DSM-5 Diagnosis Case Study of a 26-yr-old with Obsessive-Compulsive Disorder

Chapter 6, Case 1: Case Summary

The presented case deals with a 26-year-old woman presenting to the clinic with psychological issues. The woman reports that she is exhausted from her cleaning rituals and could only enter two of her five rooms. Her worries revolve around the cleanliness of the house and the health of her 3-year-old son. Other symptoms associated with these worries include repeated disinfection of the surface she touches for several hours, repeatedly washing her hands, and sterilization of equipment before eating. The patient explains that she cannot stop thinking items may have germs and she fears her son may get sick which leads to frequent cleaning of surfaces and hands.

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DSM-5 Diagnosis

The primary diagnosis of this patient is obsessive-compulsive disorder (OCD). This condition is characterized by recurrent and persistent thoughts accompanied by repetitive and ritualistic behaviors (American Psychiatric Association, 2013). The DSM-5 diagnostic criteria outline several features that must be present to warrant the diagnosis of OCD. The first characteristic involves the existence of obsessions and compulsions (American Psychiatric Association, 2013). Obsessions include recurrent and persistent thoughts about a phenomenon that is intrusive and distressful. Compulsions may include things like repetitive hand washing, ordering, or counting. Secondly, obsessions and compulsions consume most of the patient’s time or can be observed to cause significant impairment in performing roles (American Psychiatric Association, 2013). Apart from these key features, it is important to rule out the psychological effects of substance abuse or other mental health disorders that may mimic symptoms of OCD.

Theoretical and Scientific Foundations of Nursing Research

The diagnosis of OCD is based on the patient’s fear of contamination and the effects of germs. The patient understands that she is cleaning a lot but she cannot get the thoughts out of her mind. Temporary solutions to these problems include repeatedly disinfecting surfaces, washing hands, and sterilizing cutlery before eating. The patient has constant worries that her 3-year-old son will get sick because she believes items have germs on them. These features are consistent with washers who are afraid of contamination and have a cleaning or hand-washing compulsions.

Pharmacological Treatment

Antidepressants are the first-line treatment options for patients with OCD (Del Casale et al., 2019). Selective serotonin-reuptake inhibitors (SSRIs) are thought to be effective in managing this condition because they improve serotonin levels in the brain. The medication of choice for this patient is Zoloft (Sertraline) 25 mg PO once daily. This drug is effective in managing OCD by decreasing the number of intrusive thoughts and making it easier for patients to manage their symptoms. Research establishes that slightly higher doses of sertraline are required to achieve desired effects for people with OCD (Del Casale et al., 2019). Increasing the dosage to 50 mg within two weeks and even further up to a maximum of 200 mg PO once daily can result in improvement of functioning and social skills. Common side effects that patients may experience upon taking Zoloft include nausea, headaches, lack of sleep, dizziness, and diarrhea (Del Casale et al., 2019). The cost of sertraline 25 mg (30 tablets) in GoodRx pharmacy, Pensacola is $12.73.

Non-Pharmacological Treatment

Deep brain stimulation (DBS) is a non-pharmacological treatment approach that has shown significant results in managing OCD (Borders et al., 2018). This approach involves the use of electrical signals to stimulate brain parts observed to cause symptoms of OCD. DBS is FDA-approved for the management of OCD in patients that have failed to respond to pharmacological and psychotherapy approaches under a humanitarian device. (Borders et al., 2018) The importance of DBS is that individuals feel the relief of symptoms soon after the procedure and it decreases the dosage of medication required during subsequent treatments. Side effects following DBS surgery are rare but may include headaches, seizures, and confusion.

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Author.

Borders, C., Hsu, F., Sweidan, A. J., Matei, E. S., & Bota, R. G. (2018). Deep brain stimulation for obsessive compulsive disorder: A review of results by anatomical target. Mental Illness, 10(2), 7900. https://doi.org/10.4081/mi.2018.7900

Del Casale, A., Sorice, S., Padovano, A., Simmaco, M., Ferracuti, S., Lamis, D. A., Rapinesi, C., Sani, G., Girardi, P., Kotzalidis, G. D., & Pompili, M. (2019). Psychopharmacological treatment of obsessive-compulsive disorder (OCD). Current Neuropharmacology, 17(8), 710–736.

https://doi.org/10.2174/1570159X16666180813155017