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.  Obsessive Compulsive Disorders Essay Example

Obsessive-Compulsive Disorders

Introduction

Obsessive-compulsive disorder (OCD) is a mental disorder characterized by obsessions and compulsions. Obsessions are normally repetitive and include intrusive thoughts that result to extreme distress. Compulsions include the repetitive behaviors done to respond to the obsessions in order to reduce the anxiety (Reddy et al, 2017). The focus of this assignment is to present a HPI for a client with OCD as well as psychopharmacologic and psychotherapy treatments. Finally, the client’s medical needs, community support resources, as well as the client’s follow-up plan will be discussed.

HPI and Clinical Impression for the Client

The client XX a 32-year-old male lives with his mother and a sister. When the client was 20 years old, he suffered from mild epilepsy and he takes bland medication to control it. XX presented to the clinic with OCD symptoms that included repetitive hand washing and controlling. XX control and equipment and after using them, he makes sure that everything is under control. He keeps on checking them to ensure everything is in its place.  This fear interferes with his sleep and he keeps on waking up to confirm if they are off or in their place. Lack of restful sleep further interferes with his job performance. The client also performs repetitive hand washing when he gets home and before sleeping. He cleans his hands repeatedly using different kinds of detergents in a systematic pattern. He also rinses his hands several times in order to overcome the idea that something is not in place. Lately, the client has been experiencing obsessive symptoms 5 hours daily and this has significantly interfered with his activities of daily living. The client has never taken OCD medications or any form of psychotherapy. From the client’s obsession and compulsions, it is evident that he manifests symptoms of OCD.

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Psychopharmacologic Treatments for the Client

Fluoxetine (Prozac): Fluoxetine is the recommended medication to treat OCD for the client. Fluoxetine is an SSRI that has been demonstrated to be effective in treating OCD. Secondly, SSRIs have fewer side effects and hence suitability of Fluoxetine for the client (Pietrabissa et al, 2016). The recommended dose for the client is 40 mg because evidence shows that the highest dose provides the highest benefits for patients with OCD. This is because OCD symptoms denote a dose-response effect (Fenske & Ketti, 2015). Fluoxetine will significantly reduce the evident OCD symptoms for the patient.  Obsessive Compulsive Disorders Essay Example

Psychotherapy Choices for the Client

Cognitive–behavioral therapy (CBT) is the proposed psychotherapy for the client. Combination of CBT with medication has been demonstrated to be the most effective treatment option for individuals with OCD (Pietrabissa et al, 2016). Accordingly, CBT will be combined with the Fluoxetine in order to control the client’s OCD symptoms and facilitate restoration of his normal functioning. Cognitive therapy (CT) is the form of CBT that will be used for the client. In CT, the client will be taught on how to interpret his obsessions: this will help the client to identify and re-examine beliefs regarding the likely effects of performing or not performing the obsessive acts and behavior, in order to address them (O’Neill & Feusner, 2015).  Exposure and response prevention (ERP) will also be used to where the client will be encouraged to confront situations that induce anxiety and avoid performing the obsessive act/behavior he used to reduce anxiety (Pietrabissa et al, 2016).

Medical Management Needs

Medical management needs for this client include managing his epilepsy because it is a comorbid likely to interfere with the client’s recovery and therefore its proper management will ensure effective management of as the OCD symptoms (Seibell &Eric, 2014). It is also important to educate the client about how to identify the cues of OCD. In addition, it would be important to monitor the effects of the medication on the OCD symptoms. In case the OCD symptoms persist, it is recommended to increase the dose to 60mg because OCD-symptoms are dose-dependent and a higher dose is associated with better effects. Finally, it will be necessary to educate the client and monitor him about treatment adherence, medication dosage, as well as the duration of treatment (Seibell &Eric, 2014). In addition, it will be necessary to address the client’s sleep problem and this aspect will be addressed during CBT.

Community Support Resources

The client will be referred to the local self-help and support groups with other individuals with OCD. The support groups will assist the client to meet other individuals experiencing the same situation and this will be very beneficial to the client. It will also make him feel less lonely and keep him more connected to people who understand what he is going through. Moreover, the client will also be referred to an organization that provides psychotherapy treatment free or for minimal charges. This will relieve the financial burden for the client. Finally, the client will be provided with educational materials about OCD and its management.

Follow-up Plan for the Client

The client will be instructed to attend clinic reviews after every two weeks. A social worker will also be assigned to the client in order to monitor his progress and adherence to the treatment regimen while at home. The case manager will be responsible for managing the client’s treatment, assessment and other aspects of his care, as well as updating other healthcare providers about his progress. The nurse will be responsible for assessing the client while a psychiatrist will evaluate him and prescribe the required medications. It will also be ensured that all healthcare providers taking part in the client’s treatment collaborate effectively (Lack, 2014).

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Conclusion

The client’s symptoms of OCD include his obsession with equipment and compulsions such as hand washing and regular monitoring of the equipment. The recommended medication for the client includes Fluoxetine while the recommended psychotherapy is CBT.  It is important to monitor the client’s epileptic condition and at the same time educate him regarding symptoms of OCD and medication adherence. Finally, the client will be referred to local support groups and provided with the required materials about OCD.

References

Fenske J & Ketti P. (2015). Obsessive-Compulsive Disorder: Diagnosis and Management. American Family Physician.  15; 92(10):896-903.

Lack C. (2014). Obsessive-compulsive disorder: Evidence-based treatments and future directions for research. World J Psychiatry. 2(6): 86–90.

O’Neill J & Feusner J. (2015). Cognitive-behavioral therapy for obsessive–compulsive disorder: access to treatment, prediction of long-term outcome with neuroimaging. Psychol Res Behav Manag. 1(8): 211–223.

Pietrabissa G, Manzoni G, Gibson P, Donald B & Gori A. (2016). Brief strategic therapy for obsessive–compulsive disorder: a clinical and research protocol of a one-group observational study. BMJ Open. 6(3): e009118.

Reddy J, Sundar S & Math S. (2017). Clinical practice guidelines for Obsessive-Compulsive Disorder. Indian J Psychiatry. 59(S1): S74–S90.

Seibell P &Eric H. (2014). Management of Obsessive-Compulsive Disorder. F1000Prime Rep. 6(68).  Obsessive Compulsive Disorders Essay Example