Pseudo Dementia

[cognitivelykaput]

After having experienced progressive cognitive decline over the past ten months, coupled with all manner of random shooting pains, blurred vision, muscle twitching, movement issues, etc, I've now been told by two different neurologists in the past month, I'm suffering from some sort of pseudo dementia / severe somatisation disorder.

As  previously, perfectly healthy 35 year old male, I find this very hard to accept, but have now had so many different opinions this year, all alluding to the same diagnosis, two normal MRI scans of the brain, innumerable blood tests, etc, I guess I'm just going to have to go with it.

My question is, how is something like pseudo dementia treated?

[lost_myself]

Im no doctor, while what you describe could be a number of things, the symptoms you list are ALL ones that i suffered from when panic /anxiety disorders hit me . I was 37 when mine happened and like you an otherwise perfectly healthy male. I would suggest a re-evalution,not the testing as the results of the test are not likely to change, but a 2nd (or 3,4 whatever) opinion on the available data. I would also suggest not telling whoever reviews it what what the previous person concluded, as it is just too easy to look at it and agree..let them develope thier own opinion.

I would look into anxiety disorers in the mean time on your own. Good Luck.

[mammo]

I totally agree with the last post.  When seeking another opinion go in stating all the tests that have been done, BUT with no diagnosis.
Pseudodementia is a syndrome seen in older people in which they exhibit symptoms consistent with dementia but the cause is a pre-existing psychiatric illness rather than a degenerative one.[1] The name is derived from the Ancient Greek prefix pseudo- "false", prepended to dementia.
Older people with predominant cognitive symptoms such as loss of memory, and vagueness, as well as prominent slowing of movement and reduced or slowed speech, were sometimes misdiagnosed as having dementia when further investigation showed they were suffering from a major depressive episode.[2] This was an important distinction as the former was untreatable and progressive and the latter treatable with antidepressant therapy or electroconvulsive therapy or both.[3]

You don't fit the profiel, get a second opinion.

[cognitivelykaput]

I think you've hit the nail on the head, with how it's all too easy for doctors to read the previous doctors opinion and just side with that - I think that's very true of my case so far.

As I'm in the U.K, you need a referral from your family doctor to see any sort of consultant, and with that, they have to supply a degree of background information. It's practically impossible to just see a consultant, whether it be a psychiatrist, neurologist, etc or otherwise, without going down this route.

Since the onset of my symptoms in December 2008, I've seen 4 different neurologists, two psychiatrists, an endocrinologist, and a neuropsychatrist, all of whom have seen each others opinion to some degree, which I can't but help feel has influenced each of their diagnosis.

I don't really believe I've got pseudo dementia for one minute, especially given my age, and having no previous history of depression whatsoever, except a moderate bout 10 years ago, after a particularly unpleasant relationship break-up.

The fact now I have tremendous anxiety, as a direct consequence of the debilitating cognitive problems I'm experiencing, seems to have only clouded doctors evaluation of my case. I've told them all innumerable times, that the anxiety was not present to begin with, and has only come about over more recent times, given how my cognition has declined so rapidly, but this just seems to fall on deaf ears.

The symptoms of cognitive decline, memory loss, etc, have all been progressive since onset, and there's been no good/bad days, which would make me question how an anxiety disorder could explain things, pretty much in the same way that I'm at a loss about the diagnosis of pseudo dementia, which I've been informed originates from having some sort of underlying depressive disorder, which just wasn't present.

I've been told it's now out of the question that I'd be able to seek the opinion of a fifth neurologist, within the space of 10 months, and to be honest, given my experiences with all the ones I've seen so far, think it would be an absolute waste of time, despite my symptoms being predominately ones of a neurological nature, so feel I have little choice now, other than to go down the route that this is some sort of psychological condition, irrespective of how crazy the notion is.

I think my main problem is, that whilst I get terribly confused now, not really knowing what I'm doing half of the time, unable to follow steps, sequences etc where the likes of self care, meal preparation is involved, I'm still able to articulate myself fairly coherently verbally, when it comes to informing doctors of my problems.

I think this is what's led to such a diagnosis having been made, given how in neurologists eyes, it seems impossible that someone could be confused to the degree I'm telling them I am, yet be able to explain all this to them without much trouble.

[opus88]

so sorry for all your run around and still really UN diagnosis!!

question ...I'm sure this must have been covered thru your many neurology appointments....but I will ask anyway.
HAVE YOU SUFFERED ANY SORT OF HEAD INJURY?

