Case Discussion 140916

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14 Sep 2016 - General

A middled age woman, with background of renal tranplanst (end stage renal failure due to polycystic kidney) on immunosupressant, hypertension, depresssion, was admitted through emergenncy departement by general practitioner referral due to the fact that she was acting strangely for the last 1 week. According to her husband, patient did has some sudden change of behaviour 1 week before. Patient would suddenly laughing or crying for around 20-30 minutes without any predisposing events. This will occur a few times a day for the pass 1 week. Patient was acting strangely as well, not herself. And patient was not aware about the reason why she was doing so. She did mentioned that her mood was quite low for the last few months. Based on this information, what will be your differential diagnois ? what are the invetsigations and management plan?

Patient did have the renal transplant around 6 years ago, and her immunosuppressant medications were not changed recently, on the stable dose, and she was not having tacrolimus overdose. I would agree that psychiatric condition would definitely be an important differential diagnosis in this case. If patient is taking steroid, steroid induced psychosis can be a differential diagnosis as well. But, given the history with an acute behavioural and personality changes, encephalitis is an important m...
 (Total 117 words)
For this case, its important to determine if these behavioral changes are secondary to an underlying psychiatric condition or a medical condition. For psychiatric condition, post-traumatic stress disorder, adjustment disorder, mood disorder and psychosis are differential diagnoses. For medical condition, since this patient is on immunosuppressants, especially if this is in the acute period, patients can acquire central nervous system infections that can bring about symptoms of behavioral changes...
 (Total 112 words)
It seems like the patient has developed a mood disorder like Bipolar due to the manic and depressive states but it doesn't fit the criteria for Bipolar due to its course. I would set my first differential as Mood disorder secondary to possibly an electrolyte imbalance or uremia. I would check the patient's electrolytes, BUN, creatinine and CBC. I do wonder what the other medications that patient is on as they could've caused it as well. It could possibly be a psychiatric condition in...
 (Total 102 words)