Although actual statistics vary, obsessive-compulsive disorder impacts approximately 1.2% of the population in the United States (APA, 2013, p. 239). It is characterized by the presence of obsessive thoughts, which are manifested as persistent thoughts, images, or even “urges.” The only way that the individual can disperse the anxiety of these persistent thoughts/images or urges is to perform a behavior (the compulsion). The compulsion could be checking things, counting, reciting a silent prayer, or repeating a number of phrases. The disorder becomes so pervasive that the person can spend a significant amount of time each day attending to the compulsion in order to relieve the anxiety caused by the obsession.
This week, you will, once again, become “captain of the ship” as you take full responsibility for a client with an obsessive-compulsive disorder by recommending psychopharmacologic treatment and psychotherapy, identifying medical management needs and community support, and recommending follow-up plans. You also will evaluate your progress in completing your certification plan. Obsessive Compulsive Behaviors Paper
In earlier weeks, you were introduced to the concept of the “captain of the ship.” In this Assignment, you become the “captain of the ship” as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with an obsessive-compulsive disorder.
Recommend psychopharmacologic treatments based on therapeutic endpoints for clients with obsessive-compulsive disorders
Recommend psychotherapy based on therapeutic endpoints for clients with obsessive-compulsive disorders
Identify medical management needs for clients with obsessive-compulsive disorders
Identify community support resources for clients with obsessive-compulsive disorders
Recommend follow-up plans for clients with depression disorders Obsessive Compulsive Behaviors Paper
Select an adult or older adult client with an obsessive-compulsive disorder you have seen in your practicum.
In 3–4 pages, write a treatment plan for your client in which you do the following:
Describe the HPI and clinical impression for the client.
Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)
Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
Identify medical management needs, including primary care needs, specific to this client.
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Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
Recommend a plan for follow-up intensity and frequency and collaboration with other providers.
History of Presenting Illness and Clinical Impression
Sharon is a 28-year-old who presented at the clinic with complaints of excessive checking. These symptoms would be dated back to childhood when she recalls that she would spend a lot of time on house chores over the weekend and homework during the weekdays with an aim of ensuring that they were perfect. At night, she would spend hours organizing her room for perfectness before sleeping. In high school, Sharon was not able to complete assignments until the end of the term and neither did she participate in co-curricular activities since most of the time was spent on checking and perusing assignments.
As an adult, Sharon developed new traditions in ensuring that everyone and everything around her had little or no chances of causing harm to anyone. These traditions consume some of her considerable time, contributing to her lateness in class and in other cases she would miss lessons. With time, her mood and appetite decreased and she suddenly stopped to attend classes and was forced to drop out of school. During her previous visit to a psychiatrist, she was diagnosed with depression and started on anti-depressants. After approximately six weeks, there was some significant improvement in her mood although her traditions and behavior of excessive checking remained unchanged. On assessment, Sharon was composed, calm and oriented in time, place and person. She did not report to have any auditory-verbal hallucinations or suicidal ideations. However, she failed to pay attention to the entire session of assessment and history taking.
Based on the client’s presentation and the DSM-5 criteria of mental health disorders, a clinical impression of Obsessive-compulsive behavior was made.
Treatment is recommended in cases where symptoms greatly interfere with work, education and social life to result to distress and impaired functioning (Baldwin, et al., 2014). According to Sharon’s case, it is evident that the symptoms contributed to her dropping out of school and makes her to get inadequate sleep. Based on this, the first line drug of choice would be SSRIs. The best option would be to prescribe fluoxetine 40mg oral daily. However, it would be mandatory that the patient returns after two weeks so that the dosage is slightly adjusted to 80 mg for adequate health outcomes. Obsessive Compulsive Behaviors Paper
Fluoxetine is an antidepressant that is efficient in the management of OCD. However, it has been associated with suicidal thoughts since most patients with OCD have a depressive disorder. During follow-up, it would therefore be necessary to evaluate about suicidal ideations. Besides, the patient will need adequate education on the side effects that should be anticipated. The most probable side effects from fluoxetine include: nausea, anxiety, and diarrhea and sleep disturbance. With this information, it would be easier for the patient to remain calm and focuses in the course of treatment for highly effective health outcomes. With fluoxetine, it is expected that Sharon’s behavior of excessive checking that negatively influences her academic and social life will reduce (Pauls, et al., 2014)
Based on available research, it is clearly evidenced that combining behavioral therapy with pharmacological management for patients with Obsessive Compulsive Disorder results to effective health outcomes. Cognitive Behavioral therapy remains the psychotherapy of choice for patients with OCD. It is highly effective when initiated at the same time with pharmacological treatment which is similarly advised in the case of Sharon (Storch, et al., 2016). Through behavioral exercises, cognitive behavioral therapy assists the patient to consider alternative ways of thinking and to challenge her emotions. With CBT, it is expected the Sharon will be able to do away with her excessive checking behavior which interferes with her social and academic life (McKay, et al., 2015). As a result, her social and physiologic functioning will significantly improve.
Medical management needs and Community Support Resources
The medical management of Sharon will include looking out for the severity of side effects and how well to manage them such that, they do not further compromise the health status. This would also require that the nurse and therapist collaborate in ensuring that any significant signs are communicated early enough for timely management (Nathan & Gorman, 2015). The client will receive support from the local OCD foundation which has been in existence for more than 10 years. Through this foundation, Sharon will receive moral, financial, social and mental support to ensure that her life and activities of daily life progress as usual. The OCD foundation will also sponsor her education to ensure that Sharon realizes her academic and career dreams.
Follow-Up and Collaboration
The client will have to return after two weeks for follow-up. During this visit, the major issues which will be ascertained include: medication adherence, the severity of side effects and methods to cope with side effects. After every one month, the nurse and therapist will be instructed to conduct a thorough monitoring and management of medications due to the fact that CBT will be initiated at the same time with medications. It would be necessary for the primary care physician to hold weekly consultations with the therapist to get updates on the progress of the patient and address any concerns that may arise. Obsessive Compulsive Behaviors Paper
Baldwin, D. S., Anderson, I. M., Nutt, D. J., Allgulander, C., Bandelow, B., den Boer, J. A., &
Malizia, A. (2014). Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. Journal of Psychopharmacology, 28(5), 403-439.
McKay, D., Sookman, D., Neziroglu, F., Wilhelm, S., Stein, D. J., Kyrios, M., … & Veale, D.
(2015). Efficacy of cognitive-behavioral therapy for obsessive–compulsive disorder. Psychiatry research, 225(3), 236-246.
Nathan, P. E., & Gorman, J. M. (Eds.). (2015). A guide to treatments that work. Oxford
Pauls, D. L., Abramovitch, A., Rauch, S. L., & Geller, D. A. (2014). Obsessive-compulsive
Disorder: an integrative genetic and neurobiological perspective. Nature Reviews Neuroscience, 15(6), 410-424.
Storch, E. A., Wilhelm, S., Sprich, S., Henin, A., Micco, J., Small, B. J., & Geller, D. A. (2016).
Efficacy of augmentation of cognitive behavior therapy with weight-adjusted d-cycloserine vs. placebo in pediatric obsessive-compulsive disorder: a randomized clinical trial. JAMA psychiatry, 73(8), 779-788. Obsessive Compulsive Behaviors Paper
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