Assignment: “Captain of the Ship” Project – Obsessive-Compulsive Disorders
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Week 7 Assignment
Obsessive Compulsive Disorder
Jessica Kelly
NRNP 6670
Psychiatric Mental Health Nurse Practitioner Role II: Adults and Older Adults
January 17, 2021
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Osessive Compulsive Disorder
Obsessive Compulsive Disorder (OCD) is a disorder in which the individual has
recurring thoughts, ideas or sensations that drive them to do a certain behavior repetitively
(Carey, P. 2020). Examples of these repetivie behaviors include hand washing or hanging
clothes hangers in the closet based on color to name a few. These repetive behaviors can cause
severe distress on an individual and disruption in their lives. The purpose of this paper is to
create a treatment plan for a patient in my care during my practicum experience with a diagnosis
of OCD. The patient I will be discussing is a 47-year-old Caucasian male diagnosed with OCD.
HPI and Clinical Impression for the Client
T.M is a 47-year-old Caucasian male who presents to the clinic with the chief complaint
“My job is in jeopardy due to my hand washing rituals.” He is a firefighter/ paramedic at an area
local fire station. He denies any current suicidal or homicidal ideations, as well as any previous
past suicide attempts. He denies any depression. He does report alcohol use. He reports that he
drinks a 12 pack within a 7-day period. He denies any other substance use. He is alert & oriented
x 4. He is well-groomed, dressed appropriately for the climate and is presenting with a mood-
congruent affect. He denies any previous inpatient psychiatric admissions. He reports that he
lives with his wife and three grown children. He reports that he has a strong support system. He
reports that he has never been a victim of sexual, physical, mental, or emotional abuse. He
reports that he grew up in a two-parent home and would describe his childhood as being
“normal”. He reports that he enjoys spending time with his family and doing renovations on his
home. He denies any family history of mental abuse. He reports that he receives yearly physicals.
He denies any chronic medical issues and is not on any medications. He reports that he is fearful
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that his handwashing rituals are going to cost him his job. He reports that he struggles with the
reoccurring thoughts in his head that he must wash his hands. He states” I must be ready to leave
for an emergency at the drop of a hat and I cannot leave without the station without washing my
hands. My co-workers are starting to notice. It will only be a matter of time before the chief finds
out.” TM makes good eye contact during the interview, but his thoughts are preoccupied with
his obsessions and compulsions. His insight and judgment are fair.
Risk Assessment
Every patient that presents to the clinic is given a PHQ-9 & GAD7. The PHQ-9 & GAD7
were preformed with this patient and he scored a 0 on the PHQ-9, which poses him at no risk for
self-harm/suicide risk (American Psychiatric Association, 2013). According to the Florida
stature, the patient does not meet criteria for an involuntary inpatient psychiatric admission.
Psychopharmacologic Treatment and Plan
The current treatment plan for this patient is to start on Luvox 100mg PO QD. This
medication can be increased by 50mg/day each week until your reach the desired therapeutic
outcome or you reach the maximum dose of 300mg/day (Stahl, 2017). Luvox is classified as an
SSRI and helps decrease the persistent thoughts and urges to preform the repetitive behaviors,
such as hand washing (Stahl, 2017). As per Stahl (2017), the efficacy of Luvox in stabilizing the
symptoms associated with OCD may take as long as 2-4 weeks if the patient is seeing no results
after 6-8 weeks an increase in the dosage may be warranted. The timeframe for efficacy was
discussed with TM, as well as potential adverse side effects, such as sexual dysfunction. TM
verbalized understanding and provided expressed, informed consent to start on Luvox.
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Psychotherapy and Community Resources
TM was also referred to cognitive behavioral therapy (CBT), specifically exposure and
response prevention (ERP). The basic principle of ERP is for the patient to expose themselves to
the anxiety, obsessions, and distress while preventing the repetitive behaviors from being
performed. Overtime the patient adapts to the sensations or thoughts, which prevents the patient
from performing the compulsions (Carey, P., 2020). The patient was encouraged to attend ERP
therapy and verbalized his understanding. The patient was also instructed to call 911 for any
emergencies. This patient does not qualify, currently, for the FACT team due to his fulltime
employment. He was provided a GOOD RX card to reduce the cost of his medication.
. Medical Management
TM currently does not report any chronic health conditions. The importance of him
continuing to see his PCP for annual physicals, as well as the dermatologist annually was
discussed. TM verbalized understanding. TM was instructed to return to the clinic in four weeks,
or sooner if need be. His first therapy session was scheduled for the following week. The need to
use sun screen was discussed, due to increased risk of photosensitivity (Stahl, 2017). TM was
encouraged that he should not abruptly stop this medication due to the potential withdrawl
effects, such as dizziness, nausea, and sweating (Stahl, 2017). A lab order was sent to LabCorp
to draw baseline labs ( CBC, CMP, TSH, hepatic panel). The order to obatin a baseline EKG
prior to staring the medication, as SSRIs can lengthen the OT interval in otherwise healthy
indivduals (Sadock, Sadock, & Ruiz, 2014).
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Conclusion
In closing, TM played an active role in the creation of his treatment plan. It is important
for patients to serve an active role in the creation of their treatment plans, as this will increase the
probabilty of medication compliance and increase their ownership in their treatment goals. With
this patient being a first responder, he knows first hand how imporatnt it is his mental and
physical health to be complaint with his treatment plan.
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References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer
Stahl, S.M. (2017). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed). New
York, NY: Cambridge University Press.
Carey, P. (2020). How is OCD treated? Retrieved from
https://www.treatmyocd.com/education/treatment-of-ocd
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