Differential Diagnosis for Suicidal Ideation
The patient's responses indicate a history of suicidal ideation with specific plans and intent, both in the past month and at the time they felt most suicidal. Here's a differential diagnosis organized into categories:
- Single Most Likely Diagnosis
- Major Depressive Disorder (MDD): The patient's history of suicidal ideation with specific plans and intent, as well as their wish to be dead, are consistent with the diagnostic criteria for MDD. Suicidal thoughts and behaviors are common among individuals with MDD.
- Other Likely Diagnoses
- Borderline Personality Disorder (BPD): The patient's history of suicidal ideation and intent is also consistent with BPD, which is characterized by recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
- Post-Traumatic Stress Disorder (PTSD): Traumatic experiences can contribute to suicidal ideation, and the patient's responses do not rule out a history of trauma.
- Substance Use Disorder: Substance use can increase the risk of suicidal ideation and behavior, and the patient's responses do not provide information about their substance use history.
- Do Not Miss Diagnoses
- Bipolar Disorder: While the patient's responses do not provide clear evidence of manic or hypomanic episodes, bipolar disorder can increase the risk of suicidal ideation and behavior.
- Schizophrenia: Psychotic symptoms, such as hallucinations or delusions, can contribute to suicidal ideation, and the patient's responses do not rule out a psychotic disorder.
- Medical Conditions: Certain medical conditions, such as chronic pain, terminal illness, or neurological disorders, can increase the risk of suicidal ideation and behavior.
- Rare Diagnoses
- Factitious Disorder: The patient's responses could be fabricated or exaggerated, although this is less likely given the consistency of their reports.
- Malingering: The patient may be feigning suicidal ideation for attention or to achieve a specific goal, although this is also less likely given the detail and consistency of their reports.
It is essential to conduct a comprehensive diagnostic evaluation, including a thorough clinical interview, physical examination, and laboratory tests, to determine the underlying cause of the patient's suicidal ideation and to develop an effective treatment plan.