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, let’s address each question systematically:
### Clinical Case Summary
The 26-year-old woman exhibits symptoms consistent with Obsessive-Compulsive Disorder (OCD). She experiences intrusive thoughts about contamination, specifically fearing that her son will become ill and die if her house is not perfectly clean. These obsessions lead to compulsive cleaning rituals, such as disinfecting surfaces, washing hands repeatedly, and sterilizing crockery and cutlery. Despite recognizing the excessive nature of her behaviors, she feels compelled to perform them to alleviate anxiety temporarily.
### DSM-5 Diagnosis
Based on the information provided, the DSM-5 diagnosis for this case is Obsessive-Compulsive Disorder (OCD), with prominent contamination obsessions and cleaning compulsions. This diagnosis is supported by the presence of time-consuming rituals aimed at reducing anxiety or preventing harm.
### Pharmacological Treatment
According to clinical guidelines for OCD treatment, selective serotonin reuptake inhibitors (SSRIs) are first-line pharmacotherapy options. Fluoxetine (Prozac) is commonly prescribed due to its effectiveness in reducing OCD symptoms by increasing serotonin levels in the brain. The initial dosage for OCD typically starts low and gradually increases based on patient response and tolerability.
**Rationale:** Fluoxetine is chosen for its established efficacy in OCD treatment and favorable side effect profile. It helps alleviate anxiety and compulsive behaviors, reducing the frequency and intensity of intrusive thoughts.
### Non-Pharmacological Treatment
**Cognitive Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP)** is the recommended non-pharmacological treatment for OCD. This therapy involves gradually exposing the patient to feared situations (exposure) and preventing the associated rituals (response prevention). This approach helps patients learn to tolerate anxiety without performing compulsions, leading to long-term symptom improvement.
**Rationale:** CBT with ERP has strong empirical support as the most effective psychotherapy for OCD. It targets the core symptoms, teaches adaptive coping strategies, and promotes lasting behavioral change.
### Assessment of Treatment Approaches
1. **Appropriateness:** Both fluoxetine and CBT with ERP are appropriate choices for treating OCD, addressing both the biochemical and behavioral components of the disorder.
2. **Cost:** Fluoxetine is available as a generic medication, making it cost-effective compared to brand-name SSRIs. Research indicates that the average retail price for fluoxetine 20 mg capsules is approximately $15-$20 for a one-month supply.
3. **Effectiveness:** Studies consistently demonstrate the effectiveness of fluoxetine in reducing OCD symptoms, with response rates ranging from 40% to 60% in clinical trials. CBT with ERP has shown comparable efficacy, often in combination with medication for severe cases.
4. **Safety:** Fluoxetine is generally well-tolerated, with side effects such as nausea, insomnia, and sexual dysfunction being relatively common but usually mild and transient. Monitoring for rare but serious adverse effects, such as serotonin syndrome, is essential.
5. **Patient Adherence:** Adherence to fluoxetine therapy is typically high due to its once-daily dosing and manageable side effect profile. CBT with ERP requires active patient participation and commitment but yields significant benefits when integrated into treatment.
### Conclusion
In conclusion, the recommended treatment plan for the 26-year-old woman with OCD includes fluoxetine as pharmacotherapy and CBT with ERP as non-pharmacological therapy. These interventions are chosen based on their effectiveness, safety profile, and potential for improving the patient’s quality of life by reducing OCD symptoms. Cost-effective management with generic fluoxetine ensures accessibility and affordability for the patient, promoting better treatment adherence and outcomes.
### References
– American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
– National Institute of Mental Health. (n.d.). Obsessive-Compulsive Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml
This response outlines a structured approach to addressing the clinical case of OCD, integrating pharmacological and non-pharmacological treatments while considering practical aspects such as cost, effectiveness, safety, and patient adherence.
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