Differential Diagnosis for Hallucinations in a 72-year-old Woman
Single most likely diagnosis
- Bereavement-related hallucinations: This is the most likely diagnosis given the recent loss of her husband (6 months ago) and the nature of her hallucinations, which involve seeing and hearing her deceased husband. These experiences are common in the context of grief and are not necessarily indicative of a psychiatric disorder.
Other Likely diagnoses
- Major Depressive Disorder with psychotic features: The hallucinations could be a symptom of a depressive episode with psychotic features, especially given the recent loss. The hallucinations are mood-congruent, which supports this diagnosis.
- Anxiety Disorder: While less directly related to hallucinations, severe anxiety can sometimes present with dissociative symptoms that might be mistaken for hallucinations. However, this would be less likely given the specific nature of her experiences.
- Delirium: Although delirium is a condition that can present with hallucinations, it typically involves a fluctuating course, altered level of consciousness, and cognitive impairment, which are not mentioned in the scenario.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Neurosyphilis: A rare but potentially treatable condition that can cause hallucinations among other neurological symptoms. It's crucial to consider in any differential diagnosis of hallucinations due to its severe consequences if left untreated.
- Temporal Lobe Seizures: These can cause complex partial seizures that might manifest as hallucinations. Given the potential for seizures to cause significant morbidity if not treated, this is an important diagnosis not to miss.
- Lewy Body Dementia: Characterized by visual hallucinations, fluctuations in cognitive function, and parkinsonian motor symptoms. Early diagnosis is crucial for appropriate management.
Rare diagnoses
- Charles Bonnet Syndrome: A condition in which visually impaired individuals experience complex visual hallucinations. While the patient's visual status is not mentioned, this could be considered if there's a history of significant visual impairment.
- Prion Diseases (e.g., Creutzfeldt-Jakob Disease): These are rare, fatal brain disorders that can cause a variety of neurological symptoms, including hallucinations. They are exceedingly rare and would be considered only if other symptoms suggestive of these diseases were present.