Other Conditions That May Be a Focus of Clinical Attention:
The patient recently overcame an addition because he was able to feel comfortable as a counselor among peers who experienced the same problems. He felt threatened by one of his clients who questioned his interpretation of a symptom. Jim responded violently and should be assessed to determine the cause of this outbreak and whether it will likely recur. Anger problems should therefore be explored.
Rationale
1. Document the patient's symptoms that meet criteria for any diagnosis assigned.
The patient appears to be suffering from psychotic symptoms as a consequence of withdrawal. While this disorder is not typically associated with heroin use, Jim has experimented with a series of drugs that could have brought out these symptoms. Since Jim has only experienced one outburst at this time, a disease state cannot be determined from this observation alone. Further assessment will be needed to provide a definitive diagnosis.
2. Discuss any alternative diagnoses that were considered, and how the differential was made.
There are several other diagnoses that are possible, considering the small amount of evidence provided. Intermittent explosive disorder (IED) is a plausible diagnosis, but the patient's reaction was likely a consequence of drug use, so it would be classified as a substance-induced order. A substance-induced mood disorder is also possible considering that the patient's mood seemed to be improved upon his acceptance into the group as a counselor before his sudden mood disturbance occurred.