HAVE YOU BEEN GIVEN AN ECT   electrical conductivity test on your brain???

you are much too young for any dementia...there is something CAUSING your cognitive problems

[cognitivelykaput]

No, I've never had any sort of head injury of any kind.

To date, I've had two MRI's of the brain - one in April, and a repeat scan two weeks ago. Both normal. Blood tests for all the normal things, plus a whole bunch of more exotic possibilities, all of which have been normal.

Later this month, I'm having an MRI of my eyes, because of the blurred vision I keep getting. I'm also having some sort of muscle/nerve investigation carried out, along with an evoked potentials test.

One neurologist earlier in the year, mentioned about having an EEG and a lumber punch, but neither of these ever happened, I think predominately as he'd made up his mind that my symptoms were psychological. I've asked the neurologist I've seeing currently who's carrying out the above tests about these, and he deemed them to be unnecessary.

He's told me that if the tests listed come back normal, then the fact I've now also had a repeat MRI of the brain which was also normal, then the cause is definitely psychological, and the possibility of any more tests is out of the question, as I would need to start some sort of treatment for pseudo dementia.

[ILADVOCATE]

Since you are posting in the depression forum are you under treatment for depression? What medications are you taking? Some medications can cause cognitive blunting or cause movement disorders. That may very well not be the cause of it but they should rule that out. Many of these side effects are temporary so they could change or adjust your medication. Look up the medication websites for a start and speak to your psychiatrist more about it.

[HVAC]

I have MS and mostly cognitive problems and depression. I had positive MRIs but it still took two years to be diagnosed. They tried treating my cognitive problems with amphetamine. I did not like the way I felt.  I have to make lists and post its and have my husband remind me of things. I am patient with myself and realize I think differently than I used to. If I fight it makes it worse.  I use too much energy so I work with it. Like fighting depression drains more energy. When I accept I am depressed I do better.

Good luck to you.
Alex

[mammo]

Lots of good ideas on here!  You're really too young for what they have dignosed you as having.  I hope you find the answer.  It's like they really don't know so they're going with this.

[mammo]

I think MS is worth looking into. I know everyone is different with the disease, and MS seems to cause one to have good and bad days, which you experience along with many of the other symptoms. Hard to believe a neurologist would not think of this over the other.

The person with MS can suffer almost any neurological symptom or sign, including changes in sensation (hypoesthesia and paraesthesia), muscle weakness, muscle spasms, or difficulty in moving;[24] difficulties with coordination and balance (ataxia);[24] problems in speech (dysarthria) or swallowing (dysphagia),[25] visual problems (nystagmus, optic neuritis, or diplopia),[26] fatigue, acute or chronic pain,[27][28] and bladder and bowel difficulties.[28][29] Cognitive impairment of varying degrees and emotional symptoms of depression or unstable mood are also common.[30][31] The main clinical measure of disability progression and symptom severity is the Expanded Disability Status Scale or EDSS.[32]

[Jaquta]

There are expert forums here you might like to access.  There is a mental health one and also an undiagnosed symptoms one.  Probably a neurology one too -not sure.

Pseudo-dementia is likely to be treated by addressing the underlying cause or what clinicians believe to be the cause.  In your case I expect that would mean treating the underlying anxiety.

Lots of conditions can mimic dementia.  Depression and anxiety are two of them.
You should perhaps be grateful they are saying it is pseudo.  Having dementia for real would be the pits.  At least pseudo is treatable and reversible.

I think sometimes we don't see our initial problems.  I expect it was likely that there was stuff there and I expect there were warning signs too.
If your anxiety was converting emotional symptoms to physical ones then it would make sense that you experienced truckloads of physical symptoms.
I did this with depression.  I had headaches, problems with my vision, was tired, etc.

Anxiety could explain it as you may not have good days/ bad days but you do have better moments.  You say so yourself when you say you are able to articulate well with doctors.
I almost feel like you are putting your faith in these people to make you better.  When you visit them there must be a degree of hope or optimism.  Which makes you feel less anxious and able to function better.

Anxiety does cause cognitive problems (and visual problems due to changes in BP caused by changing carbon dioxide levels usually due to hyperventilating).

Personally, I think you're in denial.
Is your life working perfectly for you?  Was it prior to all this?  I expect you will say no and yes.  I think you're splitting -a primitive defense mechanism.  One which some people use when anxious.  I think you're idealizing your past and devaluing the present.

