Treatment of Obsessive-Compulsive Disorder

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Treatment of Obsessive-Compulsive Disorder Mental illnesses refer to disorders that affect a person’s behavior, feeling, mood, and thinking. These disorders can occur at any stage of life. They usually affect people who are predisposed by various environmental and underlying health factors (David, Lynn & Montgomery, 2018). Examples of mental health disorders are depression, anxiety, Obsessivecompulsive disorder, addiction and eating disorders among others. Health reports from hospitals and other organizations indicate that a large percentage of those seeking healthcare services suffer from various forms of mental illness. Obsessive-compulsive disorder (OCD), for instance, is estimated to affect approximately 2.2 million people

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This proportion constitutes 1 % of the U.S population (ADAA, 2020). This disorder affects both men and women in almost equal measures. The symptoms of OCD are first detected during the late teenage. However, some people may experience these symptoms as early as 14 years of age (ADAA, 2020). OCD is typified by intrusive and disturbing thoughts, an overwhelming urge to perform certain activities, anxiety, and obsession. Whereas some of these behaviors are observable, others are mental hence not easily observable. Some people, who experience compulsions, can exercise control and live almost normal lives. However, others experience overwhelming compulsions and obsessions, thus, necessitating treatment. If OCD is not treated it may worsen and affect the person’s daily routine, family, schoolwork and social activities (ADAA, 2020). To understand the treatment of OCD, this paper will explore the case of a male client who presented in the facility complaining of OCD with intrusive thoughts.

History of Present Illness The client is a 43 y/o male with a history of OCD. The client noted that he has been attending therapy sessions over the last two years. He presented in the facility for further assessment due to intrusive thoughts that are centered on sexual relationships with children. The client is afraid that these thoughts might lead to pedophilia. He reported OCD and overwhelming intrusive thoughts and compulsion to pray. The client also has a history of suicidal ideation but currently, he does not experience such thoughts. He has been experiencing depressive feelings, anxiety, low self-esteem, decreased energy, poor appetite, and decreased interest in social activities.

Clinical Impression The client presented with a history of obsessive-compulsive disorder. He was complaining of intrusive thoughts that have persisted for several years. He reported that the

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thoughts are centered on sexual tones that are triggering sexual feelings towards children. He is seeking help out of concern that he might eventually suffer from pedophilia. He has been experiencing intrusive thoughts of sexual activities with his sons and daughters. Although he has been undergoing counseling for the last two years the intrusive thoughts have not receded. He denies suicidal ideation and is ready to try medications that may help avert the intrusive thoughts.

Pharmacological Intervention Although no medication can effectively cure OCD, several pharmacological agents have been proposed as a potential solution to intrusive thoughts. These medications improve a person’s ability to overcome inappropriate compulsions and obsessions. Clomipramine 50mg and Fluvoxamine 50mg taken once daily are some of the medications given to OCD clients.

Fluoxetine is effective in alleviating depressive symptoms, impulsiveness, suicidal ideation, and intrusive thoughts (Reddihough et al., 2019). This medication is well tolerated since it has fewer side effects than other antipsychotic medications. It is, therefore, included in the first line of OCD treatment. Clomipramine, on the other hand, helps to reduce obsessions and compulsions (Del Casale et al., 2019).

Psychotherapy The best psychotherapeutic intervention for OCD is Exposure and Response Prevention (ERP). In this therapy, the client is asked to identify the triggers of compulsions and intrusive thoughts. The client is then slowly introduced to activities, objects, or situations that generate disturbing thoughts (Bream, Challacombe, Palmer & Salkovskis, 2017). The main intent of exposing the client to these situations is to increase psychological resistance whereby a person can face certain situations without experiencing enthralling thoughts (OCD-UK. 2020). The

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client is trained on how to avoid responding to compelling thoughts. Eventually, the client can develop resistance skills that ease distress, reduce anxiety, and improve self-control. Through ERP, the client is trained that he can interact with people and engages in activities that initially elicited disturbing feelings without yielding to compulsions (OCD-UK. 2020). In the current case, the client can interact with her children without experiencing any sexually-oriented thoughts.

Medical Management Needs The fundamental medical management needs for this client include alleviation of intrusive thoughts, decreased anxiety, increased energy, and improved appetite. Other medical needs include increased social interest, reduced compulsions, and reduced depressive feelings.

The disturbing thoughts have affected the client’s relationship with his children. The client is, therefore, anticipating that the treatment plan will help him to socially interact with children without looking at them from a sexual perspective. Thought and time management constitute the other medical needs for the client. The client reported that intrusive thoughts have persisted for years taking most of his daily time. If the thoughts are properly managed the client will engage in other more constructive tasks.

Community Support Resources The client has a range of support resources including access to a therapist, social support from family members, and a stable job. He reported that he has been receiving counseling from a therapist for two years. This indicates that he has unlimited access to healthcare services. Since the client is married with children, his family certainly provides the necessary social support. His friends at work and in the community also provide social support to the client. Unfortunately, his energy and interest in social activities have been decreasing. The client can also benefit from the

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support of various organizations including the International OCD Foundation (IOCDF) which deals with the OCD population. This organization assists OCD patients to get treatment in hospitals. This organization also conducts training, counseling, and research focusing on OCD treatment and improved healthcare outcomes.

Follow-up Plan A three-week follow-up plan was developed for the patient. This plan was guided by the medications administered. Clomipramine and Fluoxetine take 3 to 4 weeks to achieve an optimal therapeutic effect. Therefore, a three-week plan would help the therapists to accurately assess treatment progress.

Conclusion Persons with OCD experience an overwhelming compulsion to engage in specific activities. Intrusive thoughts are also common among OCD cases. The inability to control these compulsions may lead to obsession. Although OCD does not have a cure, clients can be treated with therapeutic interventions such as Exposure and Response Prevention (ERP) together with medications like Fluoxetine to reduce intrusive thoughts and other distressful symptoms. a follow-up schedule is crucial in the treatment of OCD as it helps the therapist to monitor treatment progress and initiate the necessary adjustments

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References Anxiety AND Depression Association of America (ADAA) (2020). obsessive-Compulsive Disorder. https://adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd Bream, V., Challacombe, F., Palmer, A., & Salkovskis, P. (2017). Cognitive behaviour therapy for obsessive-compulsive disorder. Oxford University Press.

David, D., Lynn, S. J., & Montgomery, G. H. (Eds.). (2018). Evidence-based psychotherapy: The state of the science and practice. John Wiley & Sons.

Del Casale, A., Sorice, S., Padovano, A., Simmaco, M., Ferracuti, S., Lamis, D. A., ... & Pompili, M. (2019). Psychopharmacological treatment of the obsessive-compulsive disorder (OCD). Current Neuropharmacology, 17(8), 710-736.

OCD-UK. (2020). What is Exposure Response Prevention (ERP)? https://www.ocduk.org/overcoming-ocd/accessing-ocd-treatment/exposure-responseprevention/ Reddihough, D. S., Marraffa, C., Mouti, A., O’Sullivan, M., Lee, K. J., Orsini, F., ... & Kohn, M. (2019). Effect of fluoxetine on obsessive-compulsive behaviors in children and adolescents with autism spectrum disorders: a randomized clinical trial. Jama, 322(16), 1561-1569. https://dx.doi.org/10.1001%2Fjama.2019.14685