Differential Diagnosis

• Single most likely diagnosis
  • E) Major depressive disorder: The patient exhibits several symptoms consistent with major depressive disorder, including expressing a desire not to live, loss of interest in social events, significant weight loss, reduced sleep, and a flat affect. These symptoms have been present for more than two weeks, which aligns with the diagnostic criteria for major depressive disorder.
• Other Likely diagnoses
  • A) Acute stress disorder: Given the patient's recent acquittal from a fraud accusation, he might be experiencing acute stress disorder, characterized by symptoms such as dissociation, anxiety, and avoidance behaviors following a traumatic event. However, the primary symptoms described lean more towards depression.
  • B) Adjustment disorder: This diagnosis could be considered due to the patient's response to the significant stressor of being accused of fraud. Adjustment disorder involves emotional or behavioral symptoms in response to an identifiable stressor, occurring within three months of the onset of the stressor. However, the severity of symptoms like significant weight loss and persistent desire not to live might exceed what is typically seen in adjustment disorder.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • C) Bipolar disorder: Although less likely given the information, bipolar disorder could be considered, especially if the patient's history includes manic or hypomanic episodes not mentioned in the scenario. Bipolar disorder with depressive episodes can present similarly to major depressive disorder, but the presence of manic or hypomanic episodes would distinguish it.
  • D) Generalized anxiety disorder: While the patient has been under significant stress, generalized anxiety disorder is characterized by excessive worry about everyday things for at least six months, which is not the primary presentation here. However, anxiety can sometimes be a precursor to or comorbid with depressive disorders.
• Rare diagnoses
  • F) Social anxiety disorder (social phobia): This diagnosis seems less likely as the patient's loss of interest in social events appears to be part of a broader pattern of depression rather than a specific fear of social or performance situations in which the person is exposed to possible scrutiny by others.

Each of these diagnoses should be considered in the context of a thorough psychiatric evaluation, including a detailed history and mental status examination, to determine the most accurate diagnosis and appropriate treatment plan.