Anxiety & Sleep Wake Disorders
Answer the questions below based on the following case study.
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. This severely limited her daily functioning and created significant distress.
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. This fear drove her compulsive behaviors.
Having touched a surface she has to disinfect it repeatedly – a procedure performed in a particular way and taking several hours. These rituals consumed a significant portion of her day.
In addition, she repetitively washes her hands and sterilizes all the crockery and cutlery before eating. This excessive hygiene practice further contributed to her time constraints and anxiety.
She realizes that she is ‘going over the top’, but she cannot stop thinking that items may have germs on them. This insight into the irrationality of her fears did not alleviate her symptoms.
This leads to disabling anxiety and fear for her son’s health, which she can only resolve by cleaning. The cleaning rituals became a maladaptive coping mechanism.
This helps temporarily, but soon the thoughts return again. The relief from anxiety was short-lived, perpetuating the cycle of compulsions.
Summarize the clinical case.
A 26-year-old woman presents with debilitating cleaning rituals that have progressively worsened over the past year. Her obsessive fear of germs and the potential harm to her 3-year-old son drives her compulsive behaviors, including repetitive disinfection, handwashing, and sterilization. Despite recognizing the excessive nature of her actions, she feels unable to control them, leading to significant distress and functional impairment, limiting her access to most of her home.
What is the DSM 5-TR diagnosis based on the information provided in the case?
Based on the information provided, the most likely DSM-5-TR diagnosis is Obsessive-Compulsive Disorder (OCD). The case clearly demonstrates the presence of both obsessions (recurrent, persistent thoughts, urges, or images about contamination) and compulsions (repetitive behaviors or mental acts aimed at preventing or reducing anxiety or distress, or preventing a dreaded event). The obsessions are characterized by intrusive and unwanted thoughts about germs and the potential for her son’s illness or death. The compulsions manifest as excessive cleaning, handwashing, and sterilization rituals. These symptoms cause significant distress and impairment in social, occupational, and other important areas of functioning.
Which pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment.
First-line pharmacological treatment for OCD, as per clinical guidelines, is a Selective Serotonin Reuptake Inhibitor (SSRI). SSRIs are chosen due to their efficacy in reducing OCD symptoms by increasing serotonin levels in the brain, which is believed to play a crucial role in regulating mood and anxiety. Specifically, I would prescribe Sertraline. It is generally well-tolerated and has a relatively favorable side effect profile compared to older antidepressants. The rationale for choosing Sertraline is its proven effectiveness in treating OCD, its relatively low potential for drug interactions, and its availability in most pharmacies.
Which non-pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment excluding a psychotherapeutic modality.
In addition to medication, I would recommend incorporating Exposure and Response Prevention (ERP) therapy, which is a type of Cognitive Behavioral Therapy (CBT). ERP is considered the gold standard non-pharmacological treatment for OCD. It involves gradually exposing the patient to their feared stimuli (e.g., touching a doorknob without immediately washing hands) and preventing them from engaging in their compulsive behaviors (e.g., handwashing). The rationale behind ERP is to help the patient confront their fears, learn to tolerate the anxiety without resorting to compulsions, and ultimately break the cycle of obsession and compulsion. This should be done with a trained therapist.
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.
Pharmacological Treatment (Sertraline):
Appropriateness: Sertraline is appropriate for this patient given her diagnosis of OCD and the presence of significant distress and functional impairment. It is a first-line treatment for OCD and has demonstrated efficacy in numerous clinical trials.
Cost: A quick search on a local online pharmacy (e.g., a reputable Kenyan pharmacy) indicates that a month’s supply of Sertraline (50mg) can range from approximately Ksh 1,500 to Ksh 3,000 depending on the brand and the specific pharmacy. Generic versions are typically more affordable. It is important to consult with a local pharmacy for the most up-to-date pricing and availability. The patient should also be advised to check if their insurance covers the medication.
Effectiveness: Sertraline has been proven effective in reducing OCD symptoms. However, it’s important to note that it may take several weeks (4-6 or even longer) for the medication to reach its full therapeutic effect. The patient should be educated about this to manage expectations.
Safety: Sertraline is generally considered safe, but it can cause side effects, such as nausea, diarrhea, insomnia, and sexual dysfunction. These side effects are usually mild and transient. It’s crucial to discuss potential side effects with the patient and monitor them closely, especially during the initial weeks of treatment. Sertraline should not be abruptly discontinued due to the risk of withdrawal symptoms.
Adherence: Patient adherence to medication is crucial for treatment success. Factors that may affect adherence include cost, side effects, and the patient’s understanding of the medication’s benefits. Addressing cost concerns by exploring generic options, managing side effects proactively, and providing thorough patient education can improve adherence. Regular follow-up appointments are essential to monitor progress, address any concerns, and reinforce the importance of adherence.
Non-Pharmacological Treatment (ERP):
Appropriateness: ERP is highly appropriate for this patient as it directly addresses the core symptoms of OCD – obsessions and compulsions. It is considered the most effective psychological treatment for OCD.
Cost: The cost of ERP therapy can vary depending on the therapist’s qualifications, experience, and the number of sessions required. It is important to discuss the cost with the therapist and explore options for insurance coverage or financial assistance.
Effectiveness: ERP has strong empirical support for its effectiveness in reducing OCD symptoms. It works by helping the patient confront their fears and learn to manage their anxiety without resorting to compulsions.
Safety: ERP is generally safe, but it can be challenging for some patients as it involves confronting their fears. A skilled therapist can guide the patient through the process gradually and provide support.
Adherence: Patient adherence to ERP therapy is essential for its success. Factors that can affect adherence include the patient’s motivation, the therapist-patient relationship, and the perceived difficulty of the therapy. Providing thorough education about ERP, establishing a strong therapeutic alliance, and tailoring the therapy to the patient’s individual needs can improve adherence.
– A Case of Debilitating Obsessive-Compulsive Disorder in a Young Mother
-=====
Anxiety & Sleep Wake Disorders
Answer the questions below based on the following case study.
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 excluding a psychotherapeutic modality.
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.
Submission Instructions:
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources within the past 5 years.
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. (150 Words each reply) You need at least 1 academic sources within the past 5 years for each reply. (I WILL SEND YOU 2 POST AFTER I SUBMIT MY WORK FOR YOU TO COMPLETE THIS STEP)
All replies must be constructive and use literature where possible.
Late work policies, expectations regarding proper citations, acceptable means of responding to peer feedback, and other expectations are at the discretion of the instructor.
