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Summary differential diagnosis in diseases of psychiatry
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Class notes Introduction to business Oxford Handbook of Psychiatry
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Chapter 6Differential Diagnosis
33
, Chapter 6: Differential Diagnosis
Introduction
The classification of psychiatric disorders and the allocation of an appropriate diagnosis in a particular
case, depend on the symptoms reported by the patient, observation through mental state examination, physical
examination and collateral history.
A differential diagnosis is a list of possible diagnoses. It is not just one diagnosis.
List the preferred diagnosis first, and then list the other diagnoses in order of likelihood.
Always consider drug/alcohol misuse (even if the person denies misusing drugs/alcohol) and organic causes
(e.g. hypothyroidism) in every differential diagnosis.
Scenario 1
A 38 year old woman described a pervasively low mood with a diurnal mood variation for the past month
associated with tearfulness, early morning wakening, a reduction in her interest in activities which she would
ordinarily have enjoyed, in addition to a reduction her energy, concentration and appetite, with the loss of 6kg
in weight over the previous two weeks. She denied any psychotic experiences such as delusions or hallucinations.
Differential diagnosis
Depressive episode if this is the first episode (or recurrent depressive disorder if at least the second episode).
Substance induced mood disorder (i.e. mood disorder secondary to drugs/alcohol).
Organic mood disorder (i.e. mood disorder secondary to thyroid dysfunction or other cause).
Schizoaffective disorder.
Scenario 2
A 28 year old woman has been spending money excessively and is sexually disinhibited. She described a two week
history of an elevated mood, increased energy, over-activity and decreased need for sleep. She believes that she is
more important than other people.
Differential diagnosis
Mania if it is the first episode (or bipolar affective disorder if it is at least the second episode).
Substance induced mood disorder (i.e. mood disorder secondary to drugs/alcohol).
Organic mood disorder (i.e. mood disorder secondary to thyroid dysfunction, frontal lobe lesion or other cause).
Schizoaffective disorder.
Paranoid schizophrenia.
Scenario 3
A 32 year old unkempt man is brought to the emergency department. His brother reported that he has become
increasingly withdrawn and his mood has deteriorated over the past month, associated with a loss of interest in
activities, reduction in his sleep, appetite, concentration, energy level and self-esteem. He believes that the FBI
are following him and controlling his actions.
Differential diagnosis
Severe depressive episode with psychotic symptoms (or bipolar affective disorder current episode severe
depression with psychotic symptoms if there was a previous manic/hypomanic episode).
Paranoid schizophrenia.
Substance induced mood disorder (i.e. mood disorder secondary to drugs/alcohol).
Schizoaffective disorder.
Organic mood disorder (i.e. mood disorder secondary to thyroid dysfunction, temporal lobe epilepsy or other
cause).
Scenario 4
A 24 year old man described a six month history of social withdrawal, talking to himself, third person auditory
hallucinations, thought withdrawal and delusions of control.
Differential diagnosis
Paranoid schizophrenia.
Drug induced psychosis.
Schizoaffective disorder.
Severe depressive episode with psychotic symptoms.
Organic cause (e.g. thyroid dysfunction, temporal lobe epilepsy).
Scenario 5
A 20 year old woman described involuntary, repetitive, unpleasant thoughts to wash her hands for the past three
years. She recognises the thoughts as her own and has been unsuccessful in resisting these thoughts. She
washes her hands up to 80 times per day.
Differential diagnosis
Obsessive compulsive disorder.
Depressive disorder with obsessive compulsive symptoms.
Schizophrenia (~ 40% of schizophrenia cases have symptoms of obsessive compulsive disorder).
34
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