The weird behavior in mental disorders - Case Study Example

The weird behavior in mental disorders Presenting Complaint A26-year-old Hispanic female visits the therapist with the complaint of some weird behavior that she is in the know that her behavior is not normal. Personal History Fannie is a 26-year-old Hispanic female living in the US since her birth. She is 5’ 8’’ tall and over-weight by 30 pounds. Fannie is employed and working as an administrative assistant in a consulting firm. As such, she is a little bit obese but otherwise healthy. Currently, she gets frequent thoughts that she might get infected with some disease such as AIDS or some other infection. Of late, the frequency of such behavior has increased affecting her work in the office. Neither she nor anybody else in her family ever had any mental illness of any kind in the past. Since her childhood, Fannie had a habit of lining up her toys and clothes in a particular way and was always conscious about dirt and dust in her room and around. With the passage of time, the frequency of cleaning hands and checking house-locks while going out has increased manifold. Diagnosis The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) provides a detailed classification system for the diagnosis of mental health disorders. DSM-IV uses a five-axis model for the diagnosis and treatment options. DSM applies several criteria while defining obsessions and compulsions as per the following. A. As per DSM obsession is defined as: recurrent and persistent thoughts or impulses experienced by the person causing anxiety or distress; the thoughts do not represent to any real-life issues; the person tries to ignore such thoughts with some other thought or action; the person clearly recognizes that the thoughts are from their own mind and not an insertion from outside. DSM defines compulsion as repetitive behaviors such as hand washing, checking or ordering by the person that he or she is driven to perform, and the behaviors that are aimed at preventing some dreaded situation or event even though they are not associated to any real-life situation. When the above criteria of obsession and compulsion are applied to Fannie, it is noticed that Fannie spends over one hour daily in hand washing activities. Sometimes, she spends more time and gets exhausted in the process. This is going on since her childhood and she is unable to control it. As she states "I spend about 2 hours every day at least washing up and if my hands need more, I will be there longer. It is exhausting, so I’m tired a lot” (From Fennie’s Case). It is clear from her talk that she feels compulsion of cleaning her hands quite often whenever she handshakes or touches someone. B. At some point, the patient realizes that the obsessions or compulsions are unreasonable and excessive. The impulses that Fannie receives do not belong to any real-life issues. She also recognizes that such obsessive thoughts are coming from within as she states "My mom and friends tell me I do it to excess. The thing is I cannot help myself. It’s like an itch you know you shouldn’t scratch, but you have to, no matter what” (From Fennie’s Case). She is obsessed with the idea of cleaning her hands because she is getting recurrent and persistent thoughts about it. C. The obsessions or compulsions develop distress and take substantial time daily and interfere with the normal routine. Above criterion also gets fulfilled in case of Fannie as she not only spends more than 2 hours daily in washing hands but also she mostly reaches late in the office and in spite of her boss repeatedly drawing her attention to this irregularity, she is unable to mend her ways. While applying various DMS criteria on Axis I, Fannie is clearly diagnosed as suffering from obsessive-compulsive disorder (OCD). She is not found to have been impacted by any Axis II or Axis III disorders. The clinical syndromes in case of Fannie have long-lasting symptoms since her childhood. Fennie – DSM-IV-TR MULTIAXIAL ASSESSMENT Axis I 300.3 Obsessive- Compulsive Disorder 300.3 Excessiveness of Obsession and Compulsion Realized by the Patient Substantial Time Consumed Daily, Normal Routine Interfered Axis II Disorder Observed Since Childhood Axis III None Axis IV None Axis V Functionality Severely Impacted Treatment Looking at the severity of the case, it is recommended that Fannie is treated with drugs combined with cognitive behavioral therapy. When the patient's symptoms are severe, the drug therapy remains an only alternative. The drugs used are known as selective serotonin reuptake inhibitors (SSRIs). They are effective and it requires some trial and error before establishing which one works best. Usually, it takes longer – more than 10-12 weeks for these drugs to eradicate symptoms of OCD. If Fannie gets benefitted from the drug treatment; she may have to continue with the treatment indefinitely because relapse rates are high once drugs are discontinued. It is also found that when a major tranquilizer is added along with a SSRI, at least 40%-55% of the patients get improvement after failing with only SSRI medications and that can be kept in sight while providing treatment to Fannie. Drug therapy can be combined with the Cognitive Behavioral Therapy that aims at learning ways to stop performing rituals while the patient is exposed with their obsessions. The Cognitive Behavioral Therapy may last for several months with several sessions in a week. If the Fannie does not get any benefit from medications and behavioral therapy; she may be given brain stimulation or recommended for brain surgery (Harvard Health Publications, 2006). Prognosis Between 40% and 60 % of the patients, who are treated with medications, feel better. Though only 10 percent of the patients recover completely through medication therapy, it does improve their condition. Fennie’s prognosis should be assumed in this line (Swinson, 1998). Discussion Stein (2002) argues that obsessive-compulsive personality traits such as over-conscientiousness and perfectionism differ from obsessive-compulsive disorder. It is important to note here that brain imaging does indicate that certain regions such as temporal dysfunction of the brain to play a part in obsessive-compulsive disorder (Stein, 2002). Swinson et al. (1998) argue that OCD leads to high health care costs with several direct and indirect costs involved with this disorder. Furthermore, OCD causes considerable deterioration in the quality of life. In fact, quality of life gets impaired to the same degree as found in the patients affected by depression. From Fannie's case history, it is quite apparent that her life has been significantly impacted from OCD. As such, across the world, OCD affects 2% to 3% of people causing great suffering to them for years. OCD usually begins in childhood or early adulthood and is found to be a chronic illness and at times, it combines with other mental disorders such as phobia or depression so that must be kept in mind while providing treatment to Fannie. References DSM (2012). American Psychiatric Association. Retrieved March 27, 2013, from http://www.psychiatry.org/practice/dsm Harvard Health Publications (2006). Treating obsessive-compulsive disorder. Retrieved March 27, 2013 from http://www.health.harvard.edu/fhg/updates/treating-obsessive-compulsive- disorder.shtml Stein, D.J. (2002). Obsessive-Compulsive Disorder. The Lancet. 360. 397-405. Retrieved March 27, 2013 from http://psych.wright.edu/~ccl/TDW/ReadingsTDW/Stein.pdf Swinson, R. P.; Antony, M. M.; Rachman, S.; Richter, M.A. (1998). Obsessive-compulsive Disorder - Theory, Research, and Treatment. The Guilford Press. New York. Read More