Practicum: Decision Tree Assignment

The focus of this assignment is to examine the case study of the client (Tyrel). This will include assessment and recommendation of the client’s treatment in accordance with the presenting symptoms. The first decision will involve making a differential diagnosis regarding the client’s mental disorder while the second decision will involve selecting the client’s psychotherapy treatment. Thirdly, the client’s treatment plan for psychopharmacology will be selected. Finally, ethical aspects that may affect Tyrel’s treatment will be analyzed.Practicum: Decision Tree Assignment

Decision Point 1

The diagnosis for the client is an obsessive-compulsive disorder (OCD). This decision was selected because the client manifests symptoms consistent with symptoms of an obsessive-compulsive disorder. According to Chowdhury et al (2016), OCD is typified by persistent obsessions such as intrusive thoughts and urges, as well as compulsions that include repetitive behaviors. The obsessions and compulsions can significantly impair an individual’s social and educational functioning (Pauls et al, 2014). In addition, OCD may present as a need to confirm something repeatedly or mental contamination where an individual with OCD has an overbearing need to clean his/her hands because they fear contamination. In the provided case study, Tyrel is obsessed with the intrusive thoughts about germs and he responds to these thoughts through repetitive hand-washing (compulsion). For Tyrel, OCD presents as the need to wash his hands in order to prevent contamination that may get him sick. In addition, symptoms of OCD have impaired Tyrel’s social and educational functioning as evidenced by him missing school and stopping to play with his friend across the street.


Decision Point 2

The selected decision point two is to begin fluvoxamine immediate release 25 mg orally at bedtime. Fluvoxamine was selected because this medication hinders reuptake of serotonin by neurons and therefore its efficacy in the treatment of OCD because OCD is caused by impairment of central serotonergic functioning (Ghanizadeh et al, 2017). Moreover, studies show that fluvoxamine is effective in treating individuals with OCD and that the medication has minimal side effects. In addition, fluvoxamine should not be administered in the morning but during bedtime, because the medication has strong sedating effects (Wang et al, 2018).

With this decision, it was hoped that symptoms of OCD such as repetitive hand washing would decrease and that Tyrel would stop having obsessions about hand-washing. It was also hoped that the social and academic functioning of Tyrel would improve and therefore his school attendance would improve and that he will also start attending the playground and playing with his friend across the street. This is because administration of fluvoxamine would be effective in treating symptoms of OCD present in the client (Ghanizadeh et al, 2017).Practicum: Decision Tree Assignment

Just as expected, there were insignificant differences between what was expected to be achieved and the results of the decision. It was expected that OCD symptoms would reduce and Tyrel’s social and academic functioning would improve. Just as expected, the results of the decision were that some OCD symptoms had reduced as well as the rate of hand washing. Similarly, Tyrel’s school attendance improved and he also went to play with his friend unlike before.

Decision Point 3

The chosen decision point three is to increase fluvoxamine dosage from 25 mg to 50 mg orally at bedtime. This decision was selected because Tyrel was responding to the 25 mg as indicated by improved OCD symptoms and he is not experiencing any side effects. Therefore, an increased dose will further improve the OCD symptoms. Studies suggest that OCD should be treated with higher doses of SSRI when compared to the doses used to treat depression (Reddy et al, 2017). The evidence further shows that there is increased efficacy when treating OCD and reduced OCD symptoms when higher doses of fluoxetine (60-80 mg) when compared to low doses of fluoxetine (20-30 mg) (Reddy et al, 2017). Therefore, a dose of fluoxetine 50 mg would be more effective in treating OCD symptoms for Tyrel when compared to 25 mg and hence the significance of increasing the dosage to 5o mg.

By selecting this decision, it was hoped that OCD symptoms for Tyrel would significantly reduce and that he would resume to attending school normally as well as continue playing with his friend. This is because evidence shows that higher dose of fluvoxamine is more effective in reducing OCD symptoms and also higher doses of SSRI are required in the treatment of OCD (Reddy et al, 2017).

Ethical Considerations for the Client’s Treatment

In the treatment of Tyrel, the main ethical aspects that may impact his treatment plan and communication include autonomy, the choice to treatment, confidentiality, as well as informed consent. This is because Tyrel is a child and his parents will consent to treatment decisions (Botkin et al, 2015). Children do have the right to refuse treatment and thus after Tyrel’s parents consent to treatment; it is ethically allowed to commence treatment. Similarly, confidently and privacy regarding Tyrel’s treatment might be compromised since information will be shared with his parents (Botkin et al, 2015). Practicum: Decision Tree Assignment


Tyrel’s diagnosis is an obsessive-compulsive disorder because he manifests symptoms consistent with OCD symptoms. The second decision for Tyrel was to comment fluvoxamine 25 mg orally during bedtime. This is because fluvoxamine has been shown to be effective in treating OCD symptoms. Additionally, the medication causes sleepiness and therefore should be administered at bedtime. The third decision is to increase the dose to 50 mg. this decision was selected because higher doses of fluvoxamine have been shown to have higher efficacy in treating OCD. Lastly, ethical issues likely to impact Tyrel’s treatment plan include autonomy, the choice of treatment, confidentiality, along with informed consent.


Botkin, J, Belmont, J,., Berg, J, Berkman, B, Bombard, Y, Holm, I & Wilfond, S. (2015). Points to consider: ethical, legal, and psychosocial implications of genetic testing in children and adolescents. The American Journal of Human Genetics. 97(1), 6-21.

Chowdhury H, Mullick M & Arafat Y. (2016). Clinical Profile and Comorbidity of Obsessive-Compulsive Disorder among Children and Adolescents: A Cross-Sectional Observation in Bangladesh. Psychiatry Journal. 2016(1), 1-7.

Ghanizadeh A, Reza M, Shahla B, Zahra K, Ali F & Alavi A. (2017). Efficacy of N-Acetylcysteine Augmentation on Obsessive Compulsive Disorder: A Multicenter Randomized Double Blind Placebo Controlled Clinical Trial. Iran J Psychiatry. 12(2): 134–141.

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.

Reddy Y, Sundar A & Math S. (2017). Clinical practice guidelines for Obsessive-Compulsive Disorder. Clinical Practice Guidelines. 59(5), 74-90.

Wang S, Han C, Bahk W, Lee S, Masand P & Pae C. (2018). Addressing the Side Effects of Contemporary Antidepressant Drugs: A Comprehensive Review. Chonnam Med J. 54(2): 101–112.

Practicum: Decision Tree Assignment

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