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Complains of inability to focus on everyday task. The client is preoccupied with compulsive thoughts and obsessiveness in arranging everything in the house.

50-year-old AA has stopped working for five years now. He is married and has two kids. He used to work in a mechanic shop abut quit his job because of his OCD. He always feels the need to clean and arrange everything including the placement and position of the furniture’s and objects. His wife is frustrated and claimed that she is sleeping in a separate room. He feels that his marriage is falling apart because of the illness. He cannot work nor take his kids to school and spends enormous amount of time with his rituals.

 

 

 

AA showed severe impairment in interpersonal functioning both in his work, his relationship with his children, his peers, and his wife. AA felt that he is losing his self and his overall ability to function.

 

 

 

AA also exhibits anxiety especially when going out. He has developed agoraphobia and tends to stay indoors. This is one of the reasons why he cannot go to work anymore.

 

The development of AA’s signs and symptoms is insidious. When they first got married, his wife only though that AA is different because he loves to clean. His wife felt that he would be the perfect partner. Throughout their marriage, his wife has noticed changes in his personality and his compulsion got worse overtime.

 

 

AA’ compulsions and obsession with cleaning, arranging, and counting to 12 is no normal for his developmental stage or socio-cultural environment.

 

 

 

 

AA have gone to numerous doctors to identify the cause of his OCD. He was told in the past that the condition was incurable so he really did not make an effort to seek therapy or be prescribed with medications for his OCD.

 

 

 

 

 

 

AA has thought about killing himself in the past because of frustration especially when he lost his job. However, currently AA denied any suicidal ideations. He develops a pattern of behavior which include arranging of objects and counting to 12. AA did not exhibit any shopping, gambling, or shoplifting behavior. AA is described by his wife as quiet and not violent.

 

 

 

 

 

 

 

AA reported inability to hold long conversations with his wife and children because of his compulsions. He gets distracted by ruminating thoughts of cleanliness and organization. AA reported that he and his wife has gone distant and felt like their marriage is falling apart. AA have a problem relating to his peers.

 

 

AA has a problem controlling his impulse to clean, arrange and count. The client scored 26 in Mini-Menta State Examination. He does not display any delirium and dementia.

 

 

AA reported being stressed out because of his compulsions and obsessions that is now putting a strain in his relationship with his wife.

 

 

 

 

 

 

AA attempts to resists his intrusive and compulsive thoughts by walking out of the living room r bedroom and sometimes spending time in the lawn or a different area. He also tries to divert his attention from these rituals, but he felt it to be very difficult.

 

The family is agnostic and does not conform to any type of religion.

 

 

The client does not understand the reason behaving his problem but he do recognize that he is different. He recounted knowing that he was different since he was a teenager. Right now, he is utterly aware that his condition has gotten worse. AA’ family is frustrated at his current condition. They are desperate to seek help, but they also worry about health care costs. With only AA’ wife working, they are unsure whether they can afford to get him to therapy. 

 

Past medical history (medical history, treatment and outcomes, recent and past hospitalizations, surgeries):

Family medical history:

 

 

Medications (side effects, adverse side effects, and treatment response) INCLUDE BELIEFS about medications

 

 

Past medical history includes a previous history of appendicitis and underwent appendectomy at the age of 16. Hospitalized 8 years ago for motor vehicular accident where he sustained mild abrasions. No current hospitalization reported.

 

Paternal grandmother: has high blood pressure, depression, and stroke

Dead at 69 years of age

Paternal grandfather: has a history of alcoholism, PTSD (army veteran) and died because of pneumonia at the age of 81.

Maternal grandmother: have a history of hepatitis, high blood pressure, diabetes, depression.

Maternal grandfather: not known, estranged from family.

Mother: has a history of depression, and substance abuse, currently on rehabilitation.

Father: has history of stroke, cardiovascular disease, hypercholesterolemia, and alcoholism, living.

Sister: has asthma, living.

Brother: estranged from the family. Health care condition, not known.

 

 

Non-prescription drugs/OTC:

 

Denies taking any non-prescription drugs

 

Substance use history (for each substance, identify the type and details to include: duration, frequency, last use; blackouts; withdrawal seizures; drug-related psychosis).

Legal, psychosocial, physical, interpersonal,   and occupational consequences.

 

 

Smoking history:

Alcohol use:

Marijuana use:

Illicit drugs: 

 

Does not smoke. Has not been addicted to prescription drugs or has used any drugs. Drinks occasionally, in the past but has topped three years ago as his OCD has gotten worse. He used to drink beer about two drinks a week. Last use was three years ago. Did not report any blackout or alcohol withdrawal. No drug-related psychosis. No legal, psychosocial, interpersonal , and occupational consequences of his drinking.

 

 

 

 

 

 

 

 

Does not smoke

Used to drink at least three drinks a week.

Denied using marijuana

Denies using illegal drugs

Herbals:

 

Complementary treatments:

 

Denied using herbal remedies

 

Denied use of complementary treatments.