I think the doctors have listened to you and taken into account your varying degree of functionality.

Check out those other expert forums -ask for their advice but at the end of the day you will still need to address other issues.
You could try checking out the dsm-iv for somatization -not sure if you will see a connection between that and your current presentation.
My advice would be to access psychotherapy.  At the end of the day nothing is lost (you can continue pursuing the answer you want) and you may even gain.

I expect this is not what you want to hear and I am sorry for that.  

God luck!!

[Jaquta]

I think the problem is that they haven't given a primary diagnosis and they perhaps haven't wanted to give a psych one until they have done appropriate tests, etc.
If a person had a psych history I doubt they would have had access to half of those tests.

Just as a final note: I would be extremely cautious about the types of tests you do expose yourself too.  There are risks from having these tests.  That is a chunk of radiation you're exposing yourself too.

[mammo]

Pseudo dementia caused by illness. It is related to the depression. This is also know as false dementia. The result of depressive illness results in cognitive impairment. As the age increased people goes in more depressed condition. The true dementia is nor curable.

Pseudo dementia is common in older people. It causes to the adult as well as children also. After the age of 65 there is a double risk of developing pseudo dementia. pseudo demented showed mild cognitive deterioration in neuropsychological evaluation after the development of depressive symptoms. Mostly the women has high depression after childbirth.

Causes of Pseudo Dementia
Active thyroid gland slows down the hole body.
Pseudo dementia causes as the age get over the 65.
Pneumonia in an old person and the brain also cause the pseudo dementia.
The depressive illness causes to the pseudo dementia.
Symptoms of Pseudo Dementia
Depression.
Thinking of suicide.
Poor concentration.
Problem in memory.
Self blemning.
Loss of interest.
Decreased energy.
Forgetfulness.
Illness.
Sadness
Treatment of Pseudo Dementia
For the treatment of pseudo dementia first find out the sign and symptoms of the disease. If the depression treated immediately then the sign of pseudo dementia will clear.

Use antidepressant to cure the pseudo dementia.
Screening tool test help to identify the root cause of the pseudo dementia.
Blood test help to the physician to find out the neurological disorders.
Electroencephalography, MRI and CT scan help in diagnosing pseudo dementia.
Single Photon Emission Computed Tomography os used to treat the pseudo dementia.
Take care at home to remain away from the depression.

[mammo]

Pseudo dementia caused by illness. It is related to the depression. This is also know as false dementia. The result of depressive illness results in cognitive impairment. As the age increased people goes in more depressed condition. The true dementia is nor curable.

Pseudo dementia is common in older people. It causes to the adult as well as children also. After the age of 65 there is a double risk of developing pseudo dementia. pseudo demented showed mild cognitive deterioration in neuropsychological evaluation after the development of depressive symptoms. Mostly the women has high depression after childbirth.

Causes of Pseudo Dementia
Active thyroid gland slows down the hole body.
Pseudo dementia causes as the age get over the 65.
Pneumonia in an old person and the brain also cause the pseudo dementia.
The depressive illness causes to the pseudo dementia.
Symptoms of Pseudo Dementia
Depression.
Thinking of suicide.
Poor concentration.
Problem in memory.
Self blemning.
Loss of interest.
Decreased energy.
Forgetfulness.
Illness.
Sadness
Treatment of Pseudo Dementia
For the treatment of pseudo dementia first find out the sign and symptoms of the disease. If the depression treated immediately then the sign of pseudo dementia will clear.

Use antidepressant to cure the pseudo dementia.
Screening tool test help to identify the root cause of the pseudo dementia.
Blood test help to the physician to find out the neurological disorders.
Electroencephalography, MRI and CT scan help in diagnosing pseudo dementia.
Single Photon Emission Computed Tomography os used to treat the pseudo dementia.
Take care at home to remain away from the depression.

[mammo]

After researching this I do think you need to take a close look at yourself and your life.  Often this can be caused by post traumatic syndrome (which you may not even remember), and the list goes on and on.  Often we don't know we're depressed and this may be the case with you.  Every article leads to depression, and the sooner it is treated as such, the better the recovery.  Your "tremendous anxiety" may have ballooned with this, but I'm betting it was there before also.  You may not have ever recovered from the break-up that had you depressed earlier.  You should really try therapy and an anti-dpressant medication before enduring further testing.

[whodunnit]

I note you have stated 2 neurologists have given you almost identical diagnoses. You also say all other opinions etc over the last year all also allude to the same diagnosis.

