Differential Diagnosis
The patient's presentation and medication regimen suggest a complex psychiatric and medical history. The following differential diagnosis is organized into categories:
- Single Most Likely Diagnosis
- Dementia with Behavioral Disturbances: The patient's history of encephalopathy, seizures, and cerebrovascular disease, combined with her argumentative and combative behavior, suggests a diagnosis of dementia with behavioral disturbances. The use of medications such as Seroquel (Quetiapine Fumarate) and Remeron (Mirtazapine) also supports this diagnosis, as they are commonly used to manage behavioral symptoms in dementia patients.
- Other Likely Diagnoses
- Major Depressive Disorder: The patient's medication regimen includes Lexapro (Escitalopram Oxalate), Cymbalta (Duloxetine HCl), and Remeron (Mirtazapine), which are commonly used to treat depression. Although the patient reports stable mood, her medication history suggests a possible diagnosis of major depressive disorder.
- Anxiety Disorder: The patient's use of Lexapro (Escitalopram Oxalate) and Cymbalta (Duloxetine HCl) also suggests a possible diagnosis of an anxiety disorder, such as generalized anxiety disorder or social anxiety disorder.
- Bipolar Disorder: The patient's medication regimen includes Seroquel (Quetiapine Fumarate), which is sometimes used to treat bipolar disorder. Although there is no clear indication of manic or hypomanic episodes, the use of this medication suggests a possible diagnosis of bipolar disorder.
- Do Not Miss Diagnoses
- Delirium: The patient's history of encephalopathy and seizures increases her risk for delirium. Although the patient appears pleasant and cooperative during the assessment, her argumentative and combative behavior at other times suggests a possible diagnosis of delirium.
- Traumatic Brain Injury: The patient's history of encephalopathy and seizures may be related to a traumatic brain injury. This diagnosis should not be missed, as it can have significant implications for the patient's treatment and management.
- Rare Diagnoses
- Frontotemporal Dementia: The patient's behavioral disturbances and history of cerebrovascular disease may suggest a diagnosis of frontotemporal dementia. Although this diagnosis is less likely, it should be considered in the differential diagnosis due to the patient's unique presentation.
- Creutzfeldt-Jakob Disease: The patient's history of encephalopathy and seizures may suggest a diagnosis of Creutzfeldt-Jakob disease, a rare and degenerative brain disorder. Although this diagnosis is unlikely, it should be considered in the differential diagnosis due to the patient's complex medical history.