Differential Diagnosis l:
Bipolar Depression
Rationale:
The average age of onset for Bipolar II is typically seen in individuals while in their mid-20s and throughout adulthood, however presentation is possible in older adolescents. Bipolar disorder often presents with characteristics of a depressive episode, thus are often not diagnosed as bipolar II until an episode of hypomania presents; reportedly 12% of individuals with bipolar depression are initially diagnosed with major depressive disorder (MDD). Additionally, symptoms of irritability may also be present in individuals with a history of mania or mixed features; a thorough patient evaluation and collection of family history is heavily relied upon in differential diagnosis of major depressive disorder versus bipolar depression. Miss S.A., is an 18 year-old reporting irritability with no additional descriptive indicators of mania or family history of bipolar depression. (American Psychiatric Association, 2013, p. 123-131, 160-167).
Differential Diagnosis ll:
Seasonal Affective Disorder
Rationale:
Seasonal Affective Disorder is a type of depression. It typically occurs in later fall through spring, and can come and go with these seasons. It is uncommon for SAD to occur in the summer season, but is still possible. The cause for SAD is unknown. In order to diagnose SAD, major depressive disorder must be present in the same season for at least two years. Miss S.A. presents at the winter semester screening with reports of fatigue, sleep disturbances, and not feeling like herself. The winter season along with meeting the criteria for major depression can be indicative of SAD. Patient’s weight loss and decreased appetite may not be in line with SAD, as those with SAD tend to crave carbohydrates and gain weight in the winter months (“Seasonal Affective Disorder”, 2016).
https://www.curascriptsd.com/Newsroom/infographic-seasonal-affective-disorder-sad
healthybynaturecalgary.ca/naturopath-calgary/seasonal-affective-disorder-winter-blues
Differential Diagnosis lll:
Adjustment Disorder with depressed mood
Rationale:
Adjustment disorder is a stress-related condition linked to genetics, life experiences, and temperament. Both positive and negative stressful events can contribute to adjustment disorder. Symptoms typically begin within three months of the introduced stressor, and last no longer than six months after the stressor is removed/resolved. Miss S.A. is experiencing her first time away from home at first year at college, and has minimal support noted. The patient feels hopeless and empty inside, has frequent spells of crying, difficulty sleeping and attending classes, decreased appetite with weight loss, suicidal ideation, and disinterest in social and extracurricular activities (“Adjustment disorders”, 2017).
https://www.mdedge.com/psychiatry/article/168861/pediatrics/adolescent-suicidal-challenges-pediatric-inpatient-consultation/page/0/1