Differential Diagnosis

The patient's presentation of anger issues, particularly around family members, and a history of suspension and inpatient admission, suggests a range of possible psychiatric and behavioral diagnoses. The fact that the patient is on Abilify (aripiprazole) and Prozac (fluoxetine) indicates that there is an ongoing treatment for psychiatric conditions, which could include mood disorders, psychotic disorders, or disruptive behavior disorders.

• Single Most Likely Diagnosis

  • Intermittent Explosive Disorder (IED): Characterized by recurrent, problematic, impulsive aggression. The patient's history of getting angry, especially around family, and the specific mention of an incident against his sister, aligns with the criteria for IED. The use of Abilify, which can be prescribed for irritability associated with autism spectrum disorder but also used off-label for mood stabilization and aggression, supports this consideration.

• Other Likely Diagnoses

  • Conduct Disorder: Given the patient's history of being suspended and admitted inpatient due to aggression against a sibling, conduct disorder is a consideration. This diagnosis involves a pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.
  • Oppositional Defiant Disorder (ODD): Characterized by a pattern of angry/irritable mood or argumentative/defiant behavior. The patient's anger issues, particularly around family, could suggest ODD, although the severity of the incidents (suspensions and inpatient admission) might lean more towards a diagnosis of conduct disorder or intermittent explosive disorder.
  • Bipolar Disorder: The patient's medication regimen (Abilify and Prozac) could suggest a mood disorder. Bipolar disorder, particularly type II or a specifier indicating irritability, might be considered, especially if there are mood swings or other manic/hypomanic symptoms not immediately apparent from the description.

• Do Not Miss Diagnoses

  • Psychotic Disorder: Although less likely given the description, a psychotic disorder (such as schizophrenia) with prominent aggressive behavior or command hallucinations to harm others must be considered due to the potential for severe consequences if missed.
  • Neurodevelopmental Disorders: Conditions like autism spectrum disorder, especially if the patient has difficulties with social interactions and flexibility, could contribute to the anger and aggression, particularly if there are misunderstandings or frustrations related to social interactions or changes in routine.
  • Substance-Induced Aggression: Substance use could exacerbate or induce aggressive behavior. It's crucial to assess for substance use, as it could significantly impact the diagnosis and treatment plan.

• Rare Diagnoses

  • Traumatic Brain Injury or Other Neurological Conditions: Certain neurological conditions could lead to aggression and mood swings. While less common, these should be considered, especially if there's a history of head trauma or other neurological symptoms.
  • Metabolic or Endocrine Disorders: Rarely, metabolic or endocrine disorders can cause mood and behavioral changes, including aggression. Conditions like hyperthyroidism or disorders affecting serotonin and dopamine regulation could potentially contribute to the patient's symptoms.