Essay Sample on Symptom: "They Make Me Mad."

Physical aggression, punching the walls, pushing kicks, breaking silverware, and as well as inflicting injuries on her peers at school. Besides, she becomes easily overwhelmed, angered, and aggravated. She always has issues with agreeing with her parents, siblings, and classmates at school.

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Identify history/history of present illness. Identify history questions to be obtained to discriminate the critical characteristics of the presenting chief complaints (symptom). Consider COLDSPA (Characteristics, Onset, Lingering, Duration, Stressors, Precipitating factors/triggers, Alleviating factors)

What seems to be the problem? Michelle reports physical aggression to siblings and school peers without remorse. She is also angered, aggravated, and overwhelmed without of sense of causing damage to the properties. Concerning this, she quit the school soccer team, and since then, she developed loneliness behaviors. However, she denies paranoia, and auditory, visual, and tactile hallucinations. But the mother had also denied sustained injury, excessive sweat, head injury, chronic fatigue, and hair loss. Although there was no history of suicide or homicide attempts. She was once diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder

When did you first notice these symptoms? Three months ago, it had worsened, and she is still since then.

How often over the last six months have you had angry and irritable mood, shown argumentative and defiant behaviors, or been vindictive? Frequently, for the previous three months.

How long does it last? The symptoms are exhibited more often over time.

In what setting does she demonstrate these behaviors? At school and home as well.

What stressors has the family been dealing with? The mother suffers from depression, and the father has high cholesterol, whereas the young sister suffers from Eczema. Besides, the mother is always at home with no work, and the father works more hours in an IT Company.

How would you describe your home and family life? The father is always busy with no time for conversation with the children, and the mother is still at home taking care of the children alone.

How do the parents typically discipline the children? The father has no time to even deal with that, whereas the mother is also more tolerant of the children's fault.

Who takes care of the children, and where do they currently live? The mother is always the one responsible for taking care of the children, and the father is the breadwinner of the family.

How has she been handling this disruptive behavior? She is often hostile, defiant, argumentative, disobedient, displaying anger, and as well as lack of concentration due to ADHD

Does any particular situation seem to trigger negative or defiant behaviors? Yes, when others try to argue or interact with her.

Has she destroyed properties before? Yes, she is more likely to cause harm when angered or overwhelmed.

What makes her feel better? It is quite hard to know what makes her happy.

Does she feel remorse when it is over? No, she perhaps thinks that they deserve what they had been given.

Has she been diagnosed with a psychiatric disorder before? Yes, she was once diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder. And currently, the diagnosis reveals ADHD and mood disorder.

Has she seen a psychiatrist previously? Yes.

Does she take any medications for the symptoms? Yes, she is currently taking the stimulant drugs coupled with low dose Risperdal as prescribed by the psychiatrist.

Did the medications help with the symptoms? No, they were no help with the symptoms.

Has she been hospitalized before? No, she had never been hospitalized. But she had seen the psychiatrist two years ago.

Has she thought about harming herself or others? No, she has no history of suicide or homicide.

Does she have substance or drug abuse problems? No, she denied any use of substances or drug abuse.

Is she sexually active? She denies it but admits to having started menstrual periods at the age of 9.

Does she have any allergies? No Known Drug Allergies (NKDA)

Differential Diagnosis: Delineate four differential diagnoses that could support the chief complaint and HPI. Include DSM-5 diagnostic code for each of the differential diagnoses and provide rationale for each choice based on the presenting case.

