Captain of the Ship” Project – Obsessive-Compulsive Disorders.

Posted: December 5th, 2022

Captain of the Ship” Project – Obsessive-Compulsive Disorders.

“Captain of the Ship” Project – Obsessive-Compulsive Disorders In earlier weeks, you were introduced to the concept of the “captain of the ship.” In this Assignment, you become the “captain of the ship” as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with an obsessive-compulsive disorder.

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Students will: • Recommend psychopharmacologic treatments based on therapeutic endpoints for clients with obsessive-compulsive disorders • Recommend psychotherapy based on therapeutic endpoints for clients with obsessive-compulsive disorders • Identify medical management needs for clients with obsessive-compulsive disorders • Identify community support resources for clients with obsessive-compulsive disorders • Recommend follow-up plans for clients with depression disorders 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.

HPI and Clinical Impression

The patient, Shannon, was a 32-year-old African American who appeared to be very normal on the outside. She reported to work daily, was married with one child. However, Shannon felt like a mess within, she was very distant with her friends and family and had lost two previous jobs due to the same problem. Every night after coming home from work, Shannon cleaned her house for hours. When she found anything to be out of place, she screamed at her child and husband. She would even be more hysterical if she saw a piece of paper on the floor. While at home, she would spend most of her time at the sink washing hands with soap and water and made her son and husband wash theirs more than eight times daily.Captain of the Ship” Project – Obsessive-Compulsive Disorders.

Not only did her son feel upset and withdrawn, but her husband was also ready to divorce her. On the verge of the divorce, Shannon came to the clinic accompanied by her husband who was a little skeptical of the nature of Shannon’s illness. An MRI of the brain showed increased activity in the anterior cingulate gyrus, a clear symbol for the physiopathology that underlies OCD. Shannon denied using any prescription or illicit drugs. She also denied having any underlying medical illnesses. She had a positive history of depression (mother) and schizophrenia (father) in her family.Captain of the Ship” Project – Obsessive-Compulsive Disorders.

A detailed clinical assessment revealed that Shannon was alert and oriented X 4 spheres. She was healthy, well-groomed, and persistently maintained eye contact during the entire assessment. Her affect was flat, she had a fair judgment with preoccupied thoughts and a depressed mood. Shannon had an intact past and recent memory. Her thoughts were preoccupied with obsessions and compulsions but she denied having any homicidal and suicidal ideations, visual and auditory hallucinations. According to the American Psychiatric Association (2013), Shannon’s presenting complaint, clinical assessment, and radiologic findings met the diagnostic criteria for OCD.Captain of the Ship” Project – Obsessive-Compulsive Disorders.

Psychopharmacologic Treatments

The American Psychiatric Association recommends the management of OCD with medications if the symptoms experienced by a patient impair his/her physical and social functioning and cause distress. Shannon had lost two previous jobs since could not concentrate at work. Similarly, her problems made her very distant with her friends and family, a clear demonstration that the symptoms impaired her social functioning and profession. It would thus be advisable to initiate treatment with an SSRI most preferably Prozac, which is approved by the FDA for managing obsessive-compulsive disorders at a daily dose of 40mg (Kramer, 2016).  Evidence suggests that high doses of Prozac result in better health outcomes. Therefore, depending on the patient’s treatment progress, her Prozac dosage will increase to a maximum of 80 mg daily.Captain of the Ship” Project – Obsessive-Compulsive Disorders.

The decision to initiate treatment with Prozac was influenced by the finding that, when compared to clomipramine, a tricyclic antidepressant used in the management of OCD, Prozac has fewer adverse effects (Fenske & Petersen, 2015). After the initiation of treatment, Shannon will have to report to the clinic to determine the drug’s efficacy and effectiveness. During the prescribing process, Shannon and her husband will be educated on the expected side effects such as nausea, headache, sleep disturbance and diarrhea that will range from mild to moderate. The primary goal of pharmacotherapy will be to make the patient feel more relaxed and ensure that her ritualistic behaviors diminish completely.Captain of the Ship” Project – Obsessive-Compulsive Disorders.

Psychotherapy Choices

Current research recommends the initiation of behavior therapy and medications at the same time to achieve better health outcomes. More particularly, a PMHNP can use the primary strategies of CB’s response and exposure prevention (ERP) therapy to implement family psychotherapy in an outpatient setting. ERP bases on the notion that the secondary thoughts that a patient experiences give rise to anxiety leading to compulsive rituals (McKay et al., 2015). In this context, secondary thoughts comprise of assumptions and beliefs with negative outcomes that increase vulnerability to self-harm. Kircanski & Peris (2015) highlight that, by using ERP (exposure response prevention) therapy, Shannon’s gradual exposure and delayed response will help her to control her fears without performing the compulsions that ease her distress and anxiety.

Although this may seem weird at first, this learned approach to confronting one’s fears directly will result in less intense and fewer obsessions and fears. The brain will gradually learn that nothing bad occurs when one stops to perform compulsive rituals. Since most patients often underestimate their ability to cope with the negative outcomes, initiating behavior therapy at the same time with medication will help to improve the rate of efficacy. The goal of psychotherapy in this patient is to learn special skills that will help the patient to control the compulsions, ease fears and lessen anxiety. Ultimately, the patient should get her social life and marriage back and have a strong support system to hasten full recovery.

Medical Needs, Community Support Resources and Agencies

It will be important to consult with Shannon’s PCP more frequently for any issues that may emerge regarding her management. This will be a good strategy since the patient’s PCP managed her for more than three years and could have more reliable and productive insights into any issues that may hinder the attainment of therapeutic goals. The frequent consultations will include discussions about baseline laboratory tests done from time to time and the patient’s adherence to medications. It will also involve close electrolytes monitoring since Prozac is well known to reduce the levels of sodium in serum which can potentially result in hyponatremia. The PCP will also have to frequently order for EKGs or ECGs. According to Stewart (2016), periodic EKG monitoring is vital when initiating treatment with Prozac since it increases the risks of ventricular arrhythmias and prolongs the QT interval. She will also be linked with the nearest OCD foundation.Captain of the Ship” Project – Obsessive-Compulsive Disorders.

Follow-Up Plan and Collaboration

During this initial visit, Shannon was to return to the clinic after two weeks to assess her progress and tolerance to the prescribed drugs. However, other subsequent visits had to take place in 4-week intervals. The initial visit could also determine whether there should be dosage adjustments and if the patient adhered to the frequency of the prescribed medication. In the same week, Shannon was also to begin weekly psychotherapy. The collaboration will be primarily with her PCP for close monitoring through regular blood tests.Captain of the Ship” Project – Obsessive-Compulsive Disorders.