Differential Diagnosis
- Single most likely diagnosis
- A) Bipolar disorder: The patient's symptoms of grandiosity (believing she owns the store), decreased need for sleep, rapid speech, and labile affect are all consistent with a manic episode, which is a hallmark of bipolar disorder. The patient's age and the acute onset of symptoms also support this diagnosis.
- Other Likely diagnoses
- C) Brief psychotic disorder: The patient's delusional thoughts (believing she is the prophet of a new religion) and visions of a "higher being" could be indicative of a brief psychotic disorder. However, the presence of manic symptoms makes bipolar disorder a more likely diagnosis.
- B) Borderline personality disorder: While the patient's irritability and labile affect could be consistent with borderline personality disorder, the presence of clear manic symptoms and delusional thoughts makes this diagnosis less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Substance-induced psychosis: Although the urine toxicology screening is negative, it is essential to consider substance-induced psychosis, as some substances may not be detected by standard screening. A more comprehensive toxicology screen or further questioning about substance use may be necessary.
- Medical conditions with psychiatric manifestations: Certain medical conditions, such as thyroid disorders or neurological conditions, can present with psychiatric symptoms. A thorough medical evaluation, including laboratory tests and imaging studies, may be necessary to rule out these conditions.
- Rare diagnoses
- D) Delusional disorder: While the patient's delusional thoughts are present, they are not the sole symptom, and the presence of manic symptoms makes this diagnosis less likely.
- E) Kleptomania: The patient's shoplifting behavior could be consistent with kleptomania, but it is likely a symptom of the underlying manic episode rather than a separate diagnosis.
- F) Schizophrenia: The patient's age and the acute onset of symptoms make schizophrenia less likely, and the presence of clear manic symptoms supports a diagnosis of bipolar disorder.