Differential Diagnosis
- Single most likely diagnosis
- D. depression: The patient's symptoms of changed sleep patterns and consumption of alcohol to help with sleep, combined with the recent loss of her spouse, suggest that she may be experiencing depressive symptoms. The CAGE questionnaire score of 2/4 indicates some concern about her drinking habits, but in the context of her recent loss and sleep changes, depression is a more likely primary diagnosis.
- Other Likely diagnoses
- C. bereavement: The patient's symptoms have occurred since the death of her spouse 9 months ago, which could suggest a bereavement reaction. However, the duration and presence of sleep changes and alcohol use suggest that bereavement may not be the sole diagnosis.
- E. insomnia disorder: The patient reports changed sleep patterns, which could indicate an insomnia disorder. However, this symptom is likely related to her underlying emotional state, making it less likely as a primary diagnosis.
- A. alcohol use disorder: Although the patient's CAGE questionnaire score is 2/4, which is not indicative of a severe alcohol use disorder, her use of alcohol to aid sleep could suggest a developing problem. However, in the context of her recent loss and depressive symptoms, this is less likely as the primary diagnosis.
- Do Not Miss
- B. Alzheimer disease: Although less likely given the patient's recent history and symptoms, it is essential to consider Alzheimer disease or other dementias in an elderly patient with changes in sleep patterns and behavior. Early detection and diagnosis of dementia are critical, and missing this diagnosis could have significant consequences for the patient's care and well-being.
- Rare diagnoses
- Other rare diagnoses, such as sleep disorders (e.g., sleep apnea, restless leg syndrome), anxiety disorders, or other psychiatric conditions, could be considered but are less likely given the patient's presentation and history. A thorough evaluation, including a physical examination, laboratory tests, and a detailed psychiatric history, would be necessary to rule out these rare diagnoses.