Patient’s Portfolio – Obsessive Compulsive Disorder : Approaches, Treatments, and Interventions

Patient’s Name Maria
Disorder Name Obsessive Compulsive Disorder
List of diagnostic criteria that the patient meets (based on the DSM-5) · Presence of obsessions, compulsions, or both.

· Obsessions: Recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate and cause marked anxiety or distress; more than just excessive worries about real-life problems (American Psychiatric Association, 2013).

· The person attempts to ignore or suppress or neutralize them and recognizes that the thoughts, impulses, or images are a product of his or her own mind.

· Compulsions: Repetitive behaviors that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly (American Psychiatric Association, 2013).

· Recognition that the obsessions or compulsions are excessive or unreasonable.

· The thoughts, impulses, or behaviors cause marked distress, consume more than an hour a day, or significantly interfere with the person’s normal functioning or relationships (American Psychiatric Association, 2013).

Part 2: Psychological Approach

Select a psychological theory from the course textbook (chose either a cognitive or behavioral theory. Refer to the textbook or an academic source to explain the theory. Next, apply the theory by explaining how the individual’s mental disorder may have developed according to the theory. (Approximately 225 words)

Obsessive Compulsive Disorder (OCD) is a mental illness resulting in persistent illogical fears and ideas. This is particularly true with habits created and followed through with so the individual can avoid the fears and anxieties they cause. The cognitive theory was developed by Jean Piaget and is defined as the comprehensive theory about the nature and development of human intelligence (Durand & Barlow, 2103). The cognitive theory explains Obsessive Compulsive Disorder (OCD) because the model suggests that catastrophic misinterpretations of one’s cognitive thoughts lead to dysfunctional and maladaptive beliefs (Durand & Barlow, 2013). This in turn leads to extreme reactions to specific intrusive thoughts, ideas, or urges which results in obsessive and compulsive symptoms (Durand & Barlow, 2013).

This especially applies to Maria’s case study because the theory states that religious beliefs and instructions are factors that can cause one in this position to strive for virtue or moral perfection (Case Study 1, n.d.). In other words, the theory describes OCD well in Maria’s case because her upbringing created elevated moral standards, particular cognitive biases, anxieties, and depressive type behaviors. The cognitive theory clearly explains the dysfunctional and maladaptive beliefs of Maria because of the way she has learned to behave in irrational ways and yet accept them as being appropriate. In other words, Maria’s dysfunctional and maladaptive beliefs and thoughts were created by the way in which she was taught to think as well as the things she was expected to do as a child growing up (Mayo Clinic, 2015).

Part 3: Biological Approach

Select a theory from the biological approach from the course textbook (Choose either the genetic or neurological influence). Refer to the textbook or an academic source to explain the theory. Next, apply the theory by explaining how the individual or character’s mental disorder may have developed according to the theory (Approximately 225 words)

Both genetic and environmental factors interact in the development of obsessive-compulsive disorder (OCD) (Grisham, Anderson, & Sachdev, 2008). But there is strong evidence that OCD has a stronger genetic component. Another approach to examining the heritability of OCD is investigating the heritability of quantitative personality traits associated with the disorder, such as neuroticism, obsessionality, and perfectionism (Grisham, Anderson, & Sachdev, 2008).

The diathesis-stress model indicates that individuals inherit tendencies to express certain traits or behaviors; which may be activated under conditions of stress (Durand & Barlow, 2013). These tendencies were shown in the case study of Maria by the way she describes being raised by a mother that was highly superstitious. And also by the way her childhood life consisted of a very oppressive environment and the rules she was expected to follow.

All of these factors could easily have been combined with the genetic make-up (received from her mother) which resulted in the long history of mild obsessions and rituals as an adolescent (Case Study 1, n.d.). Researchers have used proven that genetics plays the most vital role in developing OCD by the use of twin studies (Pomerantz, 2011). While researchers have made many strides in genetic studies they still have a ways to go before one’s genetic make-up is not fully understood. But they did determine that identical twins are more likely to develop a disorder than fraternal twins; due to having identical set of genes (Pomerantz, 2011).

