Case 1
Maria presents with symptoms of obsessive compulsive disorder. She reports of a compulsion; her constant need to pluck out one of her eyebrows. She reports that she has had a previous history of collecting items without being able to control the urge. She explains that her habit is making her feel isolated from other people who find her behaviors weird. OCD is an anxiety disorder that requires a multidisciplinary approach to its management. Maria would need a psychiatrist whose role is to take a medical history, conduct a psychological assessment, conduct a clinical interview with her family, make a diagnosis and offer management for the patient.
Maria also needs a professional who is an expert in cognitive behavioral therapy. This professional could be a clinical psychologist, social worker or a trained therapist. This professional will be important in providing cognitive behavioral therapy to Maria (Menchon et al., 2016). Another professional essential in Maria’s team is a therapist with experience in family therapy, who will take Maria’s family through therapy and through how the family can help Maria. In case of the need for inpatient services, a mental health nurse would be important to have in the team (Menchon et al., 2016). In addition, a neurosurgeon trained in deep brain stimulation would come in handy in providing this treatment to Maria.
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Follow-up for patients with OCD is important for successful treatment and avoidance of relapse. Maria’s follow-up plan would involve weekly follow-up with a licensed healthcare practitioner such as a psychiatrist or clinical psychologist. The weekly follow-up could be through phone call. In addition, a monthly follow-up is essential for assessment of symptoms and daily functioning, brain scans and other medical exams (Olsen et al., 2018). This will help a psychiatrist evaluate Maria’s recovery and decide on the need for continued therapy or medication or discontinuation of the same. Mara could also join an OCD support group which could either meet monthly or weekly (Micali et al., 2010). This will help in her recovery and assessment of progress.
Case 2
Lena is a 48 year old woman, widowed with two children, who works as a delivery driver for a flower shop. Her presenting complaints were nightmares and sadness after a robbery during delivery. She reports that while carrying out one of her deliveries, a man robbed her at gunpoint. She reports that the man shouted at her and pressed the gun against her, making her think he was going to kill her. She also reports to have heard a gunshot during the robbery. Lena reports that after the robbery, she has had difficulties concentrating and falling asleep. In addition, she has nightmares about the attack and is unable to narrate her ordeal without breaking down. In her mental state exam, she reports to have a constantly low mood and a decrease in positive emotions. In addition, she has problems with concentration and has some distorted thoughts about the event. She also has an increased vigilance and a higher startle response, coupled with emotional distress when narrating the events of that day.
The differential diagnoses for this case include: - post-traumatic stress disorder, acute stress disorder, depression, anxiety disorder and adjustment disorder (Lancaster et al., 2016). Her diagnosis is most likely formulated clinically after a psychiatric evaluation. Laboratory testing is mostly non-contributory, but it is essential to carry out tests such as cortisol levels and urine drug tests for drugs of abuse. Another test that could be done is heart rate monitoring, which indicates an increased heart rate when rethinking the events (Lancaster et al., 2016). Her management ought to include mental health providers, clinicians and a psychotherapist. Lena’s treatment plan would involve trauma-focused therapy which could be cognitive behavioral therapy, prolonged exposure and cognitive processing therapy (Watkins et al., 2018). Medications would be an optional first line treatment for Lena, especially the use of prazosin for her nightmares and insomnia (Tol et al., 2013). Medications such as antidepressants could be used as second-line after psychotherapy. In case Lena’s condition worsens, she could be considered for inpatient treatment (Tol et al., 2013). Follow-up should then continue with regular assessment to determine her progress and need for continued interventions.
References
Lancaster, C. L., Teeters, J. B., Gros, D. F., & Back, S. E. (2016). Posttraumatic Stress Disorder: Overview of Evidence-Based Assessment and Treatment. Journal of clinical medicine , 5 (11), 105. https://doi.org/10.3390/jcm5110105
Menchón, J. M., van Ameringen, M., Dell’Osso, B., Denys, D., Figee, M., Grant, J. E., ... & Ruck, C. (2016). Standards of care for obsessive–compulsive disorder centres. International journal of psychiatry in clinical practice , 20 (3), 204-208.
Micali, N., Heyman, I., Perez, M., Hilton, K., Nakatani, E., Turner, C., & Mataix-Cols, D. (2010). Long-term outcomes of obsessive–compulsive disorder: follow-up of 142 children and adolescents. The British Journal of Psychiatry , 197 (2), 128-134.
Olsen, T., Houston Mais, A., Bilet, T., & Martinsen, E. W. (2008). Treatment of obsessive–compulsive disorder: Personal follow-up of a 10-year material from an outpatient county clinic. Nordic journal of psychiatry , 62 (1), 39-45.
Tol, W. A., Barbui, C., & Van Ommeren, M. (2013). Management of acute stress, PTSD, and bereavement: WHO recommendations. Jama , 310 (5), 477-478.
Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions. Frontiers in behavioral neuroscience , 12 , 258. https://doi.org/10.3389/fnbeh.2018.00258
