Describe the HPI and clinical impression for the client.
The patient is a 24-year-old Caucasian female SA. The client came as a referral from her doctor specifically for therapy. SA has the issue of always feeling insecure of leaving the doors to her house unlocked. In every occasion where she would report for work, she was fond of going back home approximately twice for the purposes of checking whether or not the doors were locked. As a result, she started to deteriorate in her job in terms of quality and performance which contributed to her firing. After conducting a thorough medical and mental assessment, it was evident that the client did not have significant issues related to drug abuse, alcohol or tobacco.
Based on the family’s report and a past medical history, it was notable that there was a positive history of depression that his father suffered one year ago. The patient agreed to both pharmacologic and psychotherapeutic treatment. On examination, the 20-year-old was calm and composed without any signs of acute distress. Apart from being talkative, the client was not able to concentrate on one activity for quite a long time. Her thoughts were frequently preoccupied and circumstantial with obsessions and compulsions. SA declined to have experienced suicidal ideations, homicidal ideation and auditory-verbal hallucinations. Obsessive Compulsive Disorders Research
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Based on this presentation, a clinical impression of Obsessive Compulsive Disorder is certain as also supported by the DSM-5 criteria on diagnosing the Obsessive-Compulsive Disorder.
For patients diagnosed with Obsessive Compulsive Disorder, treatment is highly recommended when the symptoms experienced by a patient result to impairment in functioning and distress (Pittenger & Bloch, 2014). Basing on the case of SA, impairment in social functioning is evident as she cannot perform well at her workplace which is the result of her frequent dismissal from jobs. Therefore, the first line treatment for this patient starts with the use of selective serotonin reuptake inhibitors (SSRIs). Therefore, Prozac 40mg oral daily should be prescribed since it is the most recommended for the management of Obsessive Compulsive disorders (Baldwin, et al., 2014). After exactly one week, the patient will have to come again for the purpose of increasing the dosage to 80mg oral daily to ensure that, therapeutic levels are adequately achieved.
When prescribing the drug, the patient will be educated on some of the side effects which may be witnessed such as anxiety, nausea, disturbance of sleep and diarrhea. While this information will add to the client’s knowledge, it will help to reduce tension and nervousness when any of the effects are experienced (Fineberg, et al., 2015). With this drug, it is expected that there will be a significant reduction in the client’s intrusive thoughts which negatively impact her social life and formal employment.
Research suggests that the combination of pharmacological treatment with behavioral therapy helps to reduce the symptoms of Obsessive Compulsive Disorder to give improved health outcomes. Most specifically, Cognitive Behavioral Therapy remains the treatment of choice for patients diagnosed with OCD (McKay, et al., 2015). As a form of talking therapy, Cognitive Behavioral therapy will be initiated the same time as medications. It is highly recommended as it will help the patient to look at and comprehend other ways thinking and tends to challenge her emotions through behavioral exercises. It does so by combining cognitive therapy (thoughts) and behavioral therapy (how thoughts affect behavior) (Mancebo, et al., 2017). The expected outcome is that the patient will be able to be her own therapist in eradicating negative thoughts which influence the compulsive behavior. The key aims of CBT will be to improve the client’s social and work life, to change behavior and to reduce dysfunction. Obsessive Compulsive Disorders Research
Medical Management and Community Support Resources
It would be necessary to liaise with the primary care physician of SA to get frequent updates and be informed of any concerns that are likely to arise in the course of treatment. This decision is attributed to the fact that the primary care physician seemed to have a lot of insights in the life of SA. With regards to the prescribed medications, it would still be necessary to collaborate with the primary care physician in knowing the extent of severity of the side effects (Cruz, et al., 2016). The OCD state foundation will support the client from the social, economic and mental perspectives. By getting another job, the OCD foundation will write a formal letter to inform the client’s employer about her condition and to highlight that she is continuing with therapy and expected to be well. As recommended by Diedrich & Voderholzer (2015), this effort will only be dependent on the client’s informed consent.
Follow-up and Collaboration
Immediately after one week, the client will come again for follow-up where issues such as adherence to drugs will be done. During this visit, the patients drug dosage will also be adjusted and it will be established how well the patient can tolerate the medication. After every four weeks, there will be thorough monitoring of medication management. CBT will be initiated the same week medications will be initiated. Weekly consultations with the therapist will be done to ascertain any updates, clarifications, and concerns (Wheaton, et al., (2016). Prozac that was prescribed to the patient is an antidepressant which has been associated with high risks of suicide in patients with OCD since the majorities has depressive disorder. During follow-up, it would be necessary to instruct both the therapist and primary care physician to ask and monitor any signs or behavior of suicidal ideation.
After a complete course of treatment, poor progress will be evidenced by compulsive behaviors that will require hospitalization. As noted by Fineberg, et al., (2015), good progress will be revealed by social and occupational adjustments by the client. However, for full recovery, the client will still need the help of an interdisciplinary team. Obsessive Compulsive Disorders Research
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.
Cruz, L. F., Kolvenbach, S., Vidal-Ribas, P., Jassi, A., Llorens, M., Patel, N., & Mataix-Cols,
(2016). Illness perception, help-seeking attitudes, and knowledge related to obsessive–compulsive disorder across different ethnic groups: a community survey. Social psychiatry and psychiatric epidemiology, 51(3), 455-464.
Diedrich, A., & Voderholzer, U. (2015). Obsessive–compulsive personality disorder: a current
review. Current psychiatry reports, 17(2), 2.
Fineberg, N. A., Reghunandanan, S., Simpson, H. B., Phillips, K. A., Richter, M. A., Matthews,
K., & Sookman, D. (2015). Obsessive–compulsive disorder (OCD): practical strategies for pharmacological and somatic treatment in adults. Psychiatry research, 227(1), 114-125.
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.
Mancebo, M. C., Steketee, G., Muroff, J., Rasmussen, S., & Zlotnick, C. (2017). Behavioral
therapy teams for adults with OCD in a community mental health center: An open trial. Journal of Obsessive-Compulsive and Related Disorders, 13, 18-23.
Pittenger, C., & Bloch, M. H. (2014). Pharmacological treatment of obsessive-compulsive disorder. Psychiatric Clinics, 37(3), 375-391.
Wheaton, M. G., Huppert, J. D., Foa, E. B., & Simpson, H. B. (2016). How Important Is The
Therapeutic Alliance In Treating Obsessive-Compulsive Disorder With Exposure And Response Prevention? An Empirical Report. Clinical Neuropsychiatry, (6). Obsessive Compulsive Disorders Research
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