Differential Diagnosis

The patient's presentation is complex, with symptoms of mood swings, delusional thoughts, auditory and visual hallucinations, and a history of suicidal attempts. Here is a differential diagnosis organized into categories:

• Single Most Likely Diagnosis
  • Bipolar Disorder with Psychotic Features: The patient's history of significant mood swings, including periods of elevated mood with increased energy and decreased need for sleep, accompanied by delusional thoughts and hallucinations, suggests bipolar disorder. The presence of depressive episodes with paranoia and hallucinations further supports this diagnosis.
• Other Likely Diagnoses
  • Schizoaffective Disorder: The patient's symptoms of hallucinations, delusions, and disorganized thinking, combined with mood episodes, could also suggest schizoaffective disorder.
  • Major Depressive Disorder with Psychotic Features: The patient's depressive episodes with hallucinations and delusions could be indicative of major depressive disorder with psychotic features.
  • Attention-Deficit/Hyperactivity Disorder (ADHD): The patient's previous diagnosis of ADHD and symptoms of increased energy and difficulty sleeping could be related to this condition.
• Do Not Miss Diagnoses
  • Schizophrenia: Although less likely, schizophrenia should be considered due to the patient's hallucinations and delusions. Missing this diagnosis could lead to inadequate treatment and poor outcomes.
  • Substance-Induced Psychotic Disorder: The patient's history of substance use is not explicitly mentioned, but substance-induced psychosis should be considered, as it can present with similar symptoms.
  • Neurodegenerative Disorders (e.g., Huntington's disease): Although rare, neurodegenerative disorders can present with psychiatric symptoms, including mood swings and hallucinations.
• Rare Diagnoses
  • Cyclothymic Disorder: The patient's mood swings could be indicative of cyclothymic disorder, although the presence of psychotic symptoms makes this diagnosis less likely.
  • Borderline Personality Disorder: The patient's history of suicidal attempts and mood instability could be suggestive of borderline personality disorder, although the presence of psychotic symptoms is not typical of this condition.
  • Temporal Lobe Epilepsy: This rare condition can present with psychiatric symptoms, including hallucinations and mood swings, although it is unlikely in this case without a history of seizures.