Your question was how is this diagnosis treated.

Really a question only for a doc or even a specialist as none of us is so qualified.

I too have had long term problems with getting a diagnosis on a particular problem. But the difference was all my testing and opinions said "I don't really know and can't identify anything". This is a typical response to many of our, depressed, ailments I'm afraid.

But, in your case they have been quite specific and you seem to have accepted it. Which is best as they are all saying the same thing. Right?

I also must point out that the symptoms you record are not listed as depression symptoms, nor have you suggested they are. I see no reason to doubt the diagnosis and hope your doc can advise best on treatment. Googling the question would seem more productive too.

Last thing I will say is that any bad news diagnosis is more than difficult to accept and those of us here are no exceptions. Depression is probably one of the most denied illnesses despite diagnosis and evidence so we are not good examples of how to deal with a diagnosis.

[mammo]

What he has been diagnosed with is often misdiagnosed and is actually severe depression.
  
Somatization Disorder
SYMPTOMS
A history of many physical complaints beginning before age 30 years that occur over a period of several years and result in treatment being sought or significant impairment in social, occupational, or other important areas of functioning.
Each of the following criteria must have been met, with individual symptoms occurring at any time during the course of the disturbance:

four pain symptoms: a history of pain related to at least four different sites or functions (e.g., head, abdomen, back, joints, extremities, chest, rectum, during menstruation, during sexual intercourse, or during urination)


two gastrointestinal symptoms: a history of at least two gastrointestinal symptoms other than pain (e.g., nausea, bloating, vomiting other than during pregnancy, diarrhea, or intolerance of several different foods)


one sexual symptom: a history of at least one sexual or reproductive symptom other than pain (e.g., sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding, vomiting throughout pregnancy)

one psuedoneurological symptom: a history of at least one symptom or deficit suggesting a neurological condition not limited to pain (conversion symptoms such as impaired coordination or balance, paralysis or localized weakness, difficulty swallowing or lump in throat, aphonia, urinary retention, hallucinations, loss of touch or pain sensation, double vision, blindness, deafness, seizures; dissociative symptoms such as amnesia; or loss of consciousness other than fainting)

He does not have enough symptoms for either thing they are guessing he has.  It would be foolish for him to accept their diagnosis.

[mammo]

The treatment for what you have are anti-depressants and therapy. Why are you so willing to accept the doctor's guesses, and not even consider depression?  You are too young to have what they are saying and you admit to being depressed at one time.  How can you be sure that you still aren't?  Just look at the facts, and seek psychiatric help before enduring more tests. You are allowing your body to deteriorate, why? Why would you not consider depression when everything that's written on what they are saying you have states that it is always depresssion causing your symptoms. Are you afraid of what you might learn?  Don't be foolish about this, consider it all and don't go down without a fight!!!!

[Jaquta]

People when they post don't disclose every symptoms they have.
I personally probably wouldn't be in a huge hurry to tell a forum I experienced sexual dysfunction or was constipated or had diarrhea (especially if I thought I had a brain tumor or some other major neurological condition which all seems totally unrelated).

Does he really not show signs of cognitive impairment?  He says he does.
No one is saying that he is demented -just that his symptoms are temporary.

It would also be foolish of him not to be receptive to so many different specialist opinions.  Yes, if he's not happy he needs to follow things up but he shouldn't do that at the exclusion of other diagnoses he's been given.  He at least needs to consider them.

He isn't accepting the doctor's DIAGNOSES (not guesses).  I think he just feels powerless to pursue it further.

I don't think he is depressed, more defeated (which probably amounts to being depressed).
You mean he is too old.  Didn't you write symptoms beginning before age 30??
Are any of us too young to have any of our issues?  Depression made me feel dumb and I was barely out of my teens.  Should that have meant I couldn't be depressed and have symptoms mimicking dementia?  Mental illnesses don't discriminate.  It doesn't matter about age, gender, ethnicity, religion, etc.

Depression doesn't always CAUSE dementia like symptoms or somatization.

I have a theory that the answer lies in what happened in December '08.
(December?  Isn't that a hugely stressful or depressing time for many people?)

Conversion disorder has neurological symptoms too.  It's interesting reading if nothing else.

I expect you would treat the pseudo dementia by treating the somatization disorder.  Try googling them or looking up wikipedia.

[whodunnit]

Hi again,

I'm afraid those of us trying to reply are in the dark as indeed Cog did not give much detail to start and could never give us enough detail for so many specialists and docs to diagnose, not guess, the same thing.

