Differential Diagnosis

• Single most likely diagnosis
  • Major depressive disorder (C): The patient exhibits several symptoms consistent with major depressive disorder, including decreased appetite, difficulty sleeping, feelings of guilt, anxiety, and a preoccupation with death. Although she denies having a depressed mood, her overall clinical presentation and recent onset of symptoms following a significant life event (the death of an acquaintance) support this diagnosis.
• Other Likely diagnoses
  • Pain disorder (D): The patient's history of sinus headaches and current complaints of frontal headaches could suggest a pain disorder, especially given the chronic nature of her symptoms and the impact on her daily life.
  • Adverse effect of fluticasone (A): Although less likely, it's possible that the patient is experiencing side effects from her medication, such as mood changes or anxiety, which could contribute to her current presentation.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Cerebral infarction or stroke: Given the patient's concern about having a stroke and her history of hypertension, it's crucial to rule out a cerebral infarction or other neurological conditions that could present with similar symptoms.
  • Dementia or cognitive decline: The patient's difficulty with concentration, making decisions, and memory (as evidenced by her inability to recall three objects after 5 minutes) could indicate an underlying cognitive issue, such as early dementia or a reversible cause of cognitive decline.
• Rare diagnoses
  • Bipolar disorder (B): While the patient exhibits anxiety and guilt, there's no clear indication of manic or hypomanic episodes, making bipolar disorder less likely.
  • Schizophrenia (E): The patient's symptoms do not align with the diagnostic criteria for schizophrenia, such as delusions, hallucinations, or disorganized thinking and behavior, making this diagnosis unlikely.