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 classic signs of PTSD following a traumatic event. The incident in Denver, where the patient's life was threatened, serves as a clear precipitating factor for these symptoms.
- 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, this is a plausible diagnosis.
- 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: Although the patient's symptoms seem more severe, adjustment disorder could be considered, especially given the significant life event (the attempted killing) and the patient's difficulty adjusting to it.
- Do Not Miss Diagnoses
- Suicidal Ideation or Intent: Despite the patient's denial of current suicidal ideation or intent, their history of a suicidal attempt and current depressive symptoms make it crucial to closely monitor their mental state and ensure they do not pose a risk to themselves.
- Substance-Induced Psychotic Disorder or Substance Use Disorder: The friend's behavior under the influence of drugs could imply exposure to substances, and the patient's history of medication use (including those with potential for abuse like Lorazepam and Ambien) warrants consideration of substance use issues.
- Rare Diagnoses
- Dissociative Disorder: While less likely, the patient's flashbacks and significant distress could, in some cases, be indicative of a dissociative disorder, such as dissociative amnesia or depersonalization disorder, especially if the traumatic event led to significant dissociation.
- Psychotic Disorder: Although the patient's symptoms do not strongly suggest psychosis, the extreme nature of the traumatic event and the potential for substance exposure or severe psychiatric decompensation could, in rare cases, lead to a psychotic disorder.