Part 4: Sociocultural Approach

Select a theory from the social and cultural or interpersonal relationship approach from the course textbook. Refer to the textbook or an academic source to explain the theory. Next, apply the theory by explaining how the individual or character’s mental disorder may have developed according to this theory (Approximately 225 words)

The social theory indicates that a person’s environment, cultural beliefs, and experiences affect the development of a disorder (Himle, Chatters, Taylor, & Nguyen, 2013). While there are many contributing factors to the development of OCD, culture has been proven to play a major role in the development of this disorder. One contributing factor that compliments the case study is religion; which is part of one’s cultural make-up. Researchers have also indicated that religion can even impact an individual’s treatment outcome (Durand & Barlow, 2013).

Some common OCD symptoms related to religion include intrusive blasphemous thoughts related to religious themes, compulsive prayer, touching and repeating rituals, and cleaning/washing rituals (Himle, Chatters, Taylor, & Nguyen, 2013). Clinical studies involving samples of OCD patients have found that those with higher levels of religiosity are at increased risk of meeting criteria for OCD, having more severe OCD symptoms, and endorsing OCD symptoms related to religion (Himle, Chatters, Taylor, & Nguyen, 2013).

The Catholic background is a common religious affiliation among OCD patients. Persons with cleaning/washing rituals related to their religious beliefs often involve washing or rinsing to make up for sinful thoughts or actions (Himle, Chatters, Taylor, & Nguyen, 2013). And they also report that their body or surfaces in their environment have become contaminated with sinful thoughts/behaviors and that these sins must be washed away. This is clearly seen in the case study by the way Maria behaves.

Part 5:1 Treatment

Discuss what types of medical approaches (e.g., ECT, prescription medications, psychosurgery, or current medical devises) you recommend for the patient based on studies showing its effectiveness in treating the disorder. (Approximately 75 words)

I would suggest that Maria start to treat her OCD by considering a selective serotonin reuptake inhibitor (SSRI) antidepressant (Mayo Clinic, 2015). Maria would benefit from SSRI antidepressants because they could reduce her symptoms of OCD and interfere with brain chemicals (neurotransmitters) such as serotonin, which may be involved in causing symptoms of OCD. Some examples of antidepressants she could possibly choose from are Fluvoxamine (Luvox CR), Clomipramine (Anafranil), Fluoxetine (Prozac), Paroxetine (Paxil), or Sertraline (Zoloft) (Mayo Clinic, 2015).

Any of these antidepressants could help restore the balance of serotonin in the brain and decrease her obsessive or compulsive behavior (Mayo Clinic, 2015). Maria may however have to try several medications before finding the most effective drug to control her symptoms which could take weeks to months. It is important that the doctor explain to Maria that it is not a good idea to stop the medication because it could cause a relapse of OCD symptoms (Mayo Clinic, 2015). Studies have shown that people who take antidepressants can expect at least a 40% to 60% reduction in their OCD symptoms (Jenike, n.d.).

Medication is the best course of treatment for Maria since electroconvulsive therapy (ECT) or psychosurgery because these two choices are considered to be the last resort. Electroconvulsive therapy (ECT) is a last resort because the procedure of passing electrical current through the brain can lead to memory loss, fractured bones, or other serious side effects (Mayo Clinic, 2015). And lastly, psychosurgery is used to alleviate mental illness but it also involves destruction of specific areas of the brain (Lavoie, 2015). In other words, the last two options are considered to be last resort options because they involve more severe side effects than do just using medication.

Part 5:2 Treatment

Compare and contrast the side effects the patient may experience from the selected type of medical approach and support what benefits the treatment may have on the brain chemistry or neurotransmitter activity. (Approximately 75 words)

Antidepressants do have side effects such as nausea, vomiting, drowsiness, dizziness, loss of appetite, trouble sleeping, and weakness (Mayo Clinic, 2015). Some patients even experience a reduced interest in sexual activity (Mayo Clinic, 2015). These side effects may last longer for one patient than another but if side effects continue to persist it should be reported to the doctor or pharmacist immediately. Statistics have shown that individuals often do not take the antidepressants long enough for them to make a difference and it results in the patient having reoccurring symptoms of the disorder (Mayo Clinic, 2015).

