Differential Diagnosis

The patient's symptoms of agitation, depression, anxiety, sleep disturbances, and mood swings (highs and lows) suggest a complex psychiatric condition. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Bipolar Disorder: The patient's report of "highs and lows" along with symptoms of agitation, anxiety, and sleep disturbances aligns closely with bipolar disorder, particularly type II, which involves periods of depression and hypomania. The improvement in mood after anesthesia for eye surgery could be coincidental or related to the temporary relief from stress and discomfort, but it doesn't strongly point away from this diagnosis.

• Other Likely Diagnoses

  • Major Depressive Disorder (MDD) with Anxious Distress: While the patient mentions feeling depressed and has significant anxiety, the presence of "highs" suggests that the diagnosis might not be purely MDD. However, it's possible that the patient experiences more depressive episodes than manic or hypomanic ones, making MDD a consideration.
  • Anxiety Disorder: Given the prominent anxiety symptoms, an anxiety disorder such as generalized anxiety disorder (GAD) could be a primary diagnosis. However, the presence of "highs and lows" and agitation suggests that anxiety might be part of a broader mood disorder.
  • Borderline Personality Disorder (BPD): Patients with BPD often experience intense emotional dysregulation, which can manifest as depression, anxiety, and mood swings. However, BPD typically involves more pronounced difficulties in interpersonal relationships and self-image.

• Do Not Miss Diagnoses

  • Thyroid Disorders: Both hyperthyroidism and hypothyroidism can cause mood disturbances, including depression, anxiety, and mood swings. These conditions are critical to rule out due to their potential for serious complications if left untreated.
  • Sleep Apnea or Other Sleep Disorders: The patient's difficulty sleeping and staying awake late could be indicative of an underlying sleep disorder. Sleep apnea, in particular, can lead to significant daytime dysfunction, including mood disturbances.
  • Substance-Induced Mood Disorder: The use of substances (including prescription medications, alcohol, or illicit drugs) can induce mood symptoms that mimic primary psychiatric disorders. It's crucial to assess for substance use.

• Rare Diagnoses

  • Circadian Rhythm Sleep Disorders: While not uncommon, these disorders can sometimes present with mood disturbances due to the disruption of the body's natural sleep-wake cycle. However, they are less likely to cause the full range of symptoms described.
  • Wilson's Disease: This rare genetic disorder can cause psychiatric symptoms, including mood swings and depression, due to copper accumulation in the brain. It's essential to consider in young patients with psychiatric symptoms of unclear etiology, especially if there are additional neurological signs.