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LEARNING OBJECTIVES

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

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

  • Determine goals of pharmacotherapy for OCD.

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

  • Educate 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.

PATIENT PRESENTATION

Chief Complaint

“I am going to lose my job—if I don’t stop!”

HPI

Makela Jones is a 34-year-old woman presenting to her primary care provider along with her husband. Her husband has become increasingly concerned about Makela’s behaviors at home, prompting the visit to her provider. Makela will not walk through any doorways before counting to ten, turning in a complete circle, then stepping three steps to the left and two to the right for fear that someone will be hurt if she fails in performing this ritual. Makela has stated, “No matter how much I try to ignore these compulsions, I must complete them! My coworkers are starting to talk about me.” The patient has been experiencing a great deal of anxiety over the past several months, but it has become progressively worse since she was given a promotion at work approximately one month ago. At home, Makela will not allow her husband and daughter to eat until she has checked their food multiple times for signs of poisoning, yet this never seems to be enough. The patient states that her anxiety has risen to a level that she has never experienced before, and she no longer knows what to do. When asked about suicidal ideation, Makela says she has had fleeting thoughts of suicide but does not have a plan. She reports intrusive thoughts of running to the doorway during work meetings just to make sure she has performed her ritual and everyone is safe. She understands that these thoughts are irrational and wants them to go away. She is concerned because her thoughts and rituals consume 4–5 hours each day and have impeded her ability to complete her work and be “present” at home. She stopped preparing meals for her family because she has to check the ingredients so many times that dinner is never complete. She also reports checking the stove in multiples of three to feel some relief from the overwhelming anxiety that develops throughout the day from the intrusive thoughts and behavior. She states that she has tried to hide her ritual from her husband, but it has become so time-consuming and distressful that he has brought it to her attention. Her husband’s concern has only added to her anxiety.

PMH

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