You've had opinions galore Cog and it is time to listen to the docs.

They do not just follow the previous docs opinion. Except perhaps when you've already had 6 opinions already, all basically agreeing. They do need the background information from your doc to even make a start on a diagnosis and any other opinions are helpful. Not something to copy. They are all very litigation conscious and would do their job properly. To say they copy is bordering on a conspiracy theory and is rather odd.

Sure we deny illnesses, all the time, I did it for 25 years. But not once I had a diagnosis from a specialist. Until then I just denied it to myself.

To Mammo, I truly do not see how you can make such a firm statement about what the illness is in opposition to 4 neurologists and all the rest of the docs. To make that statement is rash and silly.

If you look up this illness it basically says it is a secondary illness initiated by depression and the treatment is with anti depressants etc, as for depression. It appears to read that by treating the depression the secondary illness is treated.

So it is not misdiagnosed at all. It appears to be a real illness co dependant with depression and treated in the same way. But it is still the correct diagnosis.

I think we should all note that Cog has stated he had NO PREVIOUS history of depression whatsoever. So there is no connection as for most of us with long histories.

Additionally none of the doco I found said much if anything about this illness for anyone other than elderly.

With no depression background and no real research on people as young as Cod I think any of us would be totally unable to even venture a guess as to what it is or what to do.

How on earth can we know any better than the number of specialists who've seen, felt, talked to and tested this young man?

Cog, stick with the doctors and start listening as saying they are all wrong is not helpful to you or any treatment. I gather you have not had treatment as yet as you are asking what treatment is relevant. Is that right or have you not told us about that?

We are not here to compete for who can research the best. What we can do is nothing compared to the training these specialists get. And so many, all in general agreement. Unless there is a real conspiracy the diagnosis is correct. Time for treatment.

I must state I know nothing of this illness other than what I've read in the last few hours and do not make any claims to knowledge of it. Specialists have such a right.

[Jaquta]

That paranoia is part of the illness too.  I had issues with multiple doctors I saw but at the end of the day I needed to confront reality.  It was difficult and I was then diagnosed with a complicated adjustment disorder.  It felt like I was being victimized and not heard.

Nobody bothered to tell me for ages that I was depressed.  I was told to take ad's (which I politely refused) but was never told my diagnosis.

"Except a moderate bout 10 years ago."  Yes?  NO?

Sometimes we are much better able to advise.  Although not always.
Come on Who.  Sometimes health professionals are clueless about how to help us or think they know but don't and don't respect their own limitations.

I think we come here for our own reasons.  Me because I'm distracting against the pain and anguish in my life.  Because I find life excruciating and this makes it bearable for a bit.  Gives more distance between life and death when there doesn't seem much.

I respect the doctor on the mental health forum -ask him the question.

[cognitivelykaput]

I'm not really able to take so many different opinions in, given the cognitive problems I'm experiencing, but thanks for all your input.

The reason I've posted in the depression forum, is that I've been told by the current neurologist I'm seeing that pseudo dementia is, or at least originates from having some sort of underlying depressive disorder.

Aside from the bout of depression I had about ten years ago, which as alluded to, had a very distinct trigger point, in the guise of a nasty relationship break-up (which was sorted out with a few good counselling sessions), I've not since experienced what would constitute any sort of episode of depression, or anxiety, and have been very content and happy in life. Subsequently, I've had no need to use any sort of medication for anxiety or depression, so no, prior to December 2008 when these issues started, I was not on any sort of medication.

The fact I've nearly come to the end of the line where tests, investigations, etc are concerned with regard to a more 'physical' cause of my problems, leaves me no choice but to accept the diagnosis which has been put forward, as it simply is not possible to get referred to anyone else now, given the sheer number of consultants I've seen already this year. I wouldn't know who to be referred to anyone now, even if it was possible.

Ultimately, as sceptical of the diagnosis as I am, I'm so desperate now to try and regain my proper level of cognitive functioning, I'm willing to embark on any course of treatment that's put forward to me. I no longer have the mental energy, nor cognitive abilities to research, or pursue my plight further, so yes, I now feel both powerless and defeated. It's taken me the best part of 2 hours to even write this reply.

I freely admit to actually being incredibly anxious now, as I'm sure anyone would be if they were experiencing such debilitating and frightening symptoms. The point which I can't stress enough being though, the anxiety is a secondary symptom, which has developed as a direct consequence of my decline in health.

