“Captain of the Ship” Project – Obsessive-Compulsive Disorders
Introduction
According to Gournay and Rodgers (2010) defines obsessive-compulsive disorder (OCD) as a mental health condition in which an individual experiences obsessive thought and or obsessional actions. Additionally, people who have tend to have obsessive thoughts and urges to engage in compulsive behaviors. Obsessive-compulsive disorder, as a result of the patient experience discomfort which leads to impairments (Fenske, and Petersen, 2015; Mais, Bilet and Martisen 2009). As the PMHNP, I will look into a case and recommend the treatment plan for a client with obsessive-compulsive disorder (OCD).
History of illness (HPI) and Clinical Impression
November 18, 2019, 0830hrs”: Heather a 29-year-old female who lived with her husband and two cats. Through structured interviews by the primary care physicians (PCP) Heather and her husband revealed that for about one and half years she has been experiencing distressing thoughts of harming herself and even her loved ones: husband and two cats. Besides, Heather reported to have reoccurring thoughts of losing her loved ones through death in various ways such as road accidents and armed home raids. As result, he resolved to engage in special practices to protect her family. For instance, she ensured ha he home was extremely proceeded by having a well-functioning security system in place and also ensuring ah she was no alone at any given time. Heather also reported having symmetrical rituals through which she checks and rechecks the security doors and windows and retested the alarms systems in the house. She admits that the rituals are vial but the continuous and repetitive actions build up anxiety and affect her relationship with the family. Furthermore, she confesses that it has been a while since she last spoke to her primary care physicians (PCP).
Despite being from a humble background with rather “normal people”, Heather suspects her father. In her family, her father had anger issues. Moreover, he succumbed to severe hypertension. Additionally, in her social circles, Heather’s condition has proven to be difficult to be relational. from a young age, the client was not a social individual. also, in her adulthood, she finds it difficult to make new friends, but her daily routine is affected.
In the workplace, the client’s routine behaviors interfere with her daily routine as her concentration levels are very low. The client finds it difficult to perform her job as a result, she has been fired from numerous jobs.
Assessment: A healthy, well-groomed 29-year-old is in acute distress A, A & x4, pleasant and well dressed. However, the client is depressed and feels insecure. Heather’s thoughts are preoccupied with obsessions and compulsions.
Clinical impression
Based on the diagnostics criteria in the American Psychiatric Association (2013) the client reveals recurring obsessions and thoughts that obstruct daily routines. These obsessions affect the client’s personal, social and work life. Furthermore, the client is characterized to be having compulsions as she has specific rituals which she uses to reduce the obsessions and anxiety (NIMH, 2019). He client is aware of her obsessions, rituals even though they are abnormal she is unable to be mental fine. Therefore, the data gathered ascertains the client is diagnosed with OCD. Hence, the client needs optimal treatment.
Plan
Based on Heather’s report, she has lost several jobs because she leaves work to go back and check if she locked her car and apartment and her weak social life. In her case, I will start her treatment on SSRI- clomipramine every morning for the next thirty days. Once this is done, we shall break for two weeks while evaluating her results. In the case that clomipramine is no effective and the client’s intrusive are still on the rise, then we move to other pharmacological strategies. I will then introduce Prozac 40mg oral daily as per the Food and Drug Administration (FDA) approved for the treatment of OCD.
The patient will return for a follow-up weekly for a least three consecutive weeks. During Heather’s follow-ups, I will check for her tolerability, therapeutic response and potential increase on the medication. A possible increment on the dosage would be the suggested 80mg oral daily. Stahl (2014) advocates for a higher dosage is essential in ensuring that the patient reaps beneficial effects. Just like any other drug, Prozac also has side effects and the client was also educated on the adverse effects such as irregular sleep, and nausea, among others.
Other than pharmacotherapy, Videbeck (2017), suggests that the inclusion of psychotherapy in the treatment of OCD patients proves to have a long-last benefit. Furthermore, Sadock, and Ruiz, (2014) that behavior therapy is valuable as it can treat both inpatients and outpatients. However, is only favorable if the patient is committed to their mental health improvement. In Heather’s case, the psychotherapy will be initiated at the same time as pharmacotherapy. I will consult with a psychotherapist who will commence and manage therapy sessions with Heather.
Before prescribing any drugs, I intend to consult with Heather’s PCP for an update and additional information. Her previous PCP is in a beer position to provide an in-depth understanding of her mental health. With her PCP, we will explore baseline labs such as CBC, CMP, TSH, hepatic panel. To reduce side effects of SSRIs such as nausea, and diarrhea I shall frequently monitor Heather’s electrolytes and their response. Also, I recommend an EKG for baseline and follow up after medication initiation as SSRIs. Sadock, Sadock, and Ruiz, (2014) suggest EKG has a high potential to lengthen the OT interval, especially in healthy people. Additionally, I recommend that Heather seeks assistance from the community resources like the local chapter of the OCD Foundation in her area hence supporting her to recover.
In conclusion, Heather’s quality of life will involve an interdisciplinary team including PCP, a therapist, support groups and the administration of Prozac and psychotherapy. I will also be supported by a good home, social and occupational adjustment.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author
Fenske, J. N, & Petersen, K. (2015). Obsessive-compulsive disorder: Diagnosis and management. American Family Physician; 92(10): 896-903. Retrieved from www.ncbi.nlm.nih.gov/pubmed/26554283
Gournay, K., & Rogers, P. (2010). Obsessive-compulsive disorder: nature and treatment. British Journal of Wellbeing, 1(8), 37-43.
National Institute of Mental Health (NIMH). (2019). Obsessive-compulsive disorder: Overview.
Retrieved from www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer
Stahl S. M. (2014). The Prescriber’s Guide: Stahl’s Essential Psychopharmacology, 5th ed.
New York, NY: Cambridge University Press
Olsen, T., Houston Mais, A., Bilet, T., & Martinsen, E. W. (2008). Treatment of obsessive-compulsive disorder: Personal follow-up of a 10-year material from an outpatient county clinic. Nordic journal of psychiatry, 62(1), 39-45.
Videbeck, S. L. (2017). Psychiatric Mental Health Nursing, 7th ed. Philadelphia, PA:
Lippincott Williams & Wilkins