Recommend psychopharmacologic treatments based on therapeutic endpoints for clients with obsessive-compulsive disorders Obsessive-Compulsive Disorder Assignment.
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
To prepare for this Assignment:
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.
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.
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Obsessive-compulsive disorder (OCD) is a chronic anxiety disorder that can have incapacitating impacts on the patient. OCD features an array of fears, worry, and thoughts (obsessions) that cause the patient to engage in repetitive rituals (compulsions). Repetitive rituals are performed as an attempt to dispel or prevent obsessions. These compulsions and obsessions interrupt everyday activities and lead to significant agony. This paper presents a case of an older adult with OCD, history of present illness (HPI) and clinical impression for the client and treatment options for the client. The paper also looks at medical management needs for the client, community resources and agencies to assist the client as well as a recommendation for a follow-up intensity and frequency and collaboration with other providers Obsessive-Compulsive Disorder Assignment.
An Older Adult Client with an obsessive –Compulsive Disorder
Smith, a 75-year-old adult was obsessed with elaborated washing and cleansing rituals. His major fears were with bodily secretions and waste, particularly faces, saliva and urine. Smith’s cleansing and washing rituals were as a result of the fear to contract human immunodeficiency virus (HIV) disease and spread the disease to his family and friends. His rituals entailed excessive handwashing routines, stereotyped and prolonged showers, as well as lengthy cleaning and wiping rituals after using the lavatory. The thought that he may become infected with HIV and that he may spread the disease to other people controlled his waking hours and he usually felt safe only when he was at home doing his cleaning rituals.
HPI and Clinical Impression for the Client
Patients with OCD have common obsessions such as fear of contamination from dirt or germs and having thoughts of causing harm to self or others. Smith developed obsessions five ago when he lost his younger who was HIV positive died, making him to fear bodily secretions and fluids which can make him contract HIV disease and transmit it to other people. This fear made Smith to develop elaborated cleaning and washing rituals. Grant (2014) notes that those in response to obsessions, people with OCD develop rituals called compulsions, which temporarily minimize nervousness connected with obsessive thoughts. The most common compulsions entail washing, arranging, praying and checking. Pharmacological interventions
Psychopharmacological Therapy for the Client
OCD can be treated with a combination of pharmacotherapy and psychotherapy interventions such as cognitive behavioral therapy and exposure and reaction therapy. According to Pittenger and Bloch (2015), selective serotonin reuptake inhibitors (SSRIs) are the first-line drugs for the treatment of OCD. Higher quantities of serotonin improve mood and serotonin levels determines whether one feels happy, angry, sad or anxious. When a person with OCD experiences low levels of serotonin, it may make them nervous and more aware of their surroundings than usual, leading to increased behaviors associated with OCD like obsessive hand washing and cleaning (Pittenger & Bloch 2015) Obsessive-Compulsive Disorder Assignment.
Psychotherapy Choices for the Client
The most appropriate psychotherapy for the client is individual psychotherapy. Behavioral cognitive therapy and exposure and response prevention (ERP) therapy focuses on the individual patient. Jones et al (2012) argue that ERP comprises of prolonged and repeated exposures to stimuli that elicit fear, together with instructions for stringent self-restraint from compulsive behavior.
According to Grant (2014), behavioral cognitive therapy for patients with OCD focuses upon teaching patients to recognize and rectify their dysfunctional belief on feared situations. It assists the patient to reduce compulsions and anxiety through recognizing these unrealistic thoughts and fears and altering their interpretations through use of behavioral experiments, the therapist will challenge unrealistic belief of the patient and help him identify cognitive distortion (Grant, 2014).
Medical Management Needs for the Client
Selecting the initial treatment for the patient is individualized and depends on how severe the symptoms are presence of any co-morbid medical conditions, past treatment history of the patient and current preferences and medications. According to Koran et al (2014), to enhance patient’s adherence to treatment, the psychiatrist must consider factors associated with the disorder, the physician, the patient and the environmental or social milieu. Since the beliefs of the patient about the nature of the disorder along with its treatment will impact adherence, offering patient and his family education must be helpful in enhancing adherence.
Community Support Resources and Community Agencies Available to Assist the Client
Understanding and acknowledgment by the community is significant for recovery. Community resources and support agencies available to assist the client include local support groups, community outreach and local treatment providers. Community support groups offer an environment when OCD patients along with their families receive support. Information on coping and self-help strategies are offered. Reddy et al (2017) note that inclusion of family in the treatment of an OCD patient improves family functioning and enhances behavioral therapy.
Recommendation of a Plan for Follow-up Intensity and Frequency and Collaboration with Other Providers
Establishment and maintenance of a strong therapeutic collaboration is crucial for the treatment to be jointly and thus more efficiently planned and executed. The psychiatrist should coordinate the care of the patient with physicians, clinicians as well as social agencies like vocational rehabilitation programs and schools. Koran et al (2014) claim that, because clinical recovery along with full remission do not happen rapidly, the continued objectives of treatment entail lessening symptom of severity and frequency, improving the functioning of the patient and assisting the patient to promote his quality of life Obsessive-Compulsive Disorder Assignment.
Obsessive compulsive disorder is a condition that can be disabling to the patient and interfere with everyday activities. Timely and effective management is important so as to enable the patient prevent or dispel obsessions and compulsions. The most appropriate treatment options include selective serotonin reuptake inhibitors and cognitive therapy, mainly cognitive behavioral therapy and exposure and response therapy.
Grant, J. (2014). Obsessive-Compulsive Disorder. New England Journal of Medicine, 371: 646-653.
Jones, M., Wootton, B., & Vaccaro, L. (2012). The Efficacy of Exposure and Response Prevention for Geriatric Obsessive Compulsive Disorder: A Clinical Case Illustration. Case Reports in Psychiatry. 2012: 394603.
Koran, L., Hanna, G., & Hollander, D et al. (2014).Practice guideline for the treatment of patients with obsessive-compulsive disorder. American Journal of Psychiatry, 164(7 Suppl): 5-53.
Pittenger, C., Bloch, M. (2015). Pharmacological treatment of obsessive-compulsive disorder. Psychiatric Clinics of North America, 37(3): 375-391.
Reddy, Y., Sundar, A., Narayanaswammy, J., & Math, S. (2017). Clinical practice guidelines for Obsessive-Compulsive Disorder. Indian Journal of Psychiatry, 59(Suppl 1): S74-S90 Obsessive-Compulsive Disorder Assignment.
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