Question

R.M. is a 28-year-old male whose mother is your patient in your primary care clinic. R.M.’s mother arranged an appointment for him today due to “concerning behavior” that has been occurring over the past 3 months. R.M. tells you that his mother is concerned because he has “found happiness.” On further questioning, he reveals that he has suddenly began attending a small local music club “once or twice a day, every day.” He also has been staying up all night on music chat boards, having intense online discussions that sometimes lead to him yelling at his computer late into the night. He has also begun “spending a lot of money on clothes that I order online,” and he has exhausted his savings on these items. He tells you that he has made the sudden decision to drop out of his graduate program in order to “travel the world” and follow his favorite band. This decision will lead to the loss of his job and an inability to pay his bills; however, he is unconcerned about these consequences and states that “my boss already is tired of me because I have started to talk non-stop” while at his job in a local restaurant supply store.

He denies any medical history or psychiatric treatment but does state he was “depressed for many years as a teenager.” He also admits that this burst of energy and passion over the past month has been “a very sudden thing,” but that he “has never felt better in my whole life” and that he does not want to ever feel depressed again. He knows his parents are concerned about his spending, sleeplessness, and energy, but he does not feel there is anything wrong with him and he is only at your clinic today at his mother’s insistence.

PART 1:

What is your differential diagnosis?

Answer 1

Mr R.M seems to spend his money lavishly and have an entertainment throughout the day.He is not bothered about the consequences onnthe grounds of physical,emotional or in society.It is because of his depression experienced in the past has disturbed his behaviour and behave like this.Some of the differential diagnosis are

• Behavioural disorder .
• Borderline personality disorder
• Disruptive behaviour