But yes, my original question was how would such a condition be treated, which I think has been answered. Of course, this is something to discuss further, with whomever ends up treating me, I just wanted to see if anyone else had heard or was familiar with such a condition, in the meantime, so I could try and understand it a little better.

[Jaquta]

I'm sorry we've all overloaded or overwhelmed you.  I think we're just a group of people, each with different experiences and ideas, who want to help others.

I would recommend you ask the doctor on the mental health expert forum -he is good -and he wouldn't tell you to get treatment that he doesn't think is necessary.

I realize that may be difficult for you but I expect it would be extremely helpful to guide you in the right direction.

Take care!

[whodunnit]

Hi again,

Jaq, I too have had a lot of paranoia and it's easily lit, that fuse. I've seen my current pdoc for 10 years yet about 3 years ago suddenly became convinced he was against me. Can't even remember the dumb details but it was excessive imagination and too much time to worry it to death that caused that.

I suspect Cog is feeling so much anxiety because he has struggled so much to accept this diagnosis. I would for sure if I thought so many were giving me the wrong answer all the time. I felt that way about an as yet undiagnosed pain issue. I got meds for it but no one could tell me what causes it. Great, but I had to give it up as there were no more options.

You raise the comment of no depression. Cog mentioned a period following a relationship breakup. A devastatingly hurtful time indeed. But he states it was brief and the likelihood is it was extended grief which many of us experience without actually being depressed. A breakup is a total shock often and leaves us with nothing. But that's not depression as listed under this illness, it was a once off horror for Cog.

Jaq, there is absolutely no doubt that some docs etc are useless and give bad advice. I comment accordingly to a number of people who have been given the run around by one doc. But this young man has about 10 identical (almost) opinions. That's no coincidence and must be listened to. If there had been just one, or even two I would agree it's doubtful but there's not, there's multiple.

I also agree we, the people who've felt depression, are likely more able to provide help than many docs. But this is a separate illness, according to the docs and I've seen no one here claim to have had this illness so they can share their experience.

Cog had reluctantly accepted this when he posted on this forum. Since then he has had his paranoia re docs confirmed on this thread and told his diagnosis was wrong. That's absolutely dreadful and cannot be justified by any one here regardless of our experience as all this approach has achieved is to make this harder for Cog and really, to hurt him. The last thing any of us want but that's effectively the result of this sort of online "expertise" without enough information.

Cog is now back to reluctantly accepting this diagnosis. That's OK, be doubtful but try the treatment and see how it goes. If it's not helping, say so and raise your issues with the doc. It may be helpful to have a relative or close friend go with you to appointments.

I did that quite often as early on I realised docs can discount what you say if you have some mental problem, such as depression. Two people forces them back to listening properly.

No need to reply Cog, you've more than enough on your plate as it is. I just hope you do go for the treatment, sounds like it's just meds, anti depressants, and get good results early. You deserve it after seeing so many docs mate.

[Jaquta]

I probably get a little paranoid when I'm not well.  I don't like to admit either though (that I'm bordering on psychotic or that I'm unwell).
Paranoid stuff can be confusing.  Too much info, feelings, etc to sort through.

I think the anxiety is mainly from the relationship.
It's easily done.  If your heart races, if you head hurts.  Many doctors don't take the time, or have the time, to offer reassurance.
Sometimes that pain is real and sometimes it does need pursuing.  Sometimes it isn't and doesn't.

Grief can become pathological.
I sense from reading posts that there is a lot of anxiety.  Anxiety and depression are often co-morbid.  Plus you can have other disorders in there as well (as long as they aren't better explained by another diagnosis).

I agree.  There were a lot of different specialties in the mix.
I wouldn't like to think that I would know your pain any better than you would know mine.    It's hard to be certain either way.  I feel like there is a strong psych component to his presentation but then who am I?  He needs to take his own journey, find his own way.  It's not something that can be forced by others.

No, I don't have either of those diagnoses (although I believe many of us have at some point experienced those symptoms).

We don't intentionally set out to hurt people.  I often hear things that I don't want to hear.  Sometimes we have to learn to adapt to the world.  It certainly doesn't stop or change for us.
He's had different opinions from different people.  He can take what is useful and leave what isn't.  He's an adult.

You could read the doctor's response on the mh expert forum to a post titled, Wierd Thing Happened, or something like that.  I think the answer is similar.  I think there are unresolved issues.
Medication probably would be helpful in the early stages of treatment.