Medical Diagnosis Report
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Specialist: Psychologist

Diagnosis:
**Possible Mental Health Issues:**

1. **Panic Disorder:** The symptoms described—sudden episodes of intense chest pain, heart palpitations, shortness of breath, dizziness, sweating, and a feeling of impending doom—are characteristic of panic attacks. Given the frequency and nature of these episodes, Michael may be experiencing panic disorder, especially considering his history of anxiety.

2. **Generalized Anxiety Disorder (GAD):** Michael has a history of anxiety and a family history of generalized anxiety disorder. The high-stress nature of his job and lifestyle factors such as irregular exercise and occasional use of caffeine and alcohol may exacerbate his anxiety symptoms.

3. **Health Anxiety:** The fear of having a heart attack during these episodes, despite normal cardiac evaluations, suggests possible health anxiety, where the patient may be overly concerned about having a serious medical condition.

**Recommended Next Steps:**

1. **Psychotherapy:**
   - **Cognitive Behavioral Therapy (CBT):** Continue or increase the frequency of CBT sessions to address panic disorder and generalized anxiety. CBT can help Michael develop coping strategies to manage panic attacks and reduce anxiety symptoms.
   - **Mindfulness-Based Stress Reduction (MBSR):** Introduce mindfulness techniques to help Michael manage stress and anxiety, potentially reducing the frequency and intensity of panic attacks.

2. **Medication Management:**
   - Review the current use of benzodiazepines (Lorazepam) with a healthcare provider to ensure it is used appropriately and explore other medication options if necessary, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) for long-term management of anxiety and panic disorder.

3. **Lifestyle Modifications:**
   - Encourage regular physical activity, which can help reduce anxiety and improve overall well-being.
   - Advise on reducing caffeine and alcohol intake, as these can trigger or worsen anxiety symptoms.
   - Implement stress management techniques, such as yoga or meditation, to help manage the high-stress nature of his job.

4. **Regular Follow-Up:**
   - Schedule regular follow-up appointments with a mental health professional to monitor progress and adjust treatment plans as needed.
   - Consider a referral to a psychiatrist for a comprehensive evaluation and medication management if symptoms persist or worsen.
