Differential Diagnosis
- Single most likely diagnosis
- Psychotic Disorder (e.g., Schizophrenia): The patient's symptoms of hallucinations ("bats on the ceiling"), disorganized thinking, and fearful behavior are characteristic of a psychotic disorder. The family history of schizophrenia in her maternal aunt also supports this diagnosis.
- Other Likely diagnoses
- Thyroid Storm: Although the patient's TSH level is within the normal range, her mother's history of Graves' disease and the patient's recent symptoms of anxiety, poor concentration, and joint pain could be indicative of a thyroid disorder. However, the lack of other typical symptoms such as tachycardia, tremors, and exophthalmos makes this diagnosis less likely.
- Severe Anxiety or Panic Disorder: The patient's symptoms of anxiety, poor sleep, and avoidance behavior could be indicative of a severe anxiety or panic disorder. However, the presence of hallucinations and disorganized thinking suggests a more complex diagnosis.
- Medication-Induced Psychosis: Although the patient's medications have not changed recently, it is possible that the mixed amphetamine salts could be contributing to her psychotic symptoms. However, this would be an unusual side effect, especially given the lack of other symptoms such as agitation or aggression.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Neuroleptic Malignant Syndrome (NMS): Although the patient is not currently taking neuroleptic medications, NMS is a life-threatening condition that can occur with the use of certain medications, including amphetamines. The patient's symptoms of anxiety, agitation, and altered mental status could be indicative of NMS, although the lack of other typical symptoms such as fever, rigidity, and autonomic instability makes this diagnosis less likely.
- Intracranial Infection or Mass: The patient's symptoms of headache, poor concentration, and altered mental status could be indicative of an intracranial infection or mass. Although the patient's temperature is normal and there are no other symptoms such as fever, seizures, or focal neurological deficits, this diagnosis should be considered due to its potential severity.
- Systemic Lupus Erythematosus (SLE): The patient's symptoms of joint pain, headaches, and proteinuria could be indicative of SLE. Although the patient's laboratory results do not show other typical findings such as anemia, leukopenia, or elevated inflammatory markers, SLE is a diagnosis that should be considered due to its potential severity.
- Rare diagnoses
- Wilson's Disease: This rare genetic disorder can cause psychiatric symptoms, including hallucinations and altered mental status, as well as liver disease and other systemic symptoms. Although the patient's laboratory results do not show other typical findings such as elevated liver enzymes or low ceruloplasmin levels, Wilson's disease should be considered due to its potential severity.
- Hashimoto's Encephalopathy: This rare condition is characterized by altered mental status, seizures, and other neurological symptoms in patients with Hashimoto's thyroiditis. Although the patient's TSH level is within the normal range and there are no other symptoms such as seizures or stroke-like episodes, Hashimoto's encephalopathy should be considered due to its potential severity.