Posted: November 27th, 2022
Obsessive Compulsive Disorder.
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.
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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 Disorder.
Describe the HPI and clinical impression for the client
Marcus is a 67-year-old male who presented at the healthcare facility for treatment of what he said was anxiety. He is a full-time janitor at a local school and engages in very few activities outside of his work. When asked about his reason for anxiety, he stated that he is afraid of contracting viral diseases such as HIV.
I became aware of a very strong smell, bleach to be more precise, and thus asked Marcus if his work involved a lot of cleaning. Marcus responded in the positive but also added that he has the habit of cleaning his hands often with bleach. He also stated that he avoids as much as possible, to touch anything outside of his house. He walks around with a small bottle of bleach in his pockets to use in case he ‘accidentally’ touches a doorknob or any ‘contaminated’ surface. Marcus cleans his hands five times in concentrated bleach every time he ‘feels’ they are contaminated. He may clean his hands up to 20-25 times a day.Obsessive Compulsive Disorder.
Upon closer inspection of Marcus’ hands, I noticed scarring and peeling from excessive use of the bleach. He said that his fear of contamination began soon after his niece died of HIV- related complications (in 2019). He also said that his niece got infected after a rape incident. Marcus believes that fate is against him as it was with his niece. He is determined to cheat fate and not get infected. Marcus is single and has never married for fear of divorce. His hand bleaching habit began three months ago. He also added that he disinfects his house every evening before going to bed. These daily routines cost him a lot of time and he hardly gets time to have a decent meal. He does not eat out and will only eat take-away food from one specific restaurant owned by a colleague’s wife.Obsessive Compulsive Disorder.
Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent.
The main pharmacological treatment choice for Obsessive Compulsive Disorder is selective serotonin reuptake inhibitors (SSRIs) (Hirschritt, Bloch & Mathew, 2017). In this case, Marcus has OCD and anxiety and this requires a low dosage of SRI treatment. The dosage will then be revised upward of several weeks. This will ensure that the anxiety is not exacerbated. Alternatively, the SRI treatment will be initiated as well as benzodiazepine for several weeks until the patient shows improvement (usually after 6 weeks). The benzodiazepine will be tapered off after the 6 or so weeks for another few weeks. The dosage of SRI is not specific and is dependent on an individual. Marcus will be started on Prozac (Fluoxetine) at 20mg per day while targeting 40-60 mg per day; with the maximal dosage being 80mg if he does not show improvement after 6 weeks.Obsessive Compulsive Disorder.
Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
Cognitive Behavior Therapy (CBT) can be delivered in an individual, family or group session (McKay et al., 2015). In Marcus’ case, CBT will be delivered in a group session. The sessions will vary form 1-2 hours. Marcus needs to overcome the grief he has over the loss of his niece. When he interacts with other persons who have gone through a grieving period and in the process picked up OCD habits, he will realize that he is not alone in the pain. Communicating his pain with other show have been and are still in the same situation as this will help Marcus learn on new coping mechanisms, create new friendships and relationships, and give him a forum to articulate his fears. Marcus will also go through booster sessions once he is done with his CBT sessions. The booster sessions will ensure that he does not re-lapse.Obsessive Compulsive Disorder.
Identify medical management needs, including primary care needs, specific to this client.
Marcus will need to have his hands examined by a physician and treated for the bleach scarring. He will also need to report to the healthcare facility to follow up on his hand treatment as well as for his OCD. The physician will recommend an antibiotic cream for Marcus’ second- degree burns (Jacobsen, 2016). The hands will be wrapped in gauze which needs changing on a daily basis for 2-3 weeks. Marcus will need to come tothe healthcare facility for dressing to ensure that he does not relapse and use bleach to clean his hands and also for proper dressing as he cannot do it himself.
Additionally, Marcus will need to see the healthcare facility nutritionist that will help him create a meal plan that will ensure that he is well nourished. Proper nourishment will help in the fast recovery of his scalded hands.Obsessive Compulsive Disorder.
Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
The physician will need to write Marcus’ a sick-off sheet pending his treatment for his hands. Meanwhile, the physician will also write a letter to write to government agencies in charge of accessing disability income. Marcus will not be in a position to work even after his hands heal because of the risk of relapse that comes with his work. His work involves the use of bleach and other detergents which may be a cause of relapse. Additionally, Marcus will be signed up with the Obsessive-Compulsive Foundation subsidiary in his hometown where he will be in apposition to access resources and support for his therapeutic journey to recovery.
Obsessive Compulsive Disorder.
Recommend a plan for follow-up intensity and frequency and collaboration with other providers.
The patient should be cared for in a setting that is least restrictive and in which he will feel safe and also will provide ambiance for the effective treatment of his illness. In this case, the patient will need home-based treatment at the initial stages before joining a support group (Abramowitz, et al., 2018). Home-based treatment is effective for patients that have fear of contamination among other fears, as is the case with Marcus.Obsessive Compulsive Disorder.
Once Marcus is ready to join a CBT group, he will still need to go to the healthcare facility for checkups. This is necessary because he might experience side effects from the medication he takes. The nurse will advise Marcus on the possible side effects he may experience. Any side effects will need to be responded to fast to enhance adherence. When the nurse educates Marcus, it will help in destigmatizing the illness and allow Marcus to make more informed decisions concerning his treatment. Additionally, education will more likely increase Marcus’ ability and motivation in cooperating with his care.Obsessive Compulsive Disorder.
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