Given these changes from the original case, what is your diagnosis?
What is your diagnostic explanation?
As compared to the long case, this patient is a 28 year old woman who presents to the clinic with the complaint of feeling “down.” She reports that for the past 2 months she has been feeling sad and tearful, but most of her life feels like her moods have been “all over the place.” It seems like one minute she is fine, and the next she can snap and be really angry or sad. She has trouble sleeping and even though she falls asleep easily at 10pm, she awakens by 2am and cannot fall back to sleep. She has been fired from many jobs because she has trouble getting along with coworkers and staff, saying “they all hate me and talk bad about me.” She also has had many relationships that didn’t last long because her mood changes causes many fights. Upon further questioning she reports a history of cutting herself with a thumb-tack when she was really angry or sad. She has had thoughts of suicide in the past but is not currently suicidal.
SH: same as the long case except the patient has binges of excessive alcohol use and has tried heroin and cocaine in the past. Currently does not have a job.
FMH: same as the long case, except mother is healthy.
ROS: same as the long case, except there are no weight changes.
PE: same as the long case, except skin exam shows superficial scarring on both forearms.