Differential Diagnosis for 36-year-old Woman with Schizophrenia
Single Most Likely Diagnosis
- Neuroleptic Malignant Syndrome (NMS): This condition is a life-threatening side effect of neuroleptic medications like risperidone. The patient's symptoms of fever, immobility, and altered mental status, along with a history of taking risperidone, make NMS a highly likely diagnosis.
Other Likely Diagnoses
- Infection: The patient's fever and elevated blood pressure could indicate an underlying infection, which may have been exacerbated by her immunocompromised state due to chronic illness and medication use.
- Medication-induced Akathisia: The patient's worsening agitation and immobility could be related to akathisia, a side effect of antipsychotic medications like risperidone.
- Schizophrenia Exacerbation: The patient's worsening auditory hallucinations and aggressive behavior could indicate an exacerbation of her underlying schizophrenia.
Do Not Miss Diagnoses
- Meningitis or Encephalitis: Although less likely, these conditions could present with fever, altered mental status, and agitation, and would be deadly if missed.
- Septic Shock: The patient's fever, elevated blood pressure, and respiratory rate could indicate septic shock, which requires immediate attention.
- Status Epilepticus: The patient's altered mental status and immobility could be indicative of status epilepticus, which is a medical emergency.
Rare Diagnoses
- Serotonin Syndrome: Although the patient is taking trazodone, which can contribute to serotonin syndrome, the presence of fever and immobility makes NMS more likely. However, serotonin syndrome is still a possible diagnosis.
- Catatonia: The patient's immobility and altered mental status could be indicative of catatonia, a rare condition that can be associated with schizophrenia.
- Autoimmune Encephalitis: This rare condition could present with altered mental status, agitation, and fever, but is less likely given the patient's history and symptoms.