CASE PRESENTATION
BY
Deeksha, Shivangi, Swagat,
Meenakshi & Thelma
Case: OCD
 

 
  

CASE HISTORY

Socio Demographic Details

Name: Meenakshi Phulera

Age: 41years

Gender: Female

Marital Status: Married

Occupation: Educator

Education: MCA, B.Ed.

Religion: Hindu

Language: English and Hindi

Informant: Swagat

Age: 36 years

Education: M Tech

Length of acquaintance with the client: Since birth

Relationship with the client: Brother

Any history of past psychiatric illness: No

Neurotic illness: No

Referral: Patient was referred by a general physician

 
Chief Complaints

According to the informant: Meenakshi is too much involved in cleaning. She is always
changing bedsheets and cleaning the whole house.

According to the client: In client’s word, “I had to leave my job because of my thoughts
about cleaning.” “My day begins with cleaning my entire house.” “I am always thinking
too much about cleaning. If I see anything dirty, I just get so angry.” “My children leave
for school without a packed lunch because I’m cleaning all the time.” “I’m not able to
spend quality time with my family due to my thoughts about maintaining hygiene.”
“There’s no specific time dedicated to cleaning, I just clean all day or if I feel like
anything is dirty.” “I feel like this is not normal and I should get help for this.”

History of Present Illness:

Onset: Insidious

Client was organised as a child and shared a good bond with family members
,the environment was healthy at house and no abuse or trauma can be traced
during childhood according to what the client has shared except she recalls her
ssc teacher as very strict and used to beat students.

At the age of 13-14 yrs client visited a some vegetable and chicken market where
she was hampered by the smell and even after coming home she couldn’t relax
and had to take bath a few times because of the gross feeling since then she
started having reoccurring dreams and the need for cleaning increased but it was
not too excessive but it was inducing stress and client started spending most of
her time with her mother.she had joyful childhood and according to her she was
calm and happy as a child and shared normal relations with her peers ,she was
very good at studies and participated equally in extracurricular activities.

There is one aunt she recalls about who used to do excessive cleaning but she
wasn’t influenced by her according to her, there were no biological issues during
her childhood and she was a healthy kid, also there is no history of alcohol abuse
in her family,his mother was heathy but father was a heart patient and expired
when she turned 20.

Later after getting married during her pregnancy she suffered from gestational
diabetes and was suggested to rest during whole pregnancy due to which she
left her job and that made her feel lonely and stressed,otherwise the family was
supportive and pregnancy was fine,but once the child was born he was kept in
incubation which made her feel sad and anxious but the excessive cleaning
began when the son turned 3 months old when her mother went back and
husband left  for work that is when she felt lonely again and started cleaning
more than required and since then the symptoms have been aggravating.

Her brother noticed the changes in her during that time who used to visit her
every few days.She joined work again when her son turned 2.5 yrs old but in that
time she felt depressed since she loved her work and she kept cleaning to
compensate.

Now again she has given up on work and is unemployed as according to her she
needs more time for cleaning and hence she cannot manage both the work and
cleaning.she has minimised going to social gatherings or inviting to bare
minimum because cleaning and hygiene is a concern for her.she keeps cleaning
even when extremely tired and her main focus remains on cleaning and that has
left a strong negative impact on her daily life routine.

She feels aggressive at times when things are not in order and that has
worsened her relationship with family though family is very supportive to her
,also she feels sad since she is unable to fulfill her duties as a mother and wife
due to her overly excessive cleaning habit.Her biological functions are fine
except that her quantity and quality of sleep both has reduced.When she thinks
about her condition she gets depressive thoughts and feel anxious at times but
no depressive or anxiety disorder is diagnosed and she has never attempted
suicide. She is not on any medication and is physically fit. She has lost interest in
work and concentration and attention both has suffered though she feels
optimistic and happy at times.

She is well aware of her condition and is open to work on it as guided.

Course of Illness: Deteriorating

Treatment History:

Upon consulting a general physician five years back, she was on some painkillers and
relaxing drugs. The physician also suggested her some relaxation techniques to control
her obsessive thoughts about cleaning but they did not provide any effect in her
condition. Her symptoms got worse after seeing the physician.

 
 Past History:

Past medical History: She suffered from typhoid in childhood. There is no negative
record of any medical history.

Past Psychiatric History: No history of any kind of psychiatric issue.

Family History:

o The patient’s father was a heart patient and was in a government job while
mother a house wife. She has 2 siblings, one married and is an event manager
while the other is self-employed and not married.

o There is not history of any psychiatric illness in the family

o The patient is married to a 45-year-old male with a government job and has 2
children with him and she described her marriage as love marriage.
 o She descried all her family members as supportive and caring.

o The patient describes her husband as encouraging and understanding.

Personal History:

1.Birth and Early Development: No issues in the early development period

2. Behaviour During Childhood: No history of conduct disorders, truancy, and gang

activities.

3. Physical Illness During Childhood: Suffered from typhoid as a child

4. School: No history of any misconduct in school

5.Menstrual History: Pain and discomfort during periods in teenage.

6. Marital History: Early love marriage and no history of any conflict with the partner

7.Use of alcohol, tobacco, and drugs: No history of substance

Premorbid Personality

1. Attitudes to others in social, family, and sexual relationships: sutain relationships,

friendly,

2. Attitude to Self: Self conscious and self compassion

3. Moral and Religious Attitudes and Standards: no expression on any religious beliefs

4. Mood: Ability to regulate her mood and maintain a stable mood

5. Leisure Activities and Interests: exercise and meditate

6. Fantasy Life: no expression of any daydreaming

7. Reaction Pattern to Stress: Ability to rationalise and deal with distress

8. Habits: normal eating and sleeping pattern

 
 Diagnosis:

Provisional Diagnosis: OCD (obsessive compulsive disorder)

Symptoms of repeated and obsessive thoughts about cleaning and maintaining hygiene.
She engages herself in cleaning things around her maximum times of the day. She is
aware that her thoughts are irrational and causing problems in her well-being.

Plan of Action

The client is advised to follow the treatment plan which consist of the following
interventions:

 CBT (cognitive behavioural therapy)

 Exposure and response prevention
 Relaxation and stress management techniques