Differential Diagnosis for a 45-year-old female on a TCA presenting with confusion and hallucination
- Single most likely diagnosis
- Serotonin Syndrome: This condition is a likely cause due to the use of tricyclic antidepressants (TCAs), which can increase serotonin levels. Symptoms such as confusion and hallucination, along with other possible signs like agitation, fever, and changes in blood pressure, are consistent with serotonin syndrome.
- Other Likely diagnoses
- Anticholinergic Toxicity: TCAs have anticholinergic properties, and an overdose or high levels can lead to symptoms like confusion, hallucinations, dry mouth, blurred vision, and urinary retention.
- TCA Overdose: An intentional or accidental overdose of TCAs can cause a range of symptoms including confusion, hallucinations, seizures, and cardiac arrhythmias.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Neuroleptic Malignant Syndrome (NMS): Although less common with TCAs compared to antipsychotics, NMS is a life-threatening condition that can present with confusion, hallucinations, fever, and muscle rigidity.
- Status Epilepticus: Seizures can be a complication of TCA toxicity, and status epilepticus is a medical emergency that requires immediate attention.
- Rare diagnoses
- Cerebral Vasculitis: A rare condition that could potentially cause confusion and hallucinations, but it would be unusual in this context without other systemic symptoms.
- Encephalitis: An infection of the brain that could cause similar symptoms, but it would typically be accompanied by fever, headache, and other signs of infection.