Mood swings in a 23-year-old woman
Outpatient PsychiatryPriya Raman · 23yo female · CC: Mood swings
History
0/16 key findingsAsk the questions your differential demands — not just the ones the case volunteers. Every diagnosis you intend to list owes you one discriminating question.
CASE SETTING: OUTPATIENT PSYCHIATRY
Priya Raman, a 23-year-old woman referred for mood swings after starting sertraline
Vitals
Opening
Priya Raman, 23, is referred to your outpatient clinic by her primary care physician. Six weeks ago she was started on sertraline for what was documented as depression. Her PCP's referral note says she has become "wired and not sleeping" since the dose was increased, and asks you to reassess the diagnosis. She is pleasant, talks quickly, and describes herself as having "mood swings my whole life."
Referral note
Sertraline 50 mg started six weeks ago, increased to 100 mg two weeks ago. PCP notes "patient reports feeling great, sleeping 3–4 hours, several new projects." No prior psychiatric care.
Opening statement
"Everyone keeps telling me I have mood swings. I go up and I go down. Right now I feel amazing, honestly — but my sister made me come."
Priya Raman · 23yo female
Well-groomed, engaged, speaking quickly but interruptible