Posted: February 3rd, 2025

Anxiety & Sleep Wake Disorders/9kwj

Anxiety & Sleep-Wake Disorders
Answer the questions below based on the following case study.

A 26-year-old woman presented to the clinic after her cleaning rituals had so exhausted her that she had given up and could now enter only two of the five rooms in her home. Her excessive cleaning behaviors have led to severe restrictions in her daily functioning, limiting her ability to fully engage with her environment. For more than a year, she has worried that if her house is not sufficiently clean, her 3-year-old son will become ill and could die. This persistent anxiety has created a distressing cycle, reinforcing her compulsive behaviors despite her awareness of their irrational nature. Having touched a surface, she has to disinfect it repeatedly – a procedure performed in a particular way and taking several hours. These prolonged rituals consume much of her day, preventing her from engaging in other essential tasks or leisure activities. In addition, she repetitively washes her hands and sterilizes all the crockery and cutlery before eating. Her meticulous approach to hygiene extends beyond normal precautionary measures, suggesting a deeper underlying psychological concern. She realizes that she is ‘going over the top,’ but she cannot stop thinking that items may have germs on them. This insight into her condition highlights the internal struggle between her rational understanding and the overpowering nature of her compulsions. This leads to disabling anxiety and fear for her son’s health, which she can only resolve by cleaning. While the cleaning temporarily reduces her distress, the relief is short-lived, and the cycle of intrusive thoughts and compulsions soon resumes.

Questions
1. Summarize the clinical case.

This case describes a 26-year-old woman experiencing obsessive-compulsive symptoms centered around contamination fears and excessive cleaning rituals. Her compulsions have escalated to the point where she can only access two of five rooms in her home, significantly affecting her daily life. She fears that any lapse in cleanliness could result in severe illness or death for her young son, leading to distressing repetitive behaviors such as handwashing, disinfecting surfaces, and sterilizing utensils. Despite recognizing the irrationality of these behaviors, she is unable to stop, as doing so triggers overwhelming anxiety. Her symptoms are persistent, time-consuming, and impair her functioning, indicating the need for clinical intervention.

2. What is the DSM-5-TR diagnosis based on the information provided in the case?

The most appropriate diagnosis for this patient based on DSM-5-TR criteria is Obsessive-Compulsive Disorder (OCD) with contamination-related obsessions and cleaning compulsions. According to the DSM-5-TR, OCD is characterized by the presence of persistent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed to reduce anxiety. In this case, the patient’s excessive fear of contamination, distressing repetitive cleaning behaviors, and insight into her condition align with the diagnostic criteria for OCD. Additionally, the compulsions consume a significant portion of her day and impair her ability to function normally, further supporting the diagnosis.

3. Which pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment.

The first-line pharmacological treatment for OCD, according to clinical guidelines, is Selective Serotonin Reuptake Inhibitors (SSRIs), specifically fluoxetine, fluvoxamine, or sertraline. Among these, fluoxetine (Prozac) at an initial dose of 20 mg per day is often preferred due to its efficacy, tolerability, and ease of dose adjustments. SSRIs work by increasing serotonin levels in the brain, which helps regulate mood and reduce the intensity of obsessive-compulsive symptoms. Research has shown that high-dose SSRIs are particularly effective in reducing OCD symptoms, often requiring doses higher than those used for depression. Fluoxetine is FDA-approved for OCD and has demonstrated significant improvements in reducing compulsive behaviors and intrusive thoughts over time.

4. Which non-pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment excluding a psychotherapeutic modality.

Apart from psychotherapy, a key non-pharmacological intervention would be structured exposure therapy-based self-help strategies and lifestyle modifications. Encouraging a strict sleep hygiene routine, regular physical exercise, and mindfulness-based stress reduction (MBSR) can play a crucial role in managing symptoms. Sleep disturbances are common in individuals with OCD, and poor sleep can exacerbate anxiety and compulsive behaviors. Establishing a regular sleep-wake cycle, reducing screen time before bed, and practicing relaxation techniques can improve overall mental well-being. Additionally, exercise has been shown to decrease OCD symptom severity by promoting endorphin release, reducing stress, and improving mood regulation. Mindfulness-based practices, such as guided meditation and breathing exercises, can help the patient build tolerance to distressing thoughts without resorting to compulsive behaviors.

5. Include an assessment of the treatment’s appropriateness, cost, effectiveness, safety, and potential for patient adherence to the chosen medication. Use a local pharmacy to research the cost of the medication and provide the most cost-effective choice for the patient.

Appropriateness: Fluoxetine is a well-established first-line treatment for OCD, demonstrating significant efficacy in reducing symptoms. Given that this patient exhibits severe and distressing compulsions, an SSRI is highly appropriate.
Cost: Based on local pharmacy pricing, generic fluoxetine (20 mg) costs approximately $10–$20 per month, making it one of the most cost-effective SSRI options. This affordability enhances the likelihood of patient adherence.
Effectiveness: SSRIs like fluoxetine have been found to reduce OCD symptoms by 40–60% over 8–12 weeks. However, higher doses (40–60 mg) may be required for optimal symptom control. It is essential to monitor response and adjust dosing as needed.
Safety: Fluoxetine has a well-established safety profile, with common side effects including nausea, insomnia, and mild agitation. These effects often resolve within the first few weeks of treatment. Rare but serious adverse effects include increased suicidal ideation in younger patients, requiring close monitoring.
Patient Adherence: Adherence may be influenced by side effects, treatment expectations, and the patient’s motivation for symptom relief. Given her significant impairment, she is likely to adhere to treatment if properly educated about the benefits and expected timeline for improvement. Regular follow-ups and open communication can improve compliance and address concerns.

“Obsessive-Compulsive Disorder and Contamination Fear: A Case Analysis of Anxiety-Driven Cleaning Rituals”

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Anxiety & Sleep Wake Disorders

Answer the questions below based on the following case study.

A 26-year-old woman presented to the clinic after her cleaning rituals had so exhausted her that she had given up and could now enter only two of the five rooms in her home. For more than a year she has worried that if her house is not sufficiently clean, her 3-year-old son will become ill and could die. Having touched a surface she has to disinfect it repeatedly – a procedure performed in a particular way and taking several hours. In addition, she repetitively washes her hands and sterilizes all the crockery and cutlery before eating. She realizes that she is ‘going over the top’, but she cannot stop thinking that items may have germs on them. This leads to disabling anxiety and fear for her son’s health, which she can only resolve by cleaning. This helps temporarily, but soon the thoughts return again.

Summarize the clinical case.
What is the DSM 5-TR diagnosis based on the information provided in the case?
Which pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment.
Which non-pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment excluding a psychotherapeutic modality.
Include an assessment of the treatment’s appropriateness, cost, effectiveness, safety, and potential for patient adherence to the chosen medication. Use a local pharmacy to research the cost of the medication and provide the most cost-effective choice for the patient. Use