Comprehensive Psychiatric Evaluation On Intermittent Explosive Disorder-Nursing Paper Example

Comprehensive Psychiatric Evaluation On Intermittent Explosive Disorder-Nursing Paper Example

Subjective:

CC: ” I cannot control my anger. My wife and daughter left me because of it.”

HPI: Mr. TM is a 35-year-old African American male who presents to therapy for anger issues. The client reports having angry outbursts and consequent physical altercations at home and work. Recently he was suspended after a dispute with his boss at work. His wife left two weeks ago over constant arguments and fights. The client reports difficulty sleeping and increased anxiety. He reports feeling stressed due to work demands.(Comprehensive Psychiatric Evaluation On Intermittent Explosive Disorder-Nursing Paper Example)

Past Psychiatric History:

• General Statement: This is the first time the client is entering treatment.  
• Caregivers (if applicable): NA.
• Hospitalizations: No previous hospitalization.(Comprehensive Psychiatric Evaluation On Intermittent Explosive Disorder-Nursing Paper Example)
• Medication trials: No history of medical trials.
• Psychotherapy or Previous Psychiatric Diagnosis: The client reports no previous psychiatric diagnosis or history of psychotherapy.

Substance Current Use and History: The client denies past substance use but reports current alcohol abuse.

Family Psychiatric/Substance Use History: The father was diagnosed with alcohol use disorder, and the mother was diagnosed with anxiety and depression.(Comprehensive Psychiatric Evaluation On Intermittent Explosive Disorder-Nursing Paper Example)

Psychosocial History: The patient reports a history of physical abuse in childhood by his father. He is married and has a child, a 4-year-old daughter. The wife recently left due to persistent domestic conflict. He is currently suspended from work as a construction worker. Has legal issues of physical fights since childhood.(Comprehensive Psychiatric Evaluation On Intermittent Explosive Disorder-Nursing Paper Example)

Medical History:

• Current Medications: None.
• Allergies: NKA.

Reproductive Hx: Sexually active.

ROS

• GENERAL: No weight loss, fever, or chills.
• HEENT: No visual or hearing changes. No nasal congestion or sore throat.
• SKIN: No rash or lesions.
• CARDIOVASCULAR: Regular heartbeat and sound.
• RESPIRATORY: No cough or wheezing.
• GASTROINTESTINAL: Non distended abonomen. No abdominal pain.
• NEUROLOGICAL: No tremors or tingling.(Comprehensive Psychiatric Evaluation On Intermittent Explosive Disorder-Nursing Paper Example)
• MUSCULOSKELETAL: No joint pain or swelling.
• HEMATOLOGIC: No anemia, bruising, or bleeding.
• LYMPHATICS: No lymphadenopathy or history of splenectomy.
• ENDOCRINOLOGIC: No polyuria or polydipsia.No cold, sweat, or heat intolerance.

Objective:

Physical exam: NA

Vital Signs: T- 98.5 R 16 P 88 BP 117/75, H 5”7, W 130lbs, BMI 20.4 (Normal BMI)

Diagnostic results: None.

Assessment:

Mental Status Examination: The client is alert and oriented. The patient was cooperative and engaged throughout the session. The client appeared anxious, and his affect was appropriate. The thought process was coherent. He denied any suicidal or homicidal ideation. His speech was an everyday speech with no perceptual disturbances. His judgment and insight were intact. He denied any delusions or hallucinations, symptoms of depression, or mania.(Comprehensive Psychiatric Evaluation On Intermittent Explosive Disorder-Nursing Paper Example)

Differential Diagnoses:

1. 312.34 (F63.81), Intermittent Explosive Disorder (IED) – Diagnosis of IED is based on symptoms such as persistent outbursts associated with an inability to control impulses (American Psychiatric Association [APA], 2022). Such outbursts include verbal or physical aggression toward others, animals, or things, which might lead to injury or damage to property. Such aggressions are considered out of proportion and gross and are not premeditated.(Comprehensive Psychiatric Evaluation On Intermittent Explosive Disorder-Nursing Paper Example)
2. 309.81 (F43.10), Post-traumatic stress disorder (PTSD) – PTSD is diagnosed based on direct exposure to threatened or actual injury, death, or violence, witnessing, or learning from another person. Individuals experience intrusive symptoms related to the traumatic event, such as distressing memories or dreams, flashbacks, or psychological distress (APA, 2022). Individuals also develop avoidance stimuli towards traumatic events and altered cognitions.(Comprehensive Psychiatric Evaluation On Intermittent Explosive Disorder-Nursing Paper Example)
3. 305.00 (FI 0.10), Mild Alcohol Use Disorder (AUD) – The diagnosis of AUD is based on persistent alcohol use resulting in impairment or distress. Individuals express symptoms such as consuming large amounts of alcohol, cravings, impaired social, occupational, and personal life, and inability to stop alcohol despite knowledge of risks, withdrawal, and tolerance (APA, 2022).(Comprehensive Psychiatric Evaluation On Intermittent Explosive Disorder-Nursing Paper Example)

Reflections:

IED is the primary diagnosis. The client’s primary symptom, i.e., struggle with controlling anger since childhood, leading to physical aggression and confrontations at home and work, may contribute to this behavior. Among individuals with IEDs, anger outbursts are often intense, recurrent, and disproportionate (Boland & Verduin, 2021). Besides, the current work demands and stressors might also exacerbate the condition.(Comprehensive Psychiatric Evaluation On Intermittent Explosive Disorder-Nursing Paper Example)

The client’s symptoms also suggest PTSD and AUD. For instance, his history of childhood abuse by his father could have led to the development of PTSD, partly characterized by difficulty with sleep and anxiety. Equally, the client’s alcohol abuse and stress reports due to work demands suggest he might be using alcohol to cope with anger and anxiety. Alcohol abuse can exacerbate anger issues and lead to physical altercations. However, the diagnoses are refuted since the client’s symptoms strongly suggest IED and do not meet the DSM-D diagnostic criteria for PTSD or AUD.(Comprehensive Psychiatric Evaluation On Intermittent Explosive Disorder-Nursing Paper Example)

Case Formulation and Treatment Plan:

1. Psychotherapy – The client should start CBT sessions. CBT effectively manages anger and aggression among adults (Lee et al., 2018). CBT will allow the client to explore his response to stressors and develop coping mechanisms and strategies to manage his anger. CBT will also help the client address underlying childhood trauma from physical abuse.
2. Education – Educate the client on the impact of alcohol abuse on health and its contribution to physical and verbal aggression. Alcoholism is linked to high public and domestic abuse and violence among men (Sontate et al., 2021).(Comprehensive Psychiatric Evaluation On Intermittent Explosive Disorder-Nursing Paper Example)

RTC: After four week

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disordersLinks to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787

Boland, R., & Verduin, M. (2021). Kaplan & Sadock’s Concise Textbook of Clinical Psychiatry. Lippincott Williams & Wilkins.

Lee, A. H., & DiGiuseppe, R. (2018). Anger and aggression treatments: a review of meta-analyses. Current Opinion in Psychology, 19, 65-74. https://doi.org/10.1016/j.copsyc.2017.04.004

Sontate KV, Rahim Kamaluddin M, Naina Mohamed I, Mohamed RMP, Shaikh MF, Kamal H and Kumar J (2021) Alcohol, Aggression, and Violence: From Public Health to Neuroscience. Front. Psychol. 12:699726. https://doi.org/10.3389/fpsyg.2021.699726