Practicum: Decision Tree Essay.

The focus of this assignment is to make three decisions regarding the diagnosis and treatment for the client in case study 2. The first decision will be to make a differential diagnosis; second decision, treatment plan for psychotherapy, while the third decision will involve treatment plan for psychopharmacology. Additionally, the co-morbid factors that may affect the diagnosis and treatment of the client will also be taken into account. Finally, ethical considerations affecting the client’s treatment plan will also be discussed Practicum: Decision Tree Essay.

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Decision #1: Differential Diagnosis

The selected decision is that the client’s diagnosis is obsessive-compulsive disorder.  According to DSM-5 diagnostic criteria, symptoms of obsessive-compulsive disorder include; obsessions/compulsions characterized by persistent thoughts and urges and repetitive behaviors; spending a lot of time on the compulsions such that it impairs functioning; and that the compulsions cannot be attributed to any other condition (American Psychiatric Association, 2013). From the case study 2, Tyrel is obsessed with hand-washing because he fears that germs might make him sick again. His obsession with hand-washing has impaired his normal functioning as evidenced by Tyrel not attending school and playground.  Tyrel is obsessed with the idea of his hands becoming contaminated and hand-washing relieves his anxiety and fear of getting sick. According toFenske et al (2015)the unrealistic mental act such as persistent hand washing for Tyrel is aimed to prevent or reduce anxiety or distress in individuals suffering from obsessive-compulsive disorder Practicum: Decision Tree Essay.

However, the client appears to be apprehensive especially socially as manifested by him avoiding school and stopping to play with his friend. This necessities further assessment.

Decision #2: Treatment Plan for Psychopharmacology

The selected decision is to start Fluvoxamine immediate release 25 mg orally at bedtime. The rationale for selecting this decision is because Fluvoxamine is an SRI that is approved by FDA for the treatment of obsessive-compulsive disorder (Stahl, 2014). Tyrel is 8 years and hence Fluvoxamine is appropriate to treat OCD. Additionally, evidence shows that Fluvoxamine is effective in the treatment of OCD and has minimal side effects (Pittenger& Bloch, 2014). Another reason for selecting this decision is because Fluvoxamine has sedation effects and hence it is best administered at bedtime rather than in the morning (Pittenger& Bloch, 2014).

With this decision, it was expected that there would be a significant reduction of the client’s symptoms of OCD. This will be manifested by a reduced obsession with hand-washing, reduced fear of becoming contaminated, as well as reduced anxiety. It is also expected that OCD symptoms will stop impairing the client’s functioning, for example,Tyrel will be able to attend school and play with his friend. This is because Fluvoxamine is expected to reduce OCD symptoms for the client (Ordacgi et al, 2016) Practicum: Decision Tree Essay.

The outcome of the selected decision is comparable to the expected outcome. This is indicated by reduced OCD symptoms for the client as manifested by reduced hand-washing and reduced anxiety. In addition, the client’s school attendance has improved and he also went to play with his friend, unlike before.

Decision #3: Treatment Plan for Psychopharmacology

The selected decision is to augment treatment with cognitive behavioral therapy (CBT). The rationale for selecting this decision is that evidence shows that CBT is an effective psychotherapy to treat for obsessive compulsive disorder (Moody et al, 2017). CBT achieves this by equipping individuals with OCD skills that alter maladaptive emotional reactions by changing their thoughts, feelings, behaviors, and actions (Kaczkurkin&Foa, 2015).

By selecting this decision, it was expected that symptoms of OCD for the client would further reduce because CBT has been shown to be effective treating OCD. Secondly, it was expected that the anxiety and nervousness present in the client would reduce and that his social life would significantly improve. This is because CBT will make Tyrel aware of his anxiety thoughts and help him to exchange these thoughts with more positive ones (Twomey et al, 2015). This will lead to a change in Tyrel’s attitude and hence influence behavior change and he will start socializing which will be manifested by improved school attendance, attending playground, and playing with his friend Practicum: Decision Tree Essay.

The actual outcome of the selected decision and the expected outcome are comparable. This is because it was expected that symptoms of OCD would reduce for Tyrel and that his social life will improve. The actual outcome was that OCD symptoms reduced and Tyrel’s school attendance improved and he also started socializing with his friend.

Ethical Considerations

The client is a minor and hence issues of autonomy, informed consent or confidentiality might impact the treatment plan (Parsapoor et al, 2014). For instance, Tyrel’s parents will have to be involved whenever making any decision concerning his treatment. However, even though Tyrel is not in a position to give informed consent, it would be necessary to for him to assent to treatment (Parsapoor et al, 2014).

Conclusion

Client’s diagnosis is obsessive-compulsive disorder because Tyrel manifests most of symptoms in OCD. The second decision is to start Fluvoxamine at bedtime because Fluvoxamine has been shown to be effective in treatment of OCD and since the medication has sedation effects, it should be administered at bedtime. The third decision would be to augment medication treatment with CBT because CBT has been shown to be effective in improving OCD symptoms.

