Decision Tree: Obsessive-Compulsive Disorder Essay

In this case 2 Decision point one: Obsessive-Compulsive disorder Decision point two: Begin fluvoxamine immediate release 25mg orally at bedtime. Decision point three: Increase fluvoxamine to 50mg orally at bedtime The Assignment: Examine Case 2: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment. At each Decision Point, stop to complete the following: Decision #1: Differential Diagnosis Which Decision did you select? Why did you select this Decision? Support your response with evidence and references to the Learning Resources. What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different? Decision #2: Treatment Plan for Psychotherapy Why did you select this Decision? Support your response with evidence and references to the Learning Resources. Decision Tree: Obsessive-Compulsive Disorder Essay.  What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different? Decision #3: Treatment Plan for Psychopharmacology Why did you select this Decision? Support your response with evidence and references to the Learning Resources. What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different? Also include how ethical considerations might impact your treatment plan and communication with clients and their families. Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

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According to American Psychiatric Association, personality disorder is a foreign pattern of behavior and experience that deviate an individual from the expected culture (Wang & Wang, 2019). Mostly, this condition arises at onset of adolescence or early adulthood thus creating impairment or distress to an individual. Some of these disorders include addictive behaviours, depression, eating disorders personality disorder, histrionic personality disorder, borderline personality disorders, anxiety disorders, antisocial, schizophrenia and among others. Still, the illnesses may cause distress or functional issues while relating with other persons. In the recent past, mental issues have become alarming in contemporary society thus becoming a major health concern. The main purpose of this paper is to discuss a case of an eight-year-old black male presented to a psychiatric for various complaints. More so, the paper will discuss three decisions in relation to the diagnosis, psychopharmacology, and psychotherapy in regard on the presented clinical manifestation.

Decision Pont One: Obsessive-Compulsive disorder

My initial step to make decision is weighing the illness with more weight and best suit the case. For instance, in this case the decision is chosen between Obsessive Compulsive Disorder Generalized Anxiety disorder, and Pediatric Autoimmune Neuropsychiatric Disorder. In line with the patient assessment the client meets qualifications for Obsessive Compulsive Disorder (OCD) as concluded from DSM-5 diagnosis. In this case, Tyrel has obsession by having persistent thoughts, urge, unwanted disturbances, and experienced impulses. Besides, the client experience all the above symptoms. More so, the patients try to ignore such thoughts while engaging himself with other thoughts. A patient meet compulsion while they experience repetitive behaviors such as frequent washing of hands. According to the Tyrel case in context it is a clear indication that the minor is suffering from an Obsessive-Compulsive Disorder. Also, the patient has a mental act that in return he feels the urge to respond to the same obsession. Decision Tree: Obsessive-Compulsive Disorder Essay.

Decision point two: Begin fluvoxamine immediate release 25mg orally at bedtime

My second decision is to begin Fluvoxamine immediate release 25mg orally during bed time. This type of drug is most appropriate in regard to the Tyrel’s mental illness case. Fluvoxamine is categorized as an antidepressant medication that function the brain. This medicine is also known as a selective serotonin reuptake inhibitor (SSRI) antidepressant. The mode of action of this drug is affecting chemicals in the brain that might be unbalance to individuals with OCD symptoms.

In addition, Fluvoxamine is approved for its effectiveness while treating obsessive compulsive disorder in both the adults as well as children between the age of eight or older. Fluvoxamine is a tablet administered in form of tablet that will be taken during bed time by the patient. As per my decision, there are hopes that the patient might probably improve in his current behavior of hand washing (Jiujias,  Kelley & Hall, 2017). Still, it is anticipated that the patient will normalize his school attendance schedule as well as increasing his social behavior while with friends playing.

The anticipated hopes for this decision are to have positive outcome for the patient after four weeks. Still, it was expected that the patient will decrease the number of times he washes hands as well as becoming more relaxed. Still, it is expected that Tyrel will embark on normal school program and start a new social behavior such as getting back to the playing ground with his friends.

Decision point three: Increase fluvoxamine to 50mg orally at bedtime

The start of my second decision will be based on the current report from the patient outcome from the initial dosage. At this point, the patient will be requested to start taking a higher dosage level from Fluvoxamine 25mg to 50 mg. this will double the amount of medicine treating the illness since in the first phase the drug did not fully optimize the anticipated outcome.Decision Tree: Obsessive-Compulsive Disorder Essay.  The process of administration will be monitored to ensure the patient takes the medicine consistently in respect to the stipulated amount of dosage. By choosing this decision, there is the hope that Tyrel will fully have a decline with OCD symptoms.

