A 26-year-old woman presented to the clinic after her cleaning rituals had so exhausted her that she had given up and could now enter only two of the five rooms in her home. For more than a year she has worried that if her house is not sufficiently clean, her 3-year-old son will become ill and could die. Having touched a surface she has to disinfect it repeatedly – a procedure performed in a particular way and taking several hours. In addition, she repetitively washes her hands and sterilizes all the crockery and cutlery before eating. She realizes that she is ‘going over the top’, but she cannot stop thinking that items may have germs on them. This leads to disabling anxiety and fear for her son’s health, which she can only resolve by cleaning. This helps temporarily, but soon the thoughts return again.
Summarize the clinical case.
What is the DSM 5-TR diagnosis based on the information provided in the case?
Which pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment.
Which non-pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment.
Include an assessment of the treatment’s appropriateness, cost, effectiveness, safety, and potential for patient adherence to the chosen medication. Use a local pharmacy to research the cost of the medication and provide the most cost-effective choice for the patient. Use great detail when answering questions 3-5.
Essay: Understanding and Treating Obsessive-Compulsive Disorder (OCD)
Introduction
Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by persistent, unwanted thoughts (obsessions) and repetitive behaviors (compulsions). This essay focuses on a clinical case of a 26-year-old woman who exhibits symptoms suggestive of OCD. We will delve into the DSM-5 TR diagnosis, recommended pharmacological and non-pharmacological treatments, and assess their appropriateness, cost, effectiveness, safety, and potential for patient adherence.
Clinical Case Summary
The young woman in the case presents with intense fears related to cleanliness, germ contamination, and the health of her child. Her compulsive cleaning rituals and excessive disinfection activities indicate a pattern of behavior consistent with OCD. The distress caused by intrusive thoughts and the temporary relief gained from performing rituals are classic features of this disorder.
DSM-5 TR Diagnosis
Based on the information provided, the DSM-5 TR diagnosis for this case would be Obsessive-Compulsive Disorder. The criteria include the presence of obsessions (fear of contamination in this case) and compulsions (cleaning rituals, disinfection activities) that are time-consuming and cause significant distress or impairment in daily functioning.
Pharmacological Treatment
For pharmacological treatment, selective serotonin reuptake inhibitors (SSRIs) are considered first-line agents for OCD. Specifically, medications like fluoxetine (Prozac) or sertraline (Zoloft) have shown efficacy in managing OCD symptoms by increasing serotonin levels in the brain. The rationale behind using SSRIs is their proven effectiveness in reducing obsessive thoughts and compulsive behaviors associated with OCD.
Non-Pharmacological Treatment
Cognitive-behavioral therapy (CBT), particularly exposure and response prevention (ERP), is a recommended non-pharmacological treatment for OCD. ERP involves gradually exposing the individual to feared situations or objects while refraining from engaging in compulsive behaviors. This therapy aims to help patients confront their fears and learn healthier ways to manage anxiety without resorting to rituals.
Assessment of Treatment Options
- Appropriateness: Both pharmacological (SSRIs) and non-pharmacological (ERP) treatments are appropriate for OCD management.
- Cost: SSRIs like fluoxetine or sertraline are available at most local pharmacies as generic versions, making them cost-effective options for the patient.
- Effectiveness: SSRIs have shown good efficacy in managing OCD symptoms, while CBT, particularly ERP, has demonstrated long-term benefits in reducing obsessions and compulsions.
- Safety: SSRIs are generally well-tolerated but may have side effects like nausea or insomnia. CBT is safe without significant adverse effects.
- Patient Adherence: Adherence to medication may be challenging due to potential side effects, but regular follow-ups with healthcare providers can help monitor progress and adjust treatment if needed.
In conclusion,
a combination of SSRIs and CBT, particularly ERP, offers a comprehensive approach to treating OCD symptoms effectively. With proper guidance, support, and monitoring, individuals with OCD can experience significant improvement in their quality of life and functional abilities.