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A Case Study of Obsessive-Compulsive Disorder: Some Analysis Considerations INTRODUCTION Prior to 1984, obsessive-compulsive disorder (OCD)wasconsideredarare disorder andone difficultto treat (I) In 1984 theEpidemiologic CatchmentArea (ECA) initial survey resultsbecame available for the 1st time, andOCDprevalence figuresshowed that2. 5%ofthepopulation metdiagnosticcriteriafor OBSESSIVE COMPULSIVE DISORDER (2, 3)

Finalsurvey effects publishedin 1988(4) confirmed theseearlier reports. Inaddition, a 6-monthpoint prevalence of1. 6%was noticed, andalifetimeprevalenceof 3. 0% wasfound.

OCD isan illness of secrecy, andfrequently thepatientspresentto physicians inspecialties aside from psychiatry. Another factor contributing to under prognosis ofthis disorderis thatpsychiatrists ma y are not able to ask verification questionsthat will identifyOCD. Thefollowing case study isan exampleofa patientwith moderately severe OCDwhopresentedtoaresidentpsychiatryclinicten years prior to being diagnosedwith OCD. The patientwascompliant without affected person treatment pertaining to theentire timeperiodand was treatedformajordepressivedisorderand border line personality disorder with medicine s andsupportivepsychotherapy.

The patient never discussedher OBSESSIVE-COMPULSIVE DISORDER symptomswith her doctorsbut in retrospect acquired offered many cluesthat may have allowedaswifterdiagnosis and treatment. CASEHISTORY Simran Ahuja was a 29 yearold, divorced, indian woman who workedas a file clerk. Shewas implemented as anout patientat thesameresidentclinic since1971. Ifirst saw her 2012. EARLIER PSYCHIATRIC BACKGROUND Simran got beenseen in theresidentout patientclinic since Come july 1st of 1984. Priortothis shehad not beenin psychiatric treatment. Shehad under no circumstances been hospitalized

Her initialcomplaints were major depression and anxietyand she had been placed onan phenelzineand responded well. Herdepressionwasinitially thoughtto besecondary to benzedrine withdrawal, since shehad recently been usingdietpillsfor 10years. She statedthat at firstshetook them to shed pounds, butcontinued forsolong because people at work had noted that sheconcentratedbetterand that her job efficiency had better. In addition , her past doctors hadallcommented onto her limitedibility tochangeand her neediness, insecurity, lowself-esteem, and poor boundaries. Additionally , her previous doctors got notedher promiscuity.

All notedher poor focus span and limited capacityfor insight. Neurologicaltesting during her initialevaluation experienced shown thepossibility of non-dominant parietallobedeficits. Testingwas repeatedin 1989 andshowed “problems in attention, recent visible and spoken memory(witha better deficitin visual memory), abstract thought intellectual flexibility, useof mathematical businesses, and visible analysis. A possibility of correct temporal dysfunction issuggested. “IQ testing demonstrated acom bine d credit score of seventy seven on the Mature WeschlerIQ check, whichindicated borderlinementalretardation

Over the yearsthe patient had been maintainedon variousantidepressantsand antianxiety real estate agents. Theseincludedphenelzine, trazadone, desipramine, alprazolam, clonazapam, and hydroxyzine. Currentlyshewas on fluoxetine20mgdaily and clonazaparn 0. 5 mgtwicea working day and 1 . 0 mg at going to bed. The antidepressantshad been powerful over the years in treating her despression symptoms. Shehasnever usedmore clonazapam than prescribed and there was zero history ofabuseof alcohol or perhaps street medicines. Also, there was clearly no historyof discreetmanic symptoms andshewasnever cured with neurolepics.

PAST MEDI CAL HISTORY She experienced fromgastroesophageal reflux andwas maintainedsymptom free on a combinationofranitidineandomeprazole. PSYCHOSOCIALHISTORY Simran wasbornandraise d inalarge city. She had a brother who was3 years youthful. Shedescribedher fatheras morose, taken, and recalledthat he has said, “I don’tlikemychildren. Herfather wasphysically andverbally abusive throughout herchildhood. Shehadalways longedfor a good relationshipwith him Shedescribedher mother asthefamily martyr and theglue thatheldthefamily together.

