Board doctors: question about psychiatric diagnosis

No identifying info, could just as well be a hypothetical and I’m worried about moving too fast removing and tinkering with medication. Looking for recs from more experienced people.

Damn

Yeah...this definitely is something that is better asked from a practicing physician you know and not a message board.

Are you an MD/DO or mid level?

As others posted, this is not the pace I would ask for help with this. However, since you already posted it, I'll offer a brief response. Hopefully, this will help you out until you can find another professional in person to bounce this off of. Build up that network, especially if you are in private practice!

I'm a psychologist with 10+ years experience as a treatment team member (me, psychiatrist, social worker, RN) at a psychiatric hospital. The things that jump out at me at first glance are the presence of both Bipolar Disorder and ADHD. In my experience, this is typically a red flag for an amphetamine addict. If the diagnosis of Bipolar Disorder is accurate, then that diagnosis should trump the ADHD diagnosis. You mentioned the overlap so I'm sure you had similar concerns. Stimulant medications for ADHD are going to at least exacerbate mania. They might even account for onset of mania if this patient had not presented with a manic episode prior to the initiation of of that medication.

I have seen this a lot with younger patients (ages 18-25), typically male, who presented with sleep disturbance, trouble concentrating, and hyperactivity earlier in adolescence and were diagnosed and treated for ADHD. However, it later became clear that those symptoms were actually early signs of a mood disorder that were misdiagnosed.

I am also curious about the PTSD diagnosis. Depending on whether this stems from childhood sexual abuse or combat experiences, that might lead me in different directions in terms of diagnoses. You mention that you are thinking more Borderline Personality Disorder than Bipolar Disorder but do not provide any background or examples of current symptoms. Is there a presence of self-harm, history of volatile and shallow relationships, splitting behavior, identity confusion, therapy interfering behavior?

These are all things I would want answered to be able to differentially diagnose this case.I would refer this patient for a psychological assessment. Psychological testing and a thorough clinical interview would probably help a lot. This is generally how I proceed when I have patients like this one.