Clinical picture — the synthesis
Your formulation, not the raw signal — active problems, the patterns and phenotype behind them, what's protective, what's driving, and the correlations worth acting on.
Improving — slowly, but consistently
Executive burnout with dopaminergic depletion, on a genuine if gradual recovery track. Sleep and headaches improving; the risk sits in energy and eating, and in protecting the alliance.
Active health issues
4 issues
BurnoutBAT-12 26ActiveSep 25
Anxiety · panic historyMonitored2019
Sleep disorderImprovingNov 25
Dopaminergic depletionActiveFeb 26
Protective factors
Strong alliance, rising (5.8/7)clinician
High health literacy — engages with mechanismHPI
Recovering nocturnal HRVwearable
Routine anchor — Coco, her dog (daily walks)declared
Risk factors
Skipped meals, worsening — gut-brainAVA
Single-parent load — low respite (HPP 54)SDOH
High self-expectation feeding the loopclinician
Panic history — relaxation contraindicationhistory
Patterns & phenotype
Recovery-deficit patterneffort maintained without restorationconf 0.81
Evening cortisol × screen exposurecircadian delayconf 0.68
Meal-skip → afternoon energy dipemergingconf 0.54
PhenotypeExecutive burnout + dopaminergic depletion0.79
Physiological mechanism
From the biology
Chronic HPA activation with intact adrenal reserve, sympathetic dominance beginning to recover, and dopaminergic depletion driving the motivational and energy picture. Coherent with sustained executive load — not yet exhaustion — which is why the plan protects recovery now, to keep it from tipping there.
Labs →Correlations
◆ system · ● patient · ▲ clinician
Poor sleep → next-day skipped meals → afternoon crash◆ system
Heavy work weeks → movement drops → tension rises● patient
Caffeine after 15:00 → delayed sleep onset◆ system
Body-scan on high-tension days → no panic escalation▲ clinician