She stated thatshewasverycloseto hermother, her mother constantly listenedto her and wasalwaysavailable to talk with her. Shewas a poor pupil, had difficulty all through school, and referred to herselfas “always disruptingtheclass to go to or runningaround. “Shehadabest friend through quality school whomshestated “deserted” herin highschool. Shehad maintainedfew closefriends sincethen. Your woman graduated senior high school with much difficulty andeffort. Shedated ongroup datesbut under no circumstances alone. Her husbandleft herwhileshe waspregnant with herson.

The husbandwas abus driverand had not hadarole in theirlivessince thedivorce. Afte ur thedivorce, she movedbackto her parents’homewith her sonandremained presently there until having herown apartment3 years ago. FAMILY HISTORY Simran’smotherhad twoserioussuicide attempts atage 72 and wasdiagnosed with majordepressivedisorder with psychotic featuresand OCD. In addition, she had non-insulin dependentdiabetesmellitus and irritablebowelsyndrome. Herbrother was treatedfor OCDas an outpatientfor thepast20 years and in addition has Hodgkin’s Disease, at present in remission.

The brother’s diagnosis ofOCD was stored secret fromherand did not becomeavailableto her right up until her mom died. Her fatherisalive and well. MENTAL STATUS EXAM Shewas athin bleachedblond womanwho appeared herstatedage. Shewas outfitted inskintight provocativeclothing, costume jewelry earringsthat eclipsed her earsand hung to hershoulders, heavymake-up andelaboratelystyled frizzy hair. Shehad difficultysittingstilland fidgetedconstantlyinherchair. Her body language through outthe interviewwassexually provocative. Her speech wasrapid, mildly forced, andsherarely finisheda sentence.

Shedescribedhermoodas “anxious.  Her influence appeared troubled. Herthoughtprocesses revealed mildcircumstantiality and tangentiality. Even more significantwas her inability to end athoughtas showed by her incompletesentences. COURSEOF TREATMENT Initialsessions with thepatient werespentgathering historyand forming a workingalliance. Althoughsheshowed agoodresponsebyslowingdown enough to finishsentences and emphasis onconversations shecould not toleratethe sideeffects andrefusedtocontinue taking the medication Thewinterof1993-94wasparticularlyharsh.

Thepatientmissedmany sessions because ofbad weather condition. A patternbegantoemergeofaconsistentincreasein the numberof phonecalls thatshemadeto the office voicemail tocancela session. Whenshe was questioned regarding her phonemessages she stated, “I always repeatcalls to be sure mymessageis received. ” Sincethemost recent cancellation generatedno lower than six telephone calls, shewas asked why asecond call wouldn’tbeenough “to besure. ” Shelaughednervously andsaid, “Ialways repeatthings. inch With mindful questioningthe followingbehaviorswere uncovered.

The patient checkedall locksand windows repeatedlybeforeretiring. Shechecked theiron a dozen timesbefore leaving the house. Shecheckedher doorlock”ahundredtimes” beforeshewas capable toget in hercar. The patientwashed her hands frequently. She transported disposablewashcloths inher purse “so Ican clean asoftenas We would like too “Shesaid peopleat job laughat herfor washingsomuch. Nevertheless shestated “Ican’ t help it to. I’ve been this waysinceI wasalittle girl. ” Whenquestionedabout telling formerdoctorsabout this kind of, thepatientstated that shehad nevertalkedabout it with her doctors.

Shestatedthateveryone that knewhersimply knewthatthiswasthewayshewas: “It’sjustme. “Infact, shestated, “I didn’tthink my personal doctorswouldcare,. I’ve alwaysbeen thiswaysoit, snot somethingyou canchange. ” Over the nextfew sessions, it becameclearthat her argumentswith her boyfriend centeredonhis annoyance with her needtoconstantly repeatthings. This kind of waswhat shealways referred toas “talking too much “Insessions itwasobserved thatheranxiety, neediness and poor boundariesarose over problems of misplacing things in her purse and insurance forms that were incorrectlyfilledout.

