Differential Diagnosis for 82 yo Woman with Weight Loss, Poor Sleep, and Social Withdrawal

• Single Most Likely Diagnosis
  • Depression: The patient's symptoms of weight loss, poor sleep, social withdrawal, and loss of interest in previous activities are all consistent with a diagnosis of depression. The statement about wishing she were not around anymore also suggests suicidal ideation, which is a common feature of depression.
• Other Likely Diagnoses
  • Normal Bereavement: The patient's husband recently died, and it's normal for people to experience intense grief and sadness after the loss of a loved one. However, the presence of suicidal ideation and significant impairment in daily life suggests that the patient's symptoms may be more severe than what is typically seen in normal bereavement.
  • Prolonged Grief Disorder: This is a condition characterized by intense and prolonged grief that lasts for more than 6 months after the loss of a loved one. The patient's symptoms of persistent sadness, social withdrawal, and loss of interest in previous activities could be consistent with prolonged grief disorder.
• Do Not Miss Diagnoses
  • Suicidal Ideation/Intent: The patient's statement about wishing she were not around anymore is a red flag for suicidal ideation, and it's essential to assess her risk of suicide.
  • Underlying Medical Condition: The patient's weight loss and poor sleep could be symptoms of an underlying medical condition, such as hypothyroidism, anemia, or cancer, which would need to be ruled out.
• Rare Diagnoses
  • Adjustment Disorder: This is a condition characterized by significant emotional or behavioral symptoms in response to a stressor, such as the loss of a loved one. However, the patient's symptoms seem more severe and persistent than what is typically seen in adjustment disorder.
  • Dementia or Delirium: Although less likely, it's possible that the patient's symptoms could be related to a cognitive disorder, such as dementia or delirium, which would need to be ruled out with a thorough medical and neurological evaluation.