Differential Diagnosis for Major Depressive Disorder with Occasional Episodes of Auditory Hallucinations

Single Most Likely Diagnosis

• Major Depressive Disorder with Psychotic Features: This is the most likely diagnosis because the patient's primary symptoms are consistent with major depressive disorder, and the occasional episodes of auditory hallucinations suggest psychotic features, which can occur in severe cases of depression.

Other Likely Diagnoses

• Schizoaffective Disorder: This diagnosis is possible if the patient's depressive symptoms and auditory hallucinations occur together, and there are periods where the hallucinations occur without depressive symptoms.
• Bipolar Disorder with Psychotic Features: If the patient has a history of manic or hypomanic episodes, and the auditory hallucinations occur during depressive episodes, bipolar disorder with psychotic features could be a likely diagnosis.
• Post-Traumatic Stress Disorder (PTSD) with Depressive Symptoms and Psychotic Features: If the patient has a history of trauma, and the auditory hallucinations are related to the traumatic event, PTSD with depressive symptoms and psychotic features could be considered.

Do Not Miss Diagnoses

• Neurosyphilis: This is a rare but potentially deadly diagnosis that can cause psychiatric symptoms, including depression and hallucinations. It is essential to rule out neurosyphilis, especially if the patient has a history of sexually transmitted infections.
• Temporal Lobe Epilepsy: This condition can cause auditory hallucinations, and if left untreated, can lead to significant morbidity and mortality.
• Brain Tumor or Cerebral Vasculitis: These conditions can cause psychiatric symptoms, including depression and hallucinations, and require prompt medical attention to prevent serious complications.

Rare Diagnoses

• Brief Psychotic Disorder: This diagnosis is possible if the patient's auditory hallucinations are brief (less than a month) and occur in the absence of a clear depressive episode.
• Schizophreniform Disorder: If the patient's symptoms do not meet the full criteria for schizophrenia, but the auditory hallucinations are prominent and occur without a clear depressive episode, schizophreniform disorder could be considered.
• Huntington's Disease: This is a rare genetic disorder that can cause psychiatric symptoms, including depression and hallucinations, especially in older adults.