Why Did You Select This Decision? Support Your Response
Kids with obsessive-compulsive behaviors are often associated with family fear, atrophy, somatic obsessions, and repeated washing of hands are typical behaviors (AACAP, 2012a). OCD is a disorder characterized by unreasonable fears and thoughts that results in compulsive behaviors. There are various categories of OCD, called symptom dimensions, for example, contamination and washing. Fear of contamination involves excessive apprehensions concerning the risk of disease or illness, the impressions of being physically unclean or thoughts of being mentally polluted. In the case study, Tyler repeatedly washed his hands due to the fear of contaminating his hands; hence this shows symptoms of OCD.
What Were You Hoping to Achieve by Making This Decision?
The objective is to recognize the problem the kid is experiencing and establish appropriate interventions to alleviate OCD symptoms. In this case study, the most common item of obsession is fear of contaminating the hands, which is often followed by washing hands and compulsive evasion of the object that is seemingly dirty (Sadock, Sadock & Ruiz, 2014). The object of fear is normally problematic to the patient, who may find it challenging to get outside of the house because of anxiety to germs. According to Sadock, Sadock & Ruiz (2014), people with this type of OCD may also go to extreme lengths to evade situations and places linked with feared contaminants. Therefore, they may engage in various protective rituals, for example, sterilizing and disinfecting changing clothes repeatedly and throw contaminated objects away. Tyler progressively engaged in handwashing and expressed concern about contamination because of the fear of getting sick.
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Explain Any Difference Between What You Expected to Achieve with Decision #1 and the Results of the Decision. Why Were They Different?
From the explanation, the patient exhibited the symptoms of OCD. He progressively washed his hands because of fear to wash hands; hence the results matched the decision and no differences in outcomes.
Decision #2: Treatment Plan for Psychotherapy
Cognitive behavior therapy (CBT)
Why Did You Select This Decision? Support Your Response with Evidence and References to Learning Resources.
CBT is a form of psychotherapeutic therapy that helps people to learn how to recognize and alter disturbing or destructive patterns of thought that have a negative influence on emotions and behaviors (Sadock, Sadock, & Ruiz, 2014). CBT employs a hands-on practical method to problem-solving, and change the behaviors and emotions of a person to change patterns of behavior responsible for the problems a person experiences and change their way of feeling. CBT is useful in the management of child and adolescent mood disorders and anxiety disorders.
What Were You Hoping to Achieve by Making this Decision?
CBT is a vital intervention in managing OCD and anxiety. Hence, I was hoping that through CBT, the child will be able to progressively change his obsessive behavior. According to Foa (2010), CBT helps a person to change their thinking, and hopefully, the child will improve his negative fears of germs.
Explain Any Difference Between What You Expected to Achieve with Decision #2 and the Results of the Decision. Why Were They Different?
CBT has been proven to be effective in helping individuals to manage their emotions and also to overcome their fears and traumatic events (Foa, 2010). However, CBT should often be accompanied by other treatments such as antidepressants or other anxiety medications (American Nurses Association, 2014). With the intervention, Tyler is yet to respond adequately to treatment and still shows symptoms of OCD.
Decision #3: Treatment Plan for Psychopharmacology
Fluvoxamine 25mg IR at bedtime (American Nurses Association, 2014)
Why Did You Select This Decision? Support Your Response with Evidence and References to the Learning Resources.
Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) antidepressant (Kellner, 2010). Fluvoxamine is approved by FDA to treat social anxiety behavior and OCD involving recurring actions or thoughts (Stahl, 2014). Fluvoxamine is FDA approved for OCD of children aged eight years and above, and the drug's sigma-1 antagonist characteristics may lead to sedation; hence should be administered during bedtime.
What Were You Hoping to Achieve by Making This Decision?
The expected outcome from the decision is for the child to reduce the behavior of washing hands every time, and the child should have a general feeling of relaxation (American Psychiatric Association, 2013). The child should also embrace returning to school and even begin interacting with friends.
Explain Any Difference Between What You Expected to Achieve with Decision #3 and the Results of the Decision. Why Were They Different?
The child showed improvements after the prescription was relaxed. The only difference is that he still did not fully embrace returning to school. CBT is the preferred option for managing OCD, and CBT should be augmented with SSRI, which are independently effective but collectively synergistic. According to Sharf (2015), in a research of 126 subjects in which forty-two had a placebo, forty-two had an SSRI, and forty-two had an SSRI. The two groups received twelve weeks of CBT, and the CBT group had a thirty percent decrease in OCD symptoms compared to another SSRI group.
References
American Academy of Child & Adolescent Psychiatry (AACAP). (2012a). Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 51(1), 98–113. Retrieved from http://www.jaacap.com/article/S0890-8567(11)00882-3/pdf
American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author
Foa, E. B. (2010). Cognitive-behavioral therapy of obsessive-compulsive disorder. Dialogues in Clinical Neuroscience, 12(2), 199–207.
Kellner, M. (2010). Drug treatment of the obsessive-compulsive disorder. Dialogues in Clinical
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Sharf, S. (2015). Using both therapies together shows promising results. Retrieved from https://www.anxiety.org/cbt-ssris-ocd-treatment
Stahl, S. M. (2014). Prescriber's Guide: Stahl's Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.
