Differential Diagnosis
The patient's symptoms and history suggest a range of potential diagnoses. Here are the possibilities, categorized for clarity:
Single Most Likely Diagnosis
- Post-Traumatic Stress Disorder (PTSD): The patient's symptoms, including flashbacks, hypervigilance, difficulty sleeping, and increased anxiety triggered by loud noises, are consistent with PTSD following a traumatic event. The incident in Denver, where the patient's life was threatened, is a clear traumatic stressor that could precipitate PTSD.
Other Likely Diagnoses
- Major Depressive Disorder (MDD): The patient reports feelings of depression, decreased interest in activities, reduced energy, and a marked decrease in appetite, all of which are symptoms of depression. Given the patient's history of severe depression, it's possible that the current symptoms are part of a depressive episode.
- Anxiety Disorder: The patient's increased anxiety, particularly in response to triggers like loud noises, could indicate an anxiety disorder. This could be generalized anxiety disorder or a specific phobia, among other possibilities.
- Adjustment Disorder: The patient's symptoms could also be seen as an adjustment disorder, given that they are a response to a specific stressor (the traumatic incident) and include a mix of emotional and behavioral symptoms.
Do Not Miss Diagnoses
- Suicidal Ideation or Intent: Although the patient denies current suicidal ideation or intent, the history of a previous suicidal attempt and current depressive symptoms make it crucial to closely monitor for any emergence of suicidal thoughts.
- Substance-Induced Disorder: Given the patient's history of medication use and the mention of drugs in the context of the traumatic incident, it's essential to consider the possibility of substance-induced disorders, including substance-induced mood disorder or substance-induced anxiety disorder.
- Psychotic Disorder: While less likely, given the information provided, it's crucial not to miss a potential psychotic disorder, especially if the patient's symptoms worsen or include hallucinations or delusions.
Rare Diagnoses
- Dissociative Disorder: The patient's experience of flashbacks could, in some cases, be indicative of a dissociative disorder, such as dissociative amnesia or depersonalization disorder, although these would be less common and require further specific symptoms to support the diagnosis.
- Somatization Disorder: If the patient's symptoms were to include a variety of physical complaints without a clear medical cause, somatization disorder could be considered, though this seems less likely based on the information provided.