Differential 1- Oppositional Defiant Disorder (ODD): The ODD is a mental disorder that is more likely to be experienced by children. It is, however, worth understanding that various adverse symptoms can be examined for the justification of the mental disorder (Burke et al., 2018). According to the Diagnostic and Statistical Manual (DSM-5), Oppositional Defiant Disorders is impulse control and disruptive problem among young people (Roehr, 2013). Moreover, the children suffering from this disorder may find it difficult to interact and cooperate with others, particularly peers, and as well as people in the authority position. On another hand, it is essential to recognize that ODD may not be easily differentiated from powerfully emotional child behaviors. The American Psychiatric Association had gone further to explore the main symptoms of the disorder, particularly among the children. It is often asserted that children suffering from ODD are more likely to be characterized by hostile, disobedient, displaying anger, defiant, argumentative, and vindictive behaviors (Roehr, 2013). And this is mainly based on the fact that children with this disorder find it challenging to interact with peers, and at the same time, they are not able to follow the rules provided by the people in authority position. The provision of DSM-5 reveals that the children older than five years are more likely to exhibit the behaviors at least once in a week, and this has to last for about six months (Burke et al., 2018). And this behavioral pattern continues for longer; it is wise to consider whether it is beyond the normal limits. Therefore, this implies the need for the person suffering to see a psychiatrist for further information and treatment.

Differential 2- Attention Deficit/Hyperactivity Disorder (ADHD): ADHD is a mental disorder that affects teenagers, particularly boys. And it is asserted that it may continue until adulthood if one experienced it in childhood. According to the Diagnostic and Statistical Manual (DSM-5), ADHD is often classified as a neurodevelopmental disorder that attacks the children in particular (Roehr, 2013). This disorder is highly associated with difficulties in paying attention, acting in a specific manner without regard to the consequences. It is, therefore, essential to note that these challenges are a result of the disorganization, which hinders the focus and persistence of the child affected. Nevertheless, the DSM-5 reveals that it further causes the hyper activities coupled with the so-called impulsivity traits (Neini et al., 2018). Thus, this increases the chances of the child affected to be harmed by their activities and sometimes response toward a particular scenario.

The American Psychiatric Association further indicated that the child who has ADHD might be prone to one of the behaviors aforementioned. But in some cases, the person may also have both acts of inattention coupled with hyperactivity-impulsivity (Roehr, 2013). Concerning this, it is quite clear that the symptoms need to be experienced for an extended period for it to be determined to be a symptom of ADHD. The research had shown that this disorder is more likely to have adverse impacts on the child's education because it hinders the attention and performances during the learning process (Neini et al., 2018). Thus, this may lead to drop-out of the child experiencing it in his/her life due to distraction sustained. Therefore, it is necessary for seeking assistance to professional individuals trained to deal with brain disorders.

Differential 3- Intermittent Explosive Disorder: The IED is primarily associated with a lack of control over one's behaviors and emotions. It tends to lead to ignorance of the other's needs, hence causing violation of others' rights and freedom. According to DSM-5, it revealed that IED is often described as the lack of controlling aggressive impulses due to the outbursts of the repetitive behaviors of an individual or group of people (Roehr, 2013). In this context, it is merely characterized by aggressive and impulsive outbursts of one's behaviors. It is, however, indicated that the outbreaks do not require the trigger for occurrences. As commonly known, the majority of the adolescents had at once experienced it in their childhood. However, there are about 8% of the adolescents who are in a position to meet the criteria necessary for asserting the experience of this disorder (Tuyblad et al., 2018). Thus, the American Psychiatric Association had set a frequency of occurrence for the qualification of the diagnosis. This is an indication of the experience of the outbursts for almost every individual, but the rate varies from one individual to another. Differential 4- Conduct Disorder (CD): The CD is associated with disregard of the others' needs and concerns. And it often leads to violent behaviors toward others, particularly by physical means. According to DSM-5, the disorder is more likely to cause conflicts between family members or friends due to the involvement of the aggressive response by the person experiencing it (Roehr, 2013). Nevertheless, it is also common among children in their adolescent period, whereby the child has their own set of rules. And this leads to the ignorance of the regulations set by the older persons or those in the position of authority. On another hand, the children who are experiencing this disorder are more involved in the initiation of fights during the interaction between peers. It may perhaps extend to the destruction of the physical properties either at school or at home (Gupta, 2019). Thus, the kind of damage that may be caused by CD reflects the importance of finding out effective treatment for the children or persons experiencing it.

Mental Status Examination: Delineate mental status exam findings that would be associated with each listed differential diagnosis. Use all seven components of MSE- Appearance, Behavior, Speech, Affect, Thought process, Thought content, Cognitive examination (Level of awareness, Attention, and Concentration, Memory, Orientation, etc).