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41-year-old divorced Caucasian male, with no prior mental health diagnosis who presented with severe insomnia and manic symptoms. Patient was recently seen at another hospital’s rheumatology clinic three weeks ago for treatment of of psoriatic arthritis flare affecting his left great toe not relieved by over the counter ibuprofen. He was reportedly complaint with Taltz bi weekly and he was started on prednisone 40mg/day x3 days on tapering dose down to prednisone 10mg. However, his symptoms recurred when he reached 20mgmg/day and the dose went back up to 30mg by a week later. Two days later he completed a cardiac workup in the ED for sensation in his chest, lightheadedness and elevated blood pressure, despite started lisinopril 10mg three days prior. During his follow up visit with the rheumatology clinic on march 17th, patient reported feeling manic and not sleeping at all. He was advised to taper off prednisone from 20mg to 10mg with a plan to do a trial of colchicine in 2 weeks. He was seen at hs PCP clinic and started on Seroquel 25mg at bedtime after reporting that he had not slept in 4-5 days, he tried melatonin but only got 4 hours the past 5 days, stating the world is unraveling around me. What diagnosis and differential dx would you give this patient

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