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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Identify target symptoms associated with obsessive–compulsive disorder (OCD).

  • Construct goals of pharmacotherapy for OCD.

  • Develop an appropriate plan and duration of therapy for the management of OCD.

  • Counsel patients and consult with providers about the pharmacotherapy used for OCD.

  • Develop a monitoring plan for a patient treated for OCD based on the treatment regimen.

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PATIENT PRESENTATION

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Chief Complaint

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“I am so afraid that I’m going to hurt my child.”

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HPI

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Sonya Reed is a 30-year-old woman presenting to her family physician accompanied by her mother after threatening to overdose on Benadryl. The patient has complaints of anxiety and feelings of unease that were increasing in severity over the past 2 weeks to the point that she had thoughts of killing herself. She reports having intrusive thoughts of throwing her 2-year-old child down the stairs. Because these thoughts are becoming more frequent, she feels she is a bad mother and may actually harm her child. She recently started checking all appliances in the house multiple times during the day to make sure they are turned off because she fears starting a fire that will injure the child. At first, she incessantly checked on the toddler but now is beginning to avoid the child because of her fears. She states that she knows that these thoughts are irrational. She is concerned because the checking behavior consumes 2–3 hours each day. She stopped going out with the child last week because she has to check and recheck the car seat safety belts so often that she usually does not make it to her destination. She also reports rubbing her arm in multiples of five to feel some relief from the overwhelming anxiety that develops throughout the day from the intrusive thoughts. She states that she has tried to hide this behavior from her parents, but it has become so time-consuming and distressful that she felt the only way out was to overdose. She now regrets ever thinking about killing herself.

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PMH

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  • G2P1A1—normal spontaneous vaginal delivery

  • Obesity

  • Kidney stone at age 25 years

  • Dental surgery 2 months ago

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PPH

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No hospitalizations or outpatient psychiatric treatment, but she recalls from childhood doing strange counting rituals while lying in bed or watching TV. She has always felt a need to “control things.”

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FH

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Father, 68 years old, with history of major depression. Mother, 65 years old, with multiple sclerosis. Older brother is a “perfectionist” and has to have everything “just right.”

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SH

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Divorced for 7 years and recently broke up with boyfriend of 2 years about a month ago; degree in hotel restaurant ...

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