Ethical considerations impacting treatment plan and communication

According to American Nursing Association (2014), a PMHNP is demanded by ethical consideration to maintain patient confidentiality. More so, the health sector has provided nurse with laws that govern the maintenance of health records unless the patient gives a ruling authorizing the unfolding of personal health records. In this case, family and friends are eliminated while offering support for this patient since they are not supposed to be informed about the patient’s health condition.

Informed consent is an ethical consideration in this case since the treatment process involves conducting communication with the patient’s friends and family (Lin et al., 2019). Besides, this ethical rule permits nurse to issue the patient with the correct information as per how the treatment is conducted. For instance, a PMHNP is supposed to offer Tyrel with full information as o why they decide to switch the dosage from 25 mg to 50 mg as well as an explanation about OCD. Still, this upholds patient’s autonomy which is aimed at protecting them with minimal risk. Even though this creates a dilemma in instance where the patient rejects the only treatment plan that is effective with their illness.

References

American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.

Jiujias, M., Kelley, E., & Hall, L. (2017). Restricted, repetitive behaviors in autism spectrum disorder and obsessive–compulsive disorder: a comparative review. Child Psychiatry & Human Development, 48(6), 944-959.

Lin, C. P., Evans, C. J., Koffman, J., Sheu, S. J., Hsu, S. H., & Harding, R. (2019). What influences patients’ decisions regarding palliative care in advance care planning discussions? Perspectives from a qualitative study conducted with advanced cancer patients, families and healthcare professionals. Palliative medicine, 33(10), 1299-1309. Decision Tree: Obsessive-Compulsive Disorder Essay.

Wang, J., & Wang, W. (2019). Cultural Contribution to Personality Disorders in China. In Chinese Perspectives on Cultural Psychiatry (pp. 75-91). Springer, Singapore.

Tyrel is an 8-year-old black male who is brought in by his mother for a variety of psychiatric complaints. Shaquana, Tyrel’s mother, reports that Tyrel has been exhibiting a lot of worry and “nervousness” over the past 2 months. She states that she notices that he has been quite “keyed up” and spends a great deal of time worrying about “germs.” She states that he is constantly washing his hands because he feels as though he is going to get sick like he did a few weeks ago, which kept him both out of school and off the playground. He was also not able to see his father for two weekends because of being sick. Shaquana explains that although she and her ex-husband Desmond divorced about 2 years ago, their divorce was amicable and they both endeavor to see that Tyrel is well cared for.

Shaquana reports that Tyrel is irritable at times and has also had some sleep disturbances (which she reports as “trouble staying asleep”). She reports that he has been more and more difficult to get to school as he has become nervous around his classmates. He has missed about 8 days over the course of the last 3 weeks. He has also stopped playing with his best friend from across the street.

His mother reports that she feels “responsible” for his current symptoms. She explains that after he was sick with strep throat a few weeks ago, she encouraged him to be more careful about washing his hands after playing with other children, handling things that did not belong to him, and especially before eating. She continues by saying “maybe if I didn’t make such a big deal about it, he would not be obsessed with germs.”

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Per Shaquana, her pregnancy with Tyrel was uncomplicated, and Tyrel has met all developmental milestones on time. He has had an uneventful medical history and is current on all immunizations.

OBJECTIVE

During your assessment of Tyrel, he seems cautious being around you. He warms a bit as you discuss school, his friends at school, and what he likes to do. He admits that he has been feeling “nervous” lately, but when you question him as to why, he simply shrugs his shoulders.

When you discuss his handwashing with him, he tells you that “handwashing is the best way to keep from getting sick.” When you question him how many times a day he washes his hands, he again shrugs his shoulders. Decision Tree: Obsessive-Compulsive Disorder Essay. You can see that his bilateral hands are dry. Throughout your assessment, Tyrel reveals that he has been thinking of how dirty his hands are; and no matter how hard he tries to stop thinking about his “dirty” hands, he is unable to do so. He reports that he gets “really nervous” and “scared” that he will get sick, and that the only way to make himself feel better is to wash his hands. He reports that it does work for a while and that he feels “better” after he washes his hands, but then a little while later, he will begin thinking “did I wash my hands well enough? What if I missed an area?” He reports that he can feel himself getting more and more “scared” until he washes his hands again.

MENTAL STATUS EXAM

Tyrel is alert and oriented to all spheres. Eye contact varies throughout the clinical interview. He reports his mood as “good,” admits to anxiety. Affect consistent to self-reported mood. He denies visual/auditory hallucinations. No overt delusional or paranoid thought processes were apparent. He denies suicidal ideation.

Lab studies obtained from Tyrel’s pediatric nurse practitioner were all within normal parameters. An antistreptolysin O antibody titer was obtained for reasons you are unclear of, and this titer was shown to be above normal parameters. Decision Tree: Obsessive-Compulsive Disorder Essay.