Differential Diagnosis
- Single most likely diagnosis:
- Major Depressive Disorder (MDD): The patient reports significant depressive symptoms, including anhedonia, sleep difficulties, poor appetite, and feelings of misery, which have been exacerbated by her recent relocation and inability to access her ADHD medication.
- Other Likely diagnoses:
- Attention Deficit Hyperactivity Disorder (ADHD): The patient has a history of ADHD and reports significant symptoms, including difficulty with focus, concentration, and organization, which have worsened since she stopped taking her Ritalin.
- Generalized Anxiety Disorder (GAD): The patient reports excessive worry about daily tasks and job responsibilities, which is consistent with GAD.
- Post-Traumatic Stress Disorder (PTSD): The patient has a history of PTSD related to the loss of a child in a car accident, and reports ongoing symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Bipolar Disorder: Although the patient denies a history of mania or hypomania, it is essential to consider this diagnosis, as untreated bipolar disorder can lead to severe consequences.
- Suicidal Ideation: Although the patient denies suicidal ideation, it is crucial to continue monitoring her mental state, as depression and anxiety can increase the risk of suicidal thoughts.
- Substance Use Disorder: The patient's history of taking controlled substances (Ritalin, Klonopin) and her reports of difficulty accessing her medication raise concerns about potential substance use issues.
- Rare diagnoses:
- Adjustment Disorder: Although the patient's symptoms are more severe than what is typically seen in adjustment disorder, it is possible that her relocation and job changes have contributed to her distress.
- Traumatic Brain Injury: The patient's history of a car accident (which resulted in the loss of a child) raises the possibility of a traumatic brain injury, which could contribute to her cognitive and emotional symptoms.