Presenting Complaints

The patient, a 76-year-old male, presents with a chief complaint of mood swings over the past 6 months.

History of Presenting Complaint

The patient reports that he has been experiencing significant changes in his mood, with periods of feeling irritable, anxious, and depressed, alternating with periods of feeling unusually energetic and restless. He states that these mood changes have been interfering with his daily activities and relationships. He also notes that he has been feeling more fatigued and has experienced unintentional weight changes during this time.

Significant Positives & Negatives For Differentials

Mood Disorder (e.g., Depression, Bipolar Disorder)

Positives:

• Mood swings (periods of irritability, anxiety, depression, and restlessness)
• Interference with daily activities and relationships

Negatives:

• No history of previous mood disorder diagnoses
• No significant changes in sleep, appetite, or concentration reported
• No suicidal ideation or psychotic symptoms mentioned

Medication Side Effects

Positives:

• Patient is taking several medications, including lisinopril, aspirin, and atorvastatin
• Mood changes can be a potential side effect of some medications

Negatives:

• Patient has been taking these medications for some time without any previous mood-related side effects
• Mood changes seem to have been ongoing for 6 months, which may be longer than typical medication-induced side effects

Neurological Disorder (e.g., Parkinson's Disease, Alzheimer's Disease)

Positives:

• Mood changes can be a symptom of certain neurological disorders
• Patient's age (76 years) increases the risk of neurodegenerative conditions

Negatives:

• No other neurological symptoms reported, such as changes in cognition, movement, or sensory function
• No history of head trauma or other risk factors for neurological disorders

Adrenal Dysfunction

Positives:

• Mood changes, fatigue, and unintentional weight changes can be associated with adrenal disorders
• Patient's age and medical history (hypertension, prior myocardial infarction) may increase the risk of adrenal dysfunction

Negatives:

• No other symptoms typically associated with adrenal disorders, such as electrolyte imbalances, hyperpigmentation, or orthostatic hypotension
• No history of adrenal disease or trauma

Past Medical History

The patient has a history of hypertension, for which he takes a daily medication. He also had a myocardial infarction 5 years ago, for which he underwent coronary artery bypass surgery. He has no other significant past medical history.

Drug/Medication History

The patient takes the following medications:

• Lisinopril 10 mg daily for hypertension
• Aspirin 81 mg daily
• Atorvastatin 20 mg daily

Social History

The patient is retired and lives with his spouse in a small town in Canada. He enjoys gardening and spending time with his grandchildren. He denies any history of alcohol or tobacco use.

Family History

The patient's mother had a history of hypothyroidism, for which she was treated with levothyroxine.

Systems Review

• General: Unintentional weight changes (both gain and loss) over the past 6 months
• Cardiovascular: No chest pain, palpitations, or edema
• Respiratory: No shortness of breath or cough
• Gastrointestinal: No nausea, vomiting, or changes in bowel habits
• Genitourinary: No changes in urination
• Neurological: No headaches, dizziness, or changes in vision
• Musculoskeletal: No joint pain or muscle weakness
• Skin: No rashes or changes in skin texture

Ideas, Concerns & Expectations

The patient is concerned that his mood swings may be related to an underlying medical condition and is hoping to receive a diagnosis and appropriate treatment.

Case Presentation

Based on the information provided, the most likely diagnosis is a mood disorder, such as depression or bipolar disorder. The patient's symptoms of mood swings, fatigue, and unintentional weight changes, along with the lack of significant medical history or other neurological or endocrine symptoms, suggest a primary psychiatric condition. However, further evaluation, including a comprehensive psychiatric assessment and potentially laboratory tests, would be necessary to confirm the diagnosis and rule out other potential underlying causes.