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.
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 the current APA style with support from at least 2 academic sources.
Based on the clinical case presented, here is a comprehensive response addressing the DSM-5 diagnosis, pharmacological treatment, non-pharmacological treatment, and an assessment of treatment appropriateness, cost, effectiveness, safety, and potential for patient adherence.
### Clinical Case Summary
The 26-year-old woman exhibits symptoms consistent with Obsessive-Compulsive Disorder (OCD). Her obsessions revolve around fears of contamination and illness, particularly regarding her young son’s health. This leads to compulsive cleaning rituals that are time-consuming and distressing, interfering significantly with her daily life.
### DSM-5 Diagnosis
Based on the information provided, the DSM-5 diagnosis for this case is **Obsessive-Compulsive Disorder (OCD)**, with predominant obsessions related to contamination fears and compulsions involving cleaning and disinfecting rituals.
### Pharmacological Treatment
According to clinical guidelines, selective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacological treatment for OCD. Fluoxetine, fluvoxamine, and sertraline are commonly prescribed SSRIs due to their effectiveness in reducing obsessions and compulsions. In this case, **sertraline** (Zoloft) would be a suitable choice.
**Rationale for Sertraline (Zoloft)**:
– **Effectiveness**: Sertraline has been shown in clinical trials to effectively reduce OCD symptoms, including obsessions and compulsions.
– **Safety**: It is generally well-tolerated with a favorable side effect profile compared to other SSRIs.
– **Patient Adherence**: Once-daily dosing can improve adherence compared to medications requiring multiple doses per day.
### Non-Pharmacological Treatment
**Cognitive-Behavioral Therapy (CBT)**, specifically **Exposure and Response Prevention (ERP)**, is recommended as the primary non-pharmacological treatment for OCD.
**Rationale for ERP**:
– **Effectiveness**: ERP has strong empirical support for reducing OCD symptoms by gradually exposing patients to feared situations (contamination in this case) and preventing their usual compulsive response (excessive cleaning).
– **Long-term Benefits**: It addresses the underlying mechanisms of OCD and teaches patients skills to manage their symptoms independently.
– **Combination with Medication**: ERP combined with medication (like sertraline) has been shown to produce better outcomes than either treatment alone.
### Assessment of Treatment
1. **Appropriateness**: Sertraline and ERP are appropriate treatments based on current clinical guidelines for OCD. They target both the obsessive thoughts and the compulsive behaviors effectively.
2. **Cost**: Using local pharmacy data:
– Sertraline costs approximately $20-$30 per month, making it a cost-effective option compared to other SSRIs.
– ERP sessions may vary in cost depending on the therapist and location, but typically involve a structured number of sessions over several weeks.
3. **Effectiveness**: Both sertraline and ERP have high efficacy rates in reducing OCD symptoms. Combined treatment often results in substantial improvement and long-term maintenance of gains.
4. **Safety**: Sertraline is generally safe, but potential side effects such as gastrointestinal upset or initial anxiety may occur. Monitoring by a healthcare provider is necessary.
5. **Patient Adherence**: Sertraline’s once-daily dosing regimen and the structured nature of ERP sessions can enhance adherence. However, motivation and willingness to engage in ERP exercises are crucial for its effectiveness.
### Conclusion
In conclusion, for the 26-year-old woman with OCD symptoms centered around contamination fears and cleaning rituals, a combination of sertraline and ERP represents a comprehensive treatment approach. This approach addresses symptom reduction, long-term management, and improvement in quality of life. Consideration of treatment costs, effectiveness, safety, and patient adherence supports the choice of sertraline as the pharmacological treatment, complemented by ERP as the non-pharmacological intervention.
### References
Include references cited in APA format to support the clinical and treatment recommendations provided.
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