[57F] With chronic sadness, irritability, and multiple comorbidities
Patient Description
A 57-year-old female has been experiencing chronic sadness, lack of interest, fearfulness, and irritability. She reports not wanting to see or talk to anyone, with these feelings occurring off and on for about 10 years. The sadness is described as overwhelming empathy for others' pain and suffering, exacerbated by news and real-life events. Praying helps alleviate these feelings. She has been diagnosed with panic with anxiety, depressive disorder, and PTSD, with episodes of sadness occurring at least once a day, typically lasting an hour or two if managed early. Over the past two years, she has also felt unexplainably irritated and short-fused, mostly experiencing frustration and some anger. The patient has a history of extreme abuse contributing to her PTSD. She has type 2 diabetes (diagnosed in 2015), psoriasis (diagnosed 3 years ago), psoriatic arthritis (diagnosed last year), and controlled high blood pressure (diagnosed about 20 years ago). Recently, she has noticed a slight change in appetite and increased fatigue over the past month. She has no recent thoughts of self-harm or suicide. She recently relapsed into using a nicotine vape after quitting smoking 2 years ago and drinks alcohol minimally. Current medications include Ozempic, Cosentyx, losartan, atorvastatin, metoprolol, omeprazole, Synjardy, buspirone, triamterene, and alprazolam as needed. She has had a known reaction to tetanus.
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Arora's Assessment
What might be happening
Based on the symptoms and history you've provided, here are some possible explanations for what you might be experiencing:
Depression and Anxiety
- Major Depressive Disorder (MDD): Your prolonged feelings of sadness, lack of interest in activities, and social withdrawal are classic symptoms of depression. This condition can be exacerbated by your history of trauma and PTSD.
- Generalized Anxiety Disorder (GAD): Your feelings of fear, irritability, and catastrophic thinking align with anxiety. The combination of depression and anxiety is common and can be particularly challenging to manage.
Post-Traumatic Stress Disorder (PTSD)
- PTSD: Your history of extreme abuse and the resulting fear and avoidance behaviors are consistent with PTSD. This condition can cause both emotional and physical symptoms, including irritability and hypervigilance.
Psoriatic Arthritis and Psoriasis
- Psoriatic Arthritis: This condition can cause chronic pain and fatigue, which may contribute to your overall sense of malaise and irritability.
- Psoriasis: The skin disruptions and discomfort from psoriasis can also affect your mood and energy levels.
Type 2 Diabetes
- Diabetes: Poorly controlled blood sugar levels can lead to fatigue and mood changes. It's important to manage your diabetes effectively to minimize these symptoms.
Medication Side Effects
- Medication: Some of the medications you are taking, such as buspirone and alprazolam, can have side effects that include fatigue and mood changes. It's worth discussing these with your healthcare provider.
What you can do
Depression and Anxiety
- Seek Professional Help: It's crucial to consult a mental health professional for a comprehensive evaluation and treatment plan. Cognitive-behavioral therapy (CBT) and other forms of counseling can be very effective.
- Medication Management: Discuss your current medications with your healthcare provider to ensure they are the best options for you. Sometimes, adjusting the dosage or trying a different medication can make a significant difference.
- Self-Care: Engage in activities that you enjoy and that help you relax. Mindfulness practices, such as meditation and deep-breathing exercises, can also be beneficial.
PTSD
- Therapy: Trauma-focused therapies, such as EMDR (Eye Movement Desensitization and Reprocessing) or trauma-focused CBT, can be very effective in managing PTSD symptoms.
- Support Groups: Consider joining a support group for individuals with PTSD. Sharing your experiences with others who understand can be very therapeutic.
Psoriatic Arthritis and Psoriasis
- Follow Treatment Plans: Continue with your prescribed treatments for psoriatic arthritis and psoriasis. Regular follow-ups with your rheumatologist and dermatologist are essential.
- Lifestyle Changes: Gentle exercise, a balanced diet, and stress management techniques can help manage symptoms.
Type 2 Diabetes
- Monitor Blood Sugar: Keep a close eye on your blood sugar levels and follow your diabetes management plan. Regular exercise and a healthy diet are crucial.
- Consult Your Doctor: If you notice any changes in your symptoms or if your fatigue worsens, consult your healthcare provider.
General Tips
- Stay Connected: Even though you may not feel like socializing, staying connected with friends and family can provide emotional support.
- Use MDandMe: Consider using MDandMe to journal your symptoms, track your progress, get insights, and share longitudinal medical notes with your provider.
What you should look out for
Given the complexity of your symptoms and the potential for serious underlying conditions, it's important to seek medical care as soon as possible. Reasons to seek care more urgently include:
- Worsening Mood: If you experience worsening depression, anxiety, or any thoughts of self-harm, seek immediate help.
- Severe Fatigue: If your fatigue becomes debilitating or is accompanied by other concerning symptoms, consult your healthcare provider.
- New or Worsening Symptoms: Any new or worsening symptoms, particularly those related to your chronic conditions, should be evaluated by a healthcare professional.
Remember, while I can provide information and suggestions, it's essential to consult with real health professionals to receive a formal diagnosis and appropriate treatment. If you have more questions or need further assistance, feel free to continue the conversation.
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4 mo ago