Assignment Problem:
You are asked urgently to assess a 24-year-old woman who has recently moved to a large city to find work. She previously lived in a small rural community, and has had difficulty adapting to city life and finding employment. She gave up her job 2 weeks ago because it was not the sort of thing she was used to. Her boyfriend describes her as becoming 'increasingly anxious' throughout the last week, and her conversation increasingly confused and difficult to follow. She has not been sleeping well at night, often staying up doing housework all night and then sleeping during the day. For the 2 days prior to admission her behavior had become extremely bizarre. She began to talk about people being hidden in the roof of her flat, saying that she could hear them sneezing and coughing, and could smell them as they passed in and out of the building. At one stage she said that she was a goddess who had been chosen to rid the world of evil. Sometimes she seemed happy, sometimes sad, and often very anxious and tense. On the day before admission, she spent hours sitting almost motionless in a chair doing nothing, and then suddenly became agitated, running around and trying to do everything at once.
Q1. What is the likely differential diagnosis?
Q2. What information in the history supports the diagnosis, and what other information would help to confirm it?
Q3. What might the important etiological factors be?
Q4. What treatment options are available?
Q5. What is the prognosis in this case?