Infact, when Iattempted to correct theinsurance forms on her behalf, I had difficulty because of her need to replicate theinstructions to meover and also. The Advantages Obsessive compulsive disorder (OCD) is an anxiety disorder characterized by continual obsessional thoughts and/or obsessive acts. Obsessions are recurrent ideas, images or impulses, which enter the individual’s mind in a o manner and against his will. Generally such thoughts are silly, obscene or violent in nature, or maybe senseless. Though the patient acknowledges them as his own, he feels powerless over them.

Likewise, compulsive serves or traditions are stereotyped behaviours, performed repetitively with no completion of any kind of inherently beneficial task. The commonest obsession engaged is anxiety about contamination simply by dirt, germs or grease, leading to obsessive cleaning traditions. Other themes of obsessions include out and out aggression, orderliness, disease, sex, symmetry and faith. Other compulsive behaviors include checking and counting, often in a ritualistic manner, and also a “magical” number of instances. About 70% of OBSESSIVE-COMPULSIVE DISORDER patients endure both bsessions and compulsions, obsessions alone occur in 25%, whilst compulsions alone will be rare. 1nshe spentten a few minutes checking and recheckingtheformagainst the receipts. Shebecame convinced that she’ddone it wrong, her anxiety would increase, andshewouldgetthe forms outand checkthem once again. Herneed to includeme in thischeckingwasso greatthat shewas practically physically ontopofmychair. In thefollowingweeks, session sfocusedoneducating thepatient aboutOCD. Herdose of fluoxetinewas increasedto 40 mgaday but stopped becauseof severe restlessness and insomnia.

The girl continued totake 20mg offluoxetine a day. Startinganother medication inaddition to fluoxetinewas difficult as a result of patient, sobsessivethoughtsaboutweight gain, thenumberofpillsshewastaking, and thepossible side effects. Finally, thepatient opted for try addingclomipramine to her medications. Theresults weredramatic. Shefelt”more peaceful ” and had less anxiousness. Shebegan to talk, forthefirsttime, about herabusivefather. Your woman said, “His behavior was always supposedto be the familysecret. I actually feltso afraidandanxious I didn’tdare tellanyone.

But nowIfeel better. I no longer care whoknows. It, scost mymothertoomuchtostaysilent.  Atthis timetheplan is to commence behavioral therapy withthepatientinaddition to medication sandsupportive therapy todeal with herdifficulties with human relationships. DISCUSSION This isa complicatedcasewith multiple diagnostic category: borderlinementalretardation, attention deficit disorder, borderlinepersonalitydisorder, ahistoryofmajor depressive disorder andobsessive addictive disorder. Given thelevelofcomplexity ofthiscase and thepatient , sown silenceabout hersymptoms, itisnot urprisingthat thispatient’s OBSESSIVE COMPULSIVE DISORDER remainedundiagnosedforsolong. Nevertheless , inreviewingthe literatureand the case, it is instructive tolookat theevidence thatmighthaveledto an earlier diagnosis. First ofall, therewas thefindingof smooth neurological loss. The patient, s Neuropsychological testing suggestedproblemswithvisuospacialfunctioningn visual memory space, as very well asattentional difficultiesandalow IQ. In thepast, her doctors were so impressedwith her background ofcognitive difficultiesthatneuropsychological testing wasorderedon two distinct occasions.

Fourstudies in therecent literature haveshown consistent conclusions ofright hemispheric dysfunction, specificallydifficultiesin visuospatialtasks, associatedwith OCD(6, several, 8, 9). The patient likewise had a historyof chronic diet, andalthoughextremelythin, the lady continue g to beobsessed with notgaininga single pound. This wasapatient who required dietpills intended for 10years and whosee first memoriesinvolvedher father’s disapproval ofher bodyhabitus. Eatingdisorders areviewed bysomecliniciansasa formofO C D. OC D.

Swedo and Rapoport (II)also notean increased incidenceofeating disorders in childrenandadolescentswithOCD. Whilethis wasno hesitation true, the underlyingobsessionalcontent pointed directlyto OBSESSIVE COMPULSIVE DISORDER and should havegenerated a list of testing questionsfor OBSESSIVE COMPULSIVE DISORDER. This underscorestheneed to bevigilant for classification clues also to perform one’sown diagnostic evaluation whenassuming the treatmentof anypatient. While theliteraturemakesit clear that OCDruns in families, thepatient was unaware of theillnessin her familyuntil afterher diagnosiswas made.

