Captain of the Ship: Obsessive-Compulsive Disorders

Answer

Captain of the Ship: Obsessive-Compulsive Disorders

Obsessive Compulsive Disorder (OCD) entails a diverse collection of symptoms that include rituals, compulsions, thoughts, and preoccupations (Sadock, Sadock, & Ruiz, 2014). These repetitive compulsions or obsessions cause detrimental distress to an individual. Principally, an obsession refers to an intrusive and recurrent thought while a compulsion refers to a standardized, conscious, repetitive behavior. Therefore, this paper describes management approaches of OCD in adult patients. In particular, it discusses a case and suggests medical management, treatment modalities, follow up plan, as well as, collaboration while caring for a patient suffering from OCD.

History of Present Illness (HPI) and Clinical Impression

History of Present Illness (HPI)

             Bryan is a 24 years old patient who has been referred for a psychiatric assessment by his PCP. Bryan reports that he needs urgent assistance and that he is unable to keep his job due to these rituals. He reports that he is unable to maintain his job due to his rituals checking locks. Bryan has repetitive thoughts that he had left his car and the door of his apartment unlocked. He also states that he leaves his work many times to go and check the locks on his apartment and car. Further, given that he recurrently had thoughts that his car or apartment has not been locked, it was challenging for him to leave the apartment or car until he recurrently checked that it was safe, a situation that made him to be late for work. This lateness coupled with poor attendance to his job has made him warned regularly but he keeps arguing that checking the locks constantly lowers his fear about the security. Bryan insists that he is not under any medication and does not use substances such as tobacco, alcohol or illicit drugs. However, he reports that his paternal and maternal grandmothers have been under depression. Therefore, Bryan accepts that he requires urgent assistance and he is willing to start treatment.

Assessment: A healthy, well dressed adults suffers from acute distress. He makes a positive eye contact despite the fact that his mood is depressed. Further, his remoter and recent memory is intact. His thoughts are circumstantial and anxious with compulsions and obsessions. Moreover, his judgement and insight are fair. Nonetheless, he denies SI/HI/AVH.

Clinical impression

             According to the diagnostic procedure as outlined in APA (2013), it is evident that Androville suffers from obsessive compulsive disorders (OCD).

Psychopharmacology

             As stated by American Psychiatric Association (2013), in case the symptoms depicted by the patient cause considerable impairment in function, treatment is required. According to A Bryan’s report of being fired from various jobs due to absenteeism and lateness, there is a considerable impairment in home and social functionality. Bryan has also reported that his rituals are major cause of distress. Therefore, the conventional approach is to commence treatment using clomipramine or SSRI. However, in case SSRI is not effective, other pharmacological approaches can be adopted. In this case scenario, I will start using Prozac 40 mg oral daily since it is the appropriate drug for treating obsessive compulsive disorders (Stahl, 2014). Once the treatment has commenced, the patient will be required to come back to the clinic in a week time to evaluate tolerability and increase to the recommended 80mg oral every day. Fenske and Petersen (2015) argued that higher dosages are essential for critical impact. From the case of Bryan, I prefer starting treatment using SSRI (Prozac) as compared to clomipramine because of the less challenging detrimental impacts linked to clomipramine. Bryan will be told that he is likely to experience nausea, sleep disturbances, headache, diarrhea, as well as, anxiety, which are considered detrimental impacts of SSRIs. The intended result of pharmacotherapy is to minimize Bryan’ intrusive thoughts that cause compulsions that interfere with his work and home life. Findings of a study by Fenske and Petersen (2015) have revealed that behavior therapy, pharmacotherapy or the combination of the two is effective in considerably minimizing the symptoms of patients suffering from obsessive compulsive disorders.

Psychotherapy

            Sadock, Sadock and Ruiz (2014) argued that the behavior therapy is one of the most effective pharmacoptherapies for OCD since its beneficial impacts last longer when used together with behavior therapy. Most heathcare practitioners consider behavior therapy as the most appripriete treatment option for OCD since it can be performed in both inpatient and outpatient settings. With the major behavior strategies being response and exposure prevention, patients have to be dedicated to improvemet the same way Bryan is. Therefore, I will administer behavior therapy in the period pharmacotherapy is initiated. The desired goal of the behavior therapy is to transform the behavior of the patient in order to minimize dysfuctions and make him live a quality life. In this case of Brayn, I will consult a psychotherapist to administer and manage the therapy sessions.

                                                            Medical Management

             I will seek advice from Bryan’s PCP regarding additional concerns and updates. Given that Bryan has been with his PCP for years,  the physician has more information about Bryan’s life.  I will also discuss baseline labs including TSH, CBC, hepatic panel and CMP among others. Due to SSRIs, some of the side effects include headache, nausea, dry mouth, as well as, diarrhea, there will ne need to monitor the electrolytes of the patient. More importantly, I would suggest an EKG for baseline, as well as, follow up once the medication has been administered since SSRI can prolong the OT in healthy persons. I will also provide community resources including the local newspapers of OCD to support Bryan.

Collaboration And Follow Up Plan

            Byran will be informed to come back in a week time so that his compliance and tolerability of medication can be monitored. The follow up will also help in adjusting his dose. Subsequently, he will be informed to return after every for weeks so that his medication can be managed. Moreover, he will be remined to start behavior therapy during the same week when medication is administered and make a weekly follow up for therapy sessions. I will also get in touch with the therapist on a weekly basis for any concern or update regarding Bryan’s improvement. I will emphasize to therapist and PCP the need to constantly check for suicidal ideations since the patient is using antidepressant and stopping abruptly will increase the risk of commiting suicide.

            In conclusion, a poor prognosis is depcited by Bryan compulsion or rather an urgent need for medication. Similarly, a proper prognosis for Bryan is depicted by proper housing, occupational and social adjustment. The benefit of collaborative team such as therapist, PCP, as well as, other ancillaries will improve patient’s quality life.