Question

Ms. S, a 24 year old woman, is brought for a psychiatric consultation by her mother who compains of bizarre behavior. One month ago Ms. S was firied from her job at a local bookstoroe because of frequently arriving late and not performing her duties adequately. She states that she fell in love with another employee and tried to get his attention and spend time with him, even though he seemed uninterested. Over the past 3 months she increased her use of alcohol and marijuana to three beers a day and two to three joints per day. Her mother reports a two week history of increased energy, eating little, talking a great deal, and interrupting others frequently. A week ago Ms. S. reported that her former work colleagues were plotting against her and attempting to control her by broadcasting thoughts into her brain. She did not sleep the last 2 nights. Ms. S has no significant psychiatric or medical history. She takes no medication.

On mental status testing, her mood is euphoric, her speech is pressured, and she is emotionally labile and irritable. Her thinking is illogical and disorganized. She denies hallucinations. She is alret and oriented to person, place and time. Immediate recall and recent remote memory are intact. Thoroughout the interview she is pre-occupied by thoughts of the coworker with whom she has fallen in love.

What is the most likely diagnosis at the time of admission?

a. Schizophrenia
b. Delusional disorder, erotomanic type
c. Marijuana-induced psychotic disorder
d. Bipolar Disorder

Answer 1

The most likely diagnosis for Ms. S is bipolar disorder, considering the symptoms of mania, including euphoria, decreased need for sleep, and increased energy, as well as the presence of erotomanic delusions.

Step-by-step explanation:

The most likely diagnosis at the time of admission for Ms. S, a 24-year-old woman presenting with a recent history of bizarre behavior, increased use of substances, and several psychiatric symptoms, is bipolar disorder. This diagnosis is based on her two-week history of elevated energy, decreased need for sleep, increased talkativeness, flight of ideas, distractibility, and inflated self-esteem. Furthermore, such features as the euphoric mood, presence of delusions without hallucinations, the recruitment of substances, and a hyperfocus on a particular individual (erotomanic delusions) are compatible with a manic episode. Other choices like schizophrenia are less likely due to the absence of characteristic hallucinations, negative symptoms, and a greater chronicity in symptom development, while substance-induced psychotic disorder is not typically associated with such clear manic features.