Assignment 1: Practicum: Decision Tree

Introduction

The focus of this assignment is to make three decisions regarding the diagnosis and treatment for the client in case study 2. The first decision will be to make a differential diagnosis; second decision, treatment plan for psychotherapy, while the third decision will involve treatment plan for psychopharmacology. Additionally, the co-morbid factors that may affect the diagnosis and treatment of the client will also be taken into account. Finally, ethical considerations affecting the client’s treatment plan will also be discussed Practicum: Decision Tree Essay.

Decision #1: Differential Diagnosis

The selected decision is that the client’s diagnosis is obsessive-compulsive disorder.  According to DSM-5 diagnostic criteria, symptoms of obsessive-compulsive disorder include; obsessions/compulsions characterized by persistent thoughts and urges and repetitive behaviors; spending a lot of time on the compulsions such that it impairs functioning; and that the compulsions cannot be attributed to any other condition (American Psychiatric Association, 2013). From the case study 2, Tyrel is obsessed with hand-washing because he fears that germs might make him sick again. His obsession with hand-washing has impaired his normal functioning as evidenced by Tyrel not attending school and playground.  Tyrel is obsessed with the idea of his hands becoming contaminated and hand-washing relieves his anxiety and fear of getting sick. According toFenske et al (2015)the unrealistic mental act such as persistent hand washing for Tyrel is aimed to prevent or reduce anxiety or distress in individuals suffering from obsessive-compulsive disorder.

However, the client appears to be apprehensive especially socially as manifested by him avoiding school and stopping to play with his friend. This necessities further assessment.

Decision #2: Treatment Plan for Psychopharmacology

The selected decision is to start Fluvoxamine immediate release 25 mg orally at bedtime. The rationale for selecting this decision is because Fluvoxamine is an SRI that is approved by FDA for the treatment of obsessive-compulsive disorder (Stahl, 2014). Tyrel is 8 years and hence Fluvoxamine is appropriate to treat OCD. Additionally, evidence shows that Fluvoxamine is effective in the treatment of OCD and has minimal side effects (Pittenger& Bloch, 2014). Another reason for selecting this decision is because Fluvoxamine has sedation effects and hence it is best administered at bedtime rather than in the morning (Pittenger& Bloch, 2014).

With this decision, it was expected that there would be a significant reduction of the client’s symptoms of OCD. This will be manifested by a reduced obsession with hand-washing, reduced fear of becoming contaminated, as well as reduced anxiety. It is also expected that OCD symptoms will stop impairing the client’s functioning, for example,Tyrel will be able to attend school and play with his friend. This is because Fluvoxamine is expected to reduce OCD symptoms for the client (Ordacgi et al, 2016).

The outcome of the selected decision is comparable to the expected outcome. This is indicated by reduced OCD symptoms for the client as manifested by reduced hand-washing and reduced anxiety. In addition, the client’s school attendance has improved and he also went to play with his friend, unlike before.

Decision #3: Treatment Plan for Psychopharmacology

The selected decision is to augment treatment with cognitive behavioral therapy (CBT). The rationale for selecting this decision is that evidence shows that CBT is an effective psychotherapy to treat for obsessive compulsive disorder (Moody et al, 2017). CBT achieves this by equipping individuals with OCD skills that alter maladaptive emotional reactions by changing their thoughts, feelings, behaviors, and actions (Kaczkurkin&Foa, 2015).

By selecting this decision, it was expected that symptoms of OCD for the client would further reduce because CBT has been shown to be effective treating OCD. Secondly, it was expected that the anxiety and nervousness present in the client would reduce and that his social life would significantly improve. This is because CBT will make Tyrel aware of his anxiety thoughts and help him to exchange these thoughts with more positive ones (Twomey et al, 2015). This will lead to a change in Tyrel’s attitude and hence influence behavior change and he will start socializing which will be manifested by improved school attendance, attending playground, and playing with his friend Practicum: Decision Tree Essay.

The actual outcome of the selected decision and the expected outcome are comparable. This is because it was expected that symptoms of OCD would reduce for Tyrel and that his social life will improve. The actual outcome was that OCD symptoms reduced and Tyrel’s school attendance improved and he also started socializing with his friend.

Ethical Considerations

The client is a minor and hence issues of autonomy, informed consent or confidentiality might impact the treatment plan (Parsapoor et al, 2014). For instance, Tyrel’s parents will have to be involved whenever making any decision concerning his treatment. However, even though Tyrel is not in a position to give informed consent, it would be necessary to for him to assent to treatment (Parsapoor et al, 2014).

Conclusion

Client’s diagnosis is obsessive-compulsive disorder because Tyrel manifests most of symptoms in OCD. The second decision is to start Fluvoxamine at bedtime because Fluvoxamine has been shown to be effective in treatment of OCD and since the medication has sedation effects, it should be administered at bedtime. The third decision would be to augment medication treatment with CBT because CBT has been shown to be effective in improving OCD symptoms Practicum: Decision Tree Essay.