Differential Diagnosis for Crystal Smith
- Single Most Likely Diagnosis
- Major Depressive Disorder (MDD): This diagnosis is the most likely due to Ms. Smith's symptoms of depressed mood, anhedonia, insomnia, fatigue, guilt, and irritability, which have been present for over 8 months. Her significant weight loss and difficulty performing daily activities also support this diagnosis.
- Other Likely Diagnoses
- Adjustment Disorder with Depressed Mood: This diagnosis is possible due to Ms. Smith's recent marital conflict and mistrust of her in-laws, which may have triggered her depressive symptoms.
- Dysthymic Disorder: Although less likely, dysthymic disorder could be considered if Ms. Smith's depressive symptoms have been present for most of her life, with periods of worsening symptoms.
- Postpartum Depression (PPD): Although Ms. Smith's children are school-age, it's possible that she experienced PPD in the past, which may have contributed to her current depressive symptoms.
- Do Not Miss Diagnoses
- Bipolar Disorder: Although Ms. Smith denies manic or hypomanic episodes, it's essential to rule out bipolar disorder, as antidepressant medication can trigger a manic episode.
- Suicidal Ideation: Although Ms. Smith denies current suicidal ideation, her previous thoughts of "giving up" and being "better off dead" require close monitoring and assessment for suicidal risk.
- Substance-Induced Mood Disorder: Although Ms. Smith denies substance use, it's crucial to rule out substance-induced mood disorders, as they can present with similar symptoms to MDD.
- Rare Diagnoses
- Schizoaffective Disorder: This diagnosis is less likely, but possible, if Ms. Smith's depressive symptoms are accompanied by psychotic symptoms, such as hallucinations or delusions.
- Personality Disorder: Although Ms. Smith's symptoms are more consistent with MDD, a personality disorder, such as borderline personality disorder, could be considered if she exhibits a long-standing pattern of unstable relationships, emotional dysregulation, and impulsivity.
- Thyroid Disorder: Hypothyroidism can present with depressive symptoms, fatigue, and weight loss, making it essential to rule out a thyroid disorder, especially if Ms. Smith's symptoms do not respond to treatment.