Antidepressants affect one’s brain chemistry by putting more chemical messengers (Ex: Serotonin) in the gaps across which brain cells communicate. This results in improved brain function. Serotonin works as a chemical messenger by plugging into special sockets at the tip of brain cells (Durand & Barlow, 2013). These serotonin receptors trigger a cascade of events; example: brain regeneration. In other words, drugs aimed at serotonin receptors make brain cells sprout. SSRIs ease OCD’s by affecting naturally occurring chemical messengers (neurotransmitters), which are used to communicate between brain cells (Durand & Barlow, 2013).

SSRI’s block the reabsorption (reuptake) of the neurotransmitter serotonin in the brain. Changing the balance of serotonin seems to help brain cells send and receive chemical messages, which in turn restores the balance of serotonin in the brain and decreases obsessive or compulsive behavior (Durand & Barlow, 2013). Most antidepressants work by changing the levels of one or more of these neurotransmitters. SSRIs are called selective because they seem to primarily affect serotonin, not other neurotransmitters (Durand & Barlow, 2013).

Part 5:3 Treatment

Discuss what psychotherapy options you recommend for the patient (i.e., cognitive behavioral therapy, group therapy, or exposure therapy). Do this by explaining how the chosen form of psychotherapy would work and specifically how the patient would benefit from it. (Approximately 100 words

I would suggest that Maria get cognitive behavioral therapy (CBT). Cognitive behavioral therapy is a form of therapy that focuses on examining the relationship between thoughts, feelings, and behaviors (Durand & Barlow, 2013). Cognitive behavioral therapy would help Maria focus on her thoughts, feelings, and behaviors which has resulted in alienation from her family. It would teach her ways to solve these problems and find ways to modify patterns of thinking (Freedman & Duckworth, 2012).

Cognitive behavioral therapy would benefit Maria by helping her reconstruct her negative thought process, aiding in improving the way she interacts with husband and children, and avoid further episodes in the future (Freedman & Duckworth, 2012). CBT would also allow Maria to engage in experiments that would test her beliefs which could disprove them resulting in a more positive way of interpreting her environment. It could also assist her in learning how to identify distorted thinking patterns, recognize her inaccurate beliefs, and changing her behavioral patterns (Freedman & Duckworth, 2012).

Part 5:4 Treatment

Provide both short and long-term goals for the patient’s treatment plan. Include accomplishments or behavioral changes you want to see in the patient. (Approximately 75 words)

Some short term goals for Maria would be reducing the amount of time she spends washing her hands (on a daily basis), brushes her teeth, and scrubbing fixtures and furniture that are already gleaming (Case Study 1, n.d.). I would also suggest that another of her short term goals be to interact with her children and husband by being able to touch them or kiss them goodnight. A long term goal would be to significantly reduce the symptoms of OCD and be able to interact with family in a normal functioning manner. And lastly, I would suggest that Maria attempt to overcome her obsessive religious rites so she can function in a normal manner.

Part 6: Conclusion

Defend which of the approaches can best explain the development (or cause) of the case study’s mental disorder and why your chosen treatment plan would be the most beneficial plan for the patient. (Approximately 150 words)

The most proven way to treat Maria’s OCD would be to purpose a treatment plan that consists of prescription medication combined with cognitive behavioral therapy. The antidepressants would address Maria’s brain chemistry by blocking the reabsorption (reuptake) of the neurotransmitter serotonin in the brain and changing the balance of serotonin seems to help brain cells send and receive chemical messages, which in turn restores the balance of serotonin in the brain and decreases obsessive or compulsive behavior (Durand & Barlow, 2013). The cognitive behavioral therapy (CBT) will help change her thinking and behavioral patterns (Freeman & Duckworth, 2012).

Together both of these treatments address all of the components of Maria’s needs to be successful at managing and overcoming her OCD symptoms but alone only treat one aspect of the OCD. In other words, the treatment is more effective if they are both used in conjunction with each other. And lastly, electroconvulsive therapy (ECT) and psychosurgery are considered to be last resort options because they involve more severe side effects than do just using medication and CBT (Mayo Clinic, 2015). And these treatments should only be used if Maria fails to make progress by using antidepressant and CBT because they can cause memory loss, fractured bones, and destruction of specific areas of the brain (Mayo Clinic, 2015).

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