Day 5 assignment

QUESTION 1 – Provide provisional diagnosis and treatment plan.

CASE 1-

Miss R is a 35 years old secretary who has always been a clean and tidy person. For the past 3
months, however, she has been excessively fearful of getting contaminated by “germs”. She
spends a several minutes each time washing her hands with soap whenever she touched a
surface which she deemed as “contaminated” e.g. An office document, a chair and most other
surfaces. She is starting to develop redness and peeling of her hands because of excessive
washing. At home, she can only sleep very late as she has to spend many hours cleaning her
house. Her relationship with her boyfriend suffers as she finds kissing and even holding hands
unhygienic and “dirty”. She becomes depressed as a result.

In obsessive doubt, a sufferer may have a persistent fear of having missed various things (such
as not properly switching off lights or gas stove, not closing doors or windows properly, making
a careless mistake in work or misplacing a wallet). He or she then compulsively checks for
these “mistakes”. Hence the sufferer may spend a long time checking these things.

Provisional Diagnosis & treatment plan –

Ms R is suffering from obsessive-compulsive disorder (OCD), as she is fearful of getting

infected by germs leading to obsessive cleaning of hands and office furniture, households to an
exent where her skin is getting affected. OCD can take many forms, but, in general, persons
experience repetitive, intrusive and unwelcome thoughts, images, impulses and doubts which
they find hard to ignore. These thoughts form the obsessional part of ‘obsessive-compulsive’
and they usually cause the person to perform repetitive compulsions, which are attempts to
relieve the obsessions and neutralize the anxiety. Often there is a thought about completing an
action that is accompanied by a fear that if they do not comply something dreadful will happen.
They recognize that their fears and anxious behaviors are irrational but they do not stop
themselves acting on them.

Medication is not recommended as a sole treatment method but is often used as an adjuvant
treatment if the patient is willing. Research has shown selective serotonin reuptake inhibitors
(SSRIs) are most effective for OCD, e.g. fluoxetine, fluvoxamine, paroxetine, and sertraline are
the first line of treatment, but in the case of these being ineffective, clomipramine and others
may be tried. Medication sometimes work by reducing the severity of the obsessive-compulsive
symptoms or by ‘taking the edge off’ some of the anxiety precipitated by OCD. Cognitive
behavior therapy (CBT) is a tried and tested treatment. CBT helps patients change how they
think (‘cognitive’) and what they do (‘behaviour’). CBT focuses on the ‘here and now’ problems
and difficulties. It does not seek to look at the past for causes for current behaviour and feelings
Question 2- what is the difference between obsession and
compulsion?
Parameter Obsession
Obsession are persistent and recurrent
thoughts, impulses or images that are
Definition
experienced as intrusive and generate
considerable amount of anxiety.
These thoughts do not concern real life
Nature proles/ issues at the present moment and
are often irrelevant to present reality.
The person has insight and tries to remove
Effect
thoughts without success.
# Constant irrational worries about dirt,
germs or contamination
# Excessive concern with order,
arrangement or symmetry
# Fear that negative or blasphemous
Contains
thoughts or impulses will cause personal
harm
# Distasteful religious and sexual thoughts
or images.
Compulsion
Compulsions are repetitive overt behaviors
like washing or checking or mental acts like
counting or praying in response to an
obsessive thought.
Compulsions are to be done following rigid
rules to prevent or reduce the impact of
some dreaded thing or action.
After a compulsion is performed the person
temporarily feels relieved but again succumbs
to the same cycle.
# Cleaning – repeatedly washing hands,
bathing, or cleaning household items
# Rechecking- checking and rechecking
several ties a day that doors are locked, stove
is turned off, hairdryer is unplugged, etc
# Repeating – Unable to stop repeating a
name, phrase or activity
# Touching and arranging in order
# Mental rituals- Endless reviewing of
conversations, counting or praying to
neutralize obsessions