Itwould have beenhelpful to learn this informationfrom thebeginningas that shouldimmediatelyraise a suspicion of OCD in a patientpresentingwith complaintsofdepression and anxiety. Finally, her diagnosis of borderlinepersonalitydisordermadeiteasier to passoff her observablebehaviorin the office asfurtherevidenceofhercharacter structure. The diagnosis of borderlinepersonalitydisorder wasclear. Sheused thedefense of splittingas evidence d simply by her descriptionsof her fightswith her man. He was either”wonderful” or a”complete krydsning. ” Herrelationships werechaoticand shaky.

She acquired no pals outsideof her family. Sheexhibitedaffective instability, markeddisturbance of bodyimageand impulsive manners. However , it had been difficult to detect whether hersymptoms were trulycharacter logicalordueinsteadto her underlyingOCD and relatedanxiety. As an example, theinstabilityin her relationships was, inpart, the resultofher OBSESSIVE COMPULSIVE DISORDER, sinceonce shebegan to obsessonsomething, sherepeatedherself therefore muchthatshefrequentlydrove others intoarage. Astudy by Ricciardi, investigatedDSM-III-R Axis II diagnostic category following treatment for OCD.

Overhalfofthepatients inside the studyno for a longer time met DSM-III-Rcriteria for individuality disorders afterbehavioraland/or pharmacological treatmentoftheirOCD. Theauthorsconclude thatthisraises questionsaboutthe validityof an AxisII diagnosisin thefaceofOCD. One may additionally beginto speculate how manypatientswith personalitydisordershave undiagnosedOCD? Rasmussenand Eisenfound a very high comorbidity ofother Axis I diagnoses in patientswith OCD. Thirty-onepercent of patients studiedwerealso diagnosed with majordepression, andanxiety disorders accounted for twenty-four percent.

Other coexisting disordersincluded eating disorders, alcoholabuseand dependence, and Tourette’s syndrome. Baer, investigatedthe comorbidityof AxisII disordersin patientswith OCDand found that 52percentmetthe requirements forat least onepersonalitydisorderwith blended, dependentand histrionic beingthemost common disorders diagnosed Giventhefrequency of comorbidity in patientswith OCD, it wouldbe wise to includescreening questionsineverypsychiatricevaluation. Theseneednotbe elaborate. Questions aboutchecking, washing, and ntrusive, unwanted thoughts can besimpleand direct. Ineliciting afamily record, specificquestions aboutfamily memberswho checkrepeatedlyorwashfrequentlyshouldbe included. Merely asking ifanyfamily memberhasOCDmaynotelicittheinformation sincefamily members mayalso be undiagnosed. Insummary, thiscaserepresents a complicateddiagnosticpuzzle. Herpast physiciansdid not have theinformationwe dotodayto unravelthetangled skeinsof symptoms. Itisimportant to bealertforthepossibilitythat thispatient , s story can be not anuncommon one.

BIBLIOGRAPHY * Psychology book (NCERT) * Similar * Taking once life notes 5. A verrückter test: journey through the world of madness 2. Disorder of impulse control by Hucker INDEX 2. Introduction * Case study 5. Course of treatment * Discussion 2. Bibliography ACKNOWLEDGEMENT I would like to convey my special thanks and gratitude to my instructor Mrs. Girija Singh whom gave me the golden opportunity to do this fantastic project on the topic ‘obsessive-compulsive disorder’, which will also helped me in doing a lot of analysis and I found know about numerous new things.

Subsequently I would love to give thanks to my family and my friends who helped me a whole lot in polishing off this job. CERTIFICATE This is to approve that Jailaxmi Rathore of sophistication 12 provides successfully accomplished the task on mindset titled ‘obsessive-compulsive disorder’ under the guidance of Mrs. Girija Singh. As well this job project can be as per cbse guidelines 2012-2013. Teacher’s personal unsecured (Mrs. Girija Singh) (Head of psychology department) 2012-2013 PSYCHOLOGY JOB NAME OF THE CANDIDATE: JAILAXMI RATHORE CATEGORY: XII DISCIPLINES B INSTITUTION: MGD GIRLS’ SCHOOL

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