Differential Diagnosis
- Single most likely diagnosis
- Uncomplicated grief reaction: This is the most likely diagnosis given the patient's recent loss of her husband and the nature of her hallucinations, which are related to her deceased husband. The timeframe of 6 months also fits within the expected period for grief reactions.
- Other Likely diagnoses
- Complicated grief reaction: While the patient's symptoms could be part of a normal grief reaction, the intensity and duration might also suggest a complicated grief reaction, especially if these experiences are significantly impairing her daily functioning.
- Major depression: It's possible that the patient is experiencing major depression, either as a separate condition or as a complication of her grief. Depression can include psychotic symptoms such as hallucinations, especially in older adults.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Dementia: Although less likely given the specific context of the hallucinations being related to her deceased husband, dementia can present with hallucinations and should be considered, especially in a 72-year-old patient. Missing dementia could lead to inappropriate management and failure to address significant cognitive decline.
- Schizophrenia: Late-onset schizophrenia is rare but possible. It's crucial to differentiate this from other conditions, as the treatment and prognosis would be significantly different.
- Rare diagnoses
- Other psychiatric conditions (e.g., psychotic disorder due to another medical condition, substance-induced psychotic disorder): These would be less common but should be considered if other symptoms or factors are present, such as a history of substance abuse or a medical condition known to cause psychosis.
- Neurological conditions (e.g., Charles Bonnet syndrome, especially if the patient has visual impairment): These conditions can cause hallucinations but are less likely given the auditory and visual hallucinations related to her husband.