Differential Diagnosis
- Single most likely diagnosis
- A. Bipolar disorder: The patient's symptoms of increased reactivity, irritability, and grandiosity (e.g., deciding to run for public office) suggest a manic or hypomanic episode, which is characteristic of bipolar disorder. Her rapid mood swings, from anger to tearfulness, and her distractibility and inability to be redirected also support this diagnosis.
- Other Likely diagnoses
- E. Narcissistic personality disorder: The patient's grandiose statements and lack of empathy for her boyfriend's concerns could be indicative of narcissistic personality disorder. However, this diagnosis alone does not account for her acute onset of symptoms and mood instability.
- B. Borderline personality disorder: The patient's intense emotional dysregulation, impulsivity (e.g., quitting her job), and unstable relationships (e.g., rapidly shifting from anger to affection with her boyfriend) are consistent with borderline personality disorder. However, the absence of a long-standing pattern of behavior and the presence of distinct manic symptoms make this diagnosis less likely.
- Do Not Miss
- C. Brief psychotic disorder: Although less likely, brief psychotic disorder is a critical diagnosis to consider due to the patient's delusional thoughts (e.g., her boss being jealous of her intellect). However, the absence of clear hallucinations or disorganized thinking makes this diagnosis less probable.
- D. Delusional disorder: This diagnosis is also important to consider due to the patient's delusional thoughts, but the presence of prominent mood symptoms and impulsivity makes delusional disorder less likely.
- Rare diagnoses
- Other rare diagnoses, such as schizoaffective disorder or substance-induced mood disorder, could be considered, but they are less likely given the patient's lack of substance use and the absence of prominent psychotic symptoms. Neurological or medical conditions that could mimic psychiatric symptoms (e.g., traumatic brain injury, multiple sclerosis, or thyroid disorders) should also be ruled out, but they are not explicitly suggested by the patient's presentation.