Differential Diagnosis for Restlessness

The patient presents with a 2-day history of restlessness, feeling like she cannot sit still, and exhibits anxious and fidgety behavior. Given her medical history and recent medication adjustment, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • A) Akathisia: This is the most likely cause of the patient's presentation. Akathisia is a common side effect of antipsychotic medications like aripiprazole, especially after a dosage increase. The patient's symptoms of restlessness, inability to sit still, and repetitive movements (tapping her arm) are characteristic of akathisia.

• Other Likely Diagnoses

  • B) Alcohol withdrawal: Although the patient drinks two beers daily, her consumption is relatively moderate. However, alcohol withdrawal should be considered, especially if she has recently reduced or stopped drinking. Symptoms of alcohol withdrawal can include restlessness, anxiety, and agitation.
  • E) Serotonin syndrome: As the patient is taking sertraline, a selective serotonin reuptake inhibitor (SSRI), and aripiprazole, which can also affect serotonin levels, serotonin syndrome is a possible diagnosis. However, classic symptoms of serotonin syndrome, such as fever, muscle rigidity, and autonomic instability, are not mentioned.

• Do Not Miss Diagnoses

  • C) Dystonia: Although dystonia is a possible side effect of antipsychotic medications, it typically presents with involuntary muscle contractions and abnormal postures, which are not described in the patient's presentation. However, it is essential to consider dystonia due to its potential to cause significant distress and the need for prompt treatment.
  • D) Medication-induced parkinsonism: This condition can also be a side effect of antipsychotic medications and may present with restlessness, bradykinesia, and rigidity. While the patient's symptoms do not fully align with parkinsonism, it is crucial to recognize this condition to avoid misdiagnosis and inappropriate treatment.

• Rare Diagnoses

  • Other rare conditions that could potentially cause restlessness, such as thyroid disorders or certain neurological conditions, are not strongly suggested by the patient's presentation and medical history. However, if the patient's symptoms persist or worsen despite appropriate treatment for the more likely diagnoses, further investigation into these rare conditions may be necessary.