Differential Diagnosis for Changes in Behavior
The patient's recent changes in behavior, including impulsive decisions and inappropriate advances, suggest a possible link to his medications. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Pramipexole (OE): Pramipexole, a dopamine agonist used to treat Parkinson's disease, is known to cause impulse control disorders (ICDs) in some patients. ICDs can manifest as pathological gambling, hypersexuality, or other impulsive behaviors, which aligns with the patient's recent actions.
- Other Likely diagnoses
- Carbidopa-levodopa (B): While less commonly associated with ICDs compared to dopamine agonists like pramipexole, carbidopa-levodopa can still contribute to behavioral changes, especially at high doses or in susceptible individuals.
- Clonazepam (OC): Clonazepam, a benzodiazepine, can cause disinhibition or altered mental status, particularly in elderly patients or at higher doses. However, the patient's behavior changes are more suggestive of an ICD, making this a less likely but still possible contributor.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- None of the medications listed are typically associated with life-threatening behavioral side effects that would fit into a "do not miss" category based on the information provided. However, it's essential to consider the overall clinical picture and potential interactions between medications.
- Rare diagnoses
- Atorvastatin (A) and Lisinopril (D): These medications are not commonly associated with significant behavioral changes or impulse control disorders. While any medication can potentially cause unusual side effects in rare cases, these are less likely to be the primary cause of the patient's behavioral changes.