Differential Diagnosis for Ms. Owens
- Single Most Likely Diagnosis
- Bipolar II Disorder: This diagnosis is the most likely due to Ms. Owens's history of depressive episodes and periods of moderately elevated mood, rapid thoughts, and increased energy. Her response to sertraline, which improved her sleep but worsened her anxiety, irritability, and agitation, also supports this diagnosis. The fact that she has a family history of bipolar disorder (her brother was treated with lithium) further increases the likelihood of this diagnosis.
- Other Likely Diagnoses
- Major Depressive Disorder (MDD): Ms. Owens's symptoms of poor mood, anhedonia, decreased energy, hypersomnia, and increased appetite are consistent with MDD. However, her history of elevated mood episodes and her response to sertraline suggest that bipolar II disorder is a more comprehensive diagnosis.
- Anxiety Disorder: Ms. Owens's symptoms of worry, anxiety, and agitation are consistent with an anxiety disorder. However, these symptoms are also common in bipolar disorder, and her response to alprazolam and sertraline suggests that they are part of a larger mood disorder.
- Do Not Miss Diagnoses
- Bipolar I Disorder: Although Ms. Owens does not report any episodes of mania or psychotic symptoms, it is possible that she has had mild manic episodes that she does not recognize as problematic. Missing a diagnosis of bipolar I disorder could lead to inappropriate treatment and increased risk of mood instability.
- Substance-Induced Mood Disorder: Ms. Owens's history of heavy drinking and current use of alprazolam could be contributing to her mood symptoms. It is essential to consider the potential impact of substances on her mood and to assess for any substance use disorders.
- Rare Diagnoses
- Cyclothymic Disorder: This diagnosis is characterized by periods of hypomanic symptoms alternating with periods of depressive symptoms. While Ms. Owens's symptoms are consistent with this diagnosis, her history of more severe depressive episodes and her response to sertraline suggest that bipolar II disorder is a more likely diagnosis.
- Borderline Personality Disorder: Ms. Owens's history of emotional dysregulation, impulsivity, and unstable relationships could be consistent with borderline personality disorder. However, her symptoms are more closely aligned with a mood disorder, and she does not report any self-destructive behaviors or frantic efforts to avoid abandonment.