Give a diagnosis for the patient and in detail, provide symptoms that support yo

Question

Give a diagnosis for the patient and in detail, provide symptoms that support your diagnosis. In order to receive full points, be as specific as possible in explaining why you chose your diagnosis. Both patients are suffering from one of the Somatic Symptom Disorders. Your diagnosis and explanation should be written below.

Oscar Capek, a 43-year-old man, was brought by his wife to an emergency room (ER) for what he described as a relapse of his chronic Lyme disease.  He explained that he had been fatigued for a month and bedridden for a week.  Saying he was too tired and confused to give much information, he asked the ER team to call his psychologist.

The psychologist reported that he had treated Mr. Capek for more than two decades.  He first saw Mr. Capek for what appeared to be a panic attack. It resolved quickly, but Mr. Capek continued to see him for help coping with his chronic illness.  Initially a graduate student pursuing a master’s degree in accounting, Mr. Capek dropped out of school over worries that the demands of his studies would exacerbate his disease.  Since then, his wife, a registered nurse, had been his primary support. He supplemented their income with small accounting jobs but limited these lest the stress affect his health.

Mr. Capek usually felt physically and emotionally well.  He deemed that his occasional fatigue, anxiety, and concentration difficulties were “controllable” and did not require treatment.  He was typically averse to psychotropic medications and took a homeopathic approach to his disease, including exercise and proper nutrition. When medication was required, he used small doses (e.g., one-quarter of a 0.5-mg lorazepam pill).  His psychological sessions were commonly devoted to concerns about his underlying disease; he would often bring in articles on chronic Lyme disease for support group.

Mr. Capek’s symptoms would occasionally worsen.  This occurred less than yearly, and these “exacerbations” usually related to some obvious stress.  The worse was 1 year earlier when his wife briefly left him following his revelation of an affair.  Mr. Capek expressed shame about his behavior toward his wife-both the affair and his inability to support her.  He subsequently cut off contact with the other woman and attempted to expand his accounting work.  The psychologist speculated that similar stress was behind his current symptoms.

The psychologist communicated regularly with Mr. Capek’s internist.  All testing for Lyme disease thus far had been negative.  When the internist explained this, Mr. Capek became defensive and produced literature on the inaccuracy of Lyme disease testing. Eventually, the internist and psychologist had agreed on a conservative treatment approach with a neutral stance regarding the disease’s validity.

On examination at the ER, Mr. Capek was a healthy, well-developed adult male.  He was anxious and spoke quietly with his eyes closed. He frequently lost his train of thought, but with encouragement and patience, he could give a detailed history that was consistent with the psychologist’s account.  Physical examination was unremarkable.  Lyme disease testing was deferred given his past negative tests.  A standard laboratory screen was normal with the exception of a slightly low hemoglobin. Mr. Capek became alarmed, dismissed reassurances and insisted this be investigated further.

Explanation / Answer

Answer.

The present case shows symptoms for Hypochondriasis as he shows a strong belief that his minor symptoms are due to a serious disease ( Lyne’s Disease). Moreover, he shows a great deal of preoccupation about his physical condition and shows typical symptoms like reading articles, following up with medical professionals on a regular basis, frequent visits to the hospital, etc. His psychological sessions were commonly devoted to concerns about his underlying disease; he would often bring in articles on chronic Lyme disease for support group.

He has explored several forms of treatment including homeopathy and lifestyle changes in relation to his assumed illness. Moreover, he reported that he frequently used small doses of medicines- one-quarter of a 0.5-mg lorazepam pill, to reduce his symptoms. Typical of hypochondriasis, he shows much fears and spends a lot of time thinking about his symptoms and is disbelieving and critical of his psychotherapist and medical test staff when they contest his hypotheses about having Lyne’s disease. Mr. Capek’s symptoms occasionally worsen and are usually related to some obvious stress.

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