Differential Diagnosis

The patient's symptoms of increased anger and irritability, along with intermittent hallucinations and "visions," while taking Latuda (lurasidone) and buspirone, suggest a range of potential psychiatric and neurological conditions. Here is a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Latuda-induced psychosis or exacerbation of underlying psychotic disorder: Latuda is an atypical antipsychotic used to treat schizophrenia and bipolar depression. However, in some cases, it can induce or exacerbate psychotic symptoms, especially if the dose is not optimal or if there's an underlying condition that's not fully addressed. The hallucinations and visions could be a sign of this.

• Other Likely Diagnoses

  • Buspirone-induced serotonin syndrome: Although less common, buspirone can contribute to serotonin syndrome, especially when combined with other medications that affect serotonin levels. Symptoms can include irritability, hallucinations, and altered mental status.
  • Bipolar disorder with psychotic features: If the patient has an underlying bipolar disorder, the symptoms could indicate a manic or mixed episode with psychotic features.
  • Schizophrenia: The presence of hallucinations and visions could suggest schizophrenia, especially if these symptoms persist and are accompanied by disorganized thinking and negative symptoms.

• Do Not Miss Diagnoses

  • Neuroleptic Malignant Syndrome (NMS): A life-threatening, neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic medication. Symptoms include fever, stupor, sweating, and changes in breathing and heart rate. Although rare, it's critical to consider due to its high mortality rate.
  • Serotonin syndrome: As mentioned, this is a potentially life-threatening medical condition resulting from an excess of serotonin in the central nervous system. It can be caused by the combination of buspirone with other serotonergic agents.
  • Substance-induced psychosis: If the patient is using substances that can induce psychosis (e.g., cocaine, amphetamines, cannabis), this could be a contributing factor to their symptoms.

• Rare Diagnoses

  • Charles Bonnet Syndrome: A condition in which visually impaired individuals experience complex, recurrent visual hallucinations. This would be less likely given the patient's age and lack of mention of visual impairment, but it's a consideration if other factors are present.
  • Temporal lobe epilepsy: This condition can cause hallucinations, among other symptoms. It would be a rare cause of the patient's symptoms but should be considered if there are other indications of seizure activity.
  • Wilson's Disease: A rare genetic disorder that leads to copper accumulation in the body, affecting the brain and liver. Psychiatric symptoms, including hallucinations, can be a presentation of this disease, particularly in young adults.