Running head: ANXIETY DISORDER, OCD, OR SOMETHING ELSE? 1
Anxiety disorder, OCD, or something else?
Walden University
Psychiatric Mental Health Nurse Practitioner Role 1: Child and Adolescent
NURS 6660
ANXIETY DISORDER, OCD, OR SOMETHING ELSE? 6
ANXIETY DISORDER, OCD, OR SOMETHING ELSE? 2
Anxiety disorder, OCD, or something else?
Case # 2
Decision # 1 Differential Diagnosis
Obsessive–compulsive disorder (OCD)
Reason for the Selection
Obsessive-compulsive disorder is a prototypical impulsive, compulsive disorder. The patient experiences an unusual urge to do stereotypic, formal acts despite having full knowledge of how silly and unnecessary these behaviors are and having no genuine desire for the result of these activities. The most widely recognized kinds of compulsions are cleaning and checking (Stahl, 2014). Stress and anxiety may increase the formation of habits, regardless of whether decidedly or contrarily persuaded. In any case, as the patterns turn out to be dynamically impulsive, the experience of alleviation may never again be the driving force, and somewhat the conduct goes under external control as a conditioned reaction.
Obsessive thoughts may incorporate constant feelings of fears of damage beginning to act normally again or a friend or family member, an irrational worry with being contaminated, intrusive and unsatisfactory religious, savage, or sexual considerations, and ridiculously need to do things accurately or correctly. Tyrel case above gave the indications of the Obsessive-impulsive confusion (OCD).
Expected Result with this Decision
The predicted result indicated that he has OCD. Tyrel is alert and oriented, nervous, irritable at times, trouble staying asleep, obsess with continuous handwashing. He denies suicidal ideation. He denies visual or auditory hallucinations. There are no clear overt delusional or paranoid thought processes. Mother reported that Tyrel has been anxious, nervous, irritable at times, trouble staying asleep, obsess with continuous handwashing for about two months. He has difficulty getting to school and nervous around his classmates. Tyler missed school for eight days over the last three weeks. He was no longer playing with his best friend living across the street. He was impulsive with the monotonous behavior of cleaning and washing (Laureate Education, 2017c).
Difference between Expected Result and the Achieved Result with Decision #1
There was not a contrast between the expected outcome and the achieved outcome as Tyrel has symptoms which indicative of OCD.
Decision #2:
Treatment Plan for Psychotherapy
Fluvoxamine immediate release 25mg orally daily
Reason for the Selection
Food and Drug Administration authorize fluvoxamine for the treatment of OCD in children eight years and older (Stahl 2014). Fluvoxamine immediate release 25mg orally daily is the medication of choice. Fluvoxamine influences synthetic compounds in the brain that might be uneven in individuals with obsessive-compulsive symptoms. Selective serotonin reuptake inhibitors affect neurotransmitters, chemicals that nerves in the brain use to communicate with each other. Neurotransmitters are released by nerves which travel across the spaces between nerves and then attach to receptors on other nerves.
Patient and family will be educated about the side effects of fluvoxamine which are drowsiness and fatigue, headache, sleeping problems, decreased libido, decreased sexual functioning, gastrointestinal problems, dizziness, nervousness, sweating and tremors. These side effects typically get better after taking the medication for a while (Ordacgi, Mendlowicz, & Fontenelle, 2017).
Cognitive Behavior Therapy (CBT) has proven to be useful in the treatment of OCD. CBT is created on the impression that distorted thoughts or cognitions cause and preserves harmful compulsions and obsessions (Foa, 2017). Exposure and response prevention (ERP) is an active form of behavioral therapy. ERP expose the patient to anxiety that is activated by the obsessions and after that preventing the utilization of rituals to lessen the uneasiness. This cycle of exposure and reaction prevention action is repeated to the point that the patient never again troubled by the fixations as well as impulses (Foa, 2017).
The objective of treatment is complete remission of current indications and additionally aversion of future backslides. Treatment regularly decreases or even eliminates manifestations, however not a fix since signs can repeat after the medication is stopped or therapy not completed.
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