid Association task force on thyroid hormone replacement. Thyroid, 24(12), 1670-1751. Web.
Peirce, C., Ippolito, S., Lanas, A., Pesce, M., Pontieri, G., Arpaia, D.,… Biondi, B. (2017). Treatment of refractory and severe hypothyroidism with sublingual levothyroxine in liquid formulation. Endocrine, 35(1), 1-4. Web.
Ruscio, A. M., Gentes, E. L., Jones, J. D., Hallion, L. S., Coleman, E. S., & Swendsen, J. (2015). Rumination predicts heightened responding to stressful life events in major depressive disorder and generalized anxiety disorder. Journal of Abnormal Psychology, 124(1), 17-26. Web.