Can anybody give me a diagnosis? What did you base it on? What are some differentials?Use this info:Sarah O’Neil is a 23-year-old married female with no significant past medical or psychiatric history, who is referred by her PCP. Ms O’Neil’s boss urged her to seek medical attention due to her tearful episodes at work and a decline in her work performance. Medical evaluation was recently done and was all normal. For the past month she has symptoms consistent with an atypical depression: hypersomnia, increased appetite/weight gain, poor concentration, guilt/worthlessness, and decreased interest in usually pleasurable activities.This current depressive episode presents with fleeting suicidal ideation, without intent; as well as paranoid ideation, she says her co-workers are trying to get her fired. She reports two previous depressive episodes and a hypomanic episode occurring just before this depressive episode; the hypomanic episode lasting at least one week and including symptoms of decreased need for sleep, increased energy, increased goal-directed activity, grandiosity, pressured speech, and racing thoughts. She had thoughts of having an impulsive sexual relationship with a man she met at a bar, but got drunk instead. She claims she is a moderate drinker and does not use recreational drugs. Current stressors include the challenges of working while going to night school and dealing with thoughts of wanting to have an extramarital affair.Family history is significant for her mother having schizophrenia and committing suicide 7 years ago; her father having an alcohol-use disorder; and, her sister having a history of depression.
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