Differential Diagnosis Nursing

Differential Diagnosis Nursing

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Differential Diagnosis

  1. Major Depressive Disorder

Major depressive disorder is a condition characterized by low moods and lack of energy. In addition, the victims lose interests in things they used to enjoy before. He changes in the mood and energy also result in poor eating habits. Some may lose appetite completely while other have increased urge for eating and this could result in significant weight gain. People with major depressive disorder feel worthless and guilt (Kaser & Sahakian, 2019). Their self-esteem reduces significantly and as they see everything they interact with unpleasant, they are likely to develop suicidal thoughts or even commit suicide.

The other symptom of major depressive disorder is poor concentration, sleep disturbances and increased agitation. A critical review of the patient’s symptoms and history is important in developing the right diagnosis. Based on the patient’s condition, the patient has a history of anxiety, depression and psychosis. Furthermore, he is aggressive and highly disorganized. He is violent and aggressive to his brother as he feels that his brother slept with his oldest daughter. The patients continues feeling mania, sad and worthless; these signs are consistent with the signs and symptoms of major depressive disorder. Furthermore, the patient experiences hallucination and feels that the devil is telling him bad things about himself.

According to Nelson, et al. (2018), depression is characterized by hallucination and the patients tend to ruminate the same depressive theme in their episodes. In this case, the patient is bitter about his brother and cries a betrayal. The patient has a family history of depression; his mother had depression and agitation.

  1. Post-traumatic stress disorder

Post-traumatic stress disorder occurs to people with history of traumatic events. The common symptoms include nightmare, and fearful thoughts. Besides, the patients have difficulties in sleeping and are easily irritated. They also have angry outburst especially when they see something related to traumatic experience they had. The patients also feel emotionally detached from others. The changes in the emotions and motor functioning leads to difficulties in concentrating and reduced interest in life (Norrholm & Jovanovic, 2018).

The patient in this case accuses the brother of having slept with his oldest daughter. Such claims should be analysed further as it helps in the diagnosis of the PSTD condition. The signs and symptoms indicated by the patient does not show instances of nightmare; however, the patient is constantly anxious and worried. Although he denies suicidal thoughts, the constant worry and the claim that the devil speaks bad things about his life could lead to suicide (Norrholm & Jovanovic, 2018). Furthermore, a critical analysis in the family history indicates that the patient lived with his mother until her death and now lives with the brother and daughter. The fact that he lost his mother could also trigger stressful emotions leading the current signs and symptoms.

  1. Bipolar disorder

Bipolar disorder is characterized by debilitating symptoms manic and pathological mood states. The patients may have mania, hypomania or mixed events that recur. The diagnostic criteria for the bipolar disease is characterized by at least an instance of low self-esteem, decreased sleep, having racing thoughts, agitation and risk-taking behaviours (Cerimele, et al., 2019). During hypomanic, the patients have elevated moods and anxiety. As evident in this case, the patient has difficulties concentrating on ideas and that is why he cannot fully express himself during the history taking session. The symptoms presented by the patient are consistent with bipolar condition. Further tests included in the assessment will help in reaching the right diagnosis for the patient’s condition.


Mental illnesses have similar signs and symptoms that makes them difficult to diagnose. There are many misdiagnosed cases due to the mimicking symptoms. As a result, work experience allows the healthcare providers to differentiate between the various illnesses accordingly. In my case, I found it difficult reaching the right diagnosis and so had to consult with the senior nurses. Proper history taking allows the healthcare providers to identify the possible factors likely to have contributed to the patient’s illnesses and so use them in making diagnosis (DeSocio, 2019). The patient, in this case, had various signs and symptoms consistent with major depressive disorder, bipolar condition and the post-traumatic stress disorder. Therefore, further tests and assessment will be conducted to reach the most likely diagnosis.

Early and accurate diagnosis is required for proper management and better prognosis of the patient’s condition. On the other hand, delays in the diagnosis could expose the patient to other complications that may worsen their health status.

The health assessment experience provided opportunity to learn more about patients’ interactions and history taking. Interacting with patients having mental illnesses is one of the dreadful things I have ever imagined considering that the patients may become violent sometimes. In addition, I learned to explore the socio-cultural factors and how they contribute to better patients’ management. There are more to learn and improve in the future practices such as time management as illustrated by the preceptor.




Cerimele, J. M., Fortney, J. C., Pyne, J. M., & Curran, G. M. (2019). Bipolar disorder in primary care: a qualitative study of clinician and patient experiences with diagnosis and treatment. Family practice36(1), 32-37.

DeSocio, J. E. (2019). Challenges in diagnosis and treatment of comorbid eating disorders and mood disorders. Perspectives in psychiatric care55(3), 494-500.

Kaser, M., & Sahakian, B. J. (2019). Major depressive disorder as a disorder of cognition. Cognitive Dimensions of Major Depressive Disorder, 23-34. https://doi.org/10.1093/med/9780198810940.003.0003

Nelson, J. C., Bickford, D., Delucchi, K., Fiedorowicz, J. G., & Coryell, W. H. (2018). Risk of psychosis in recurrent episodes of psychotic and Nonpsychotic major depressive disorder: A systematic review and meta-analysis. American Journal of Psychiatry175(9), 897-904. https://doi.org/10.1176/appi.ajp.2018.17101138

Norrholm, S. D., & Jovanovic, T. (2018). Fear processing, psychophysiology, and PTSD. Harvard review of psychiatry26(3), 129-141.


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