 

 

Include exposure to prescription opioids (reasons for use, pain, duration, frequency etc.)

Psychotropic medications, side effects, adverse side effects, and treatment response:

 

Have not been prescribed with opioids.

 

 

 

 

Has been prescribed with Prozac 10 mg last three years, reported good outcome with Prozac, but discontinued it because of insomnia and nervousness. Did not went back to his doctor for a follow-up.

Past psychiatric history (psychiatric history/treatment and outcomes, recent and past psychiatric or substance abuse hospitalizations, residential or outpatient treatments):

Family psychiatric history and/or substance use history:

 

 

-Sociocultural history (family and social history, work history, current employment, volunteer work, legal history, active and past, current support system, marital status, and children):

Trauma history:

 

Trauma exposure (childhood abuse or neglect, rape or sexual assault, emotional abuse, domestic violence, military/combat service, and natural disasters, historical/political trauma):

History of head injury, loss of consciousness, seizures:

 

 

Has been diagnosed 3 years ago with obsessive compulsive disorder with generalized anxiety disorder. Was prescribed medication but was noncompliant and did not went back for his follow-up. His symptoms have gotten worse throughout the years as a result. Has not been hospitalized for substance abuse.

 

 

Paternal grandmother: depression,

Dead at 69 years of age

Paternal grandfather: has a history of alcoholism, PTSD (army veteran) and died because of pneumonia at the age of 81.

Maternal grandmother: have a history of depression.

Mother: has a history of depression, and substance abuse, currently on rehabilitation.

 

AA has always been the reclusive and silent type. He is an introvert and usually does not go out and engage much socially. Before his worsening symptoms, he was still able to socialize with peers occasionally and at work. He also is able to enjoy time with family. He has never had any problems with the law. He is now jobless while his wife works as a teacher. Hs support system is his wife and children. His parents live in a different state.  They have been married for 25 years but is describing his marriage as “likely to end in divorce.”

 

 

 

Reports his mother to be alcoholic and is addicted to prescription medicine and she would neglect them as a kid. Denied violence, rape or sexual abuse history. Reported emotional abuse from her mother neglecting to care for them as children. His mother was in and out of the rehab. No significant disasters recounted.

 

 

 

No history of head injury, loss of consciousness or seizures.

COMPREHENSIVE  TREATMENT PLAN:

 

INCLUDE EVIDENCED- BASED THERAPEUTIC MODALITIES FOR THE IDENTIFIED PERSONALITY DISORDER

The treatment plan include is a combination of therapy as well as pharmacological intervention. The recommended treatment includes Clomipramine (Anafranil), Fluoxetine (Prozac), and Sertraline (Zoloft) (Goodman et al., 2021). The patient needs to start at a ow dose and then adjusts the dose after 14 days to see how the patient responds to the medication and whether the OCD signs and symptoms have reduced. There is a risk for increase suicidal behavior for patients taking antidepressants, so a suicide precaution is necessary.

 

Evidence-based treatment for OCD include cognitive behavioral therapy, more specifically, Exposure Response Prevention (ERP). ERP involves helping the patient cope and change compulsive and obsessive thoughts. In ERP, AA will be exposed to his compulsions and will be asked not to do them (Fineberg et al., 2020). This is done in a gradual manner. Gradual exposure and delayed response are two principles used in ERP.

Another evidence-based treatment for OCD is habit reversal training. This includes awareness training, introduction of competing response, social support, use of positive reinforcement as well as relaxation techniques (Del Casale et al., 2019).

 

 

 

References

Del Casale, A., Sorice, S., Padovano, A., Simmaco, M., Ferracuti, S., Lamis, D. A., Rapinesi, C., Sani, G., Girardi, P., Kotzalidis, G. D., & Pompili, M. (2019). Psychopharmacological treatment of obsessive-compulsive disorder (OCD). Current Neuropharmacology, 17(8), 710–736. https://doi.org/10.2174/1570159×16666180813155017

Fineberg, N. A., Hollander, E., Pallanti, S., Walitza, S., Grünblatt, E., Dell’Osso, B. M., Albert, U., Geller, D. A., Brakoulias, V., Janardhan Reddy, Y. C., Arumugham, S. S., Shavitt, R. G., Drummond, L., Grancini, B., De Carlo, V., Cinosi, E., Chamberlain, S. R., Ioannidis, K., Rodriguez, C. I., & Garg, K. (2020). Clinical advances in obsessive-compulsive disorder. International Clinical Psychopharmacology, Publish Ahead of Print (4). https://doi.org/10.1097/yic.0000000000000314

Goodman, W. K., Storch, E. A., & Sheth, S. A. (2021). Harmonizing the neurobiology and treatment of obsessive-compulsive disorder. American Journal of Psychiatry, 178(1), 17–29. https://doi.org/10.1176/appi.ajp.2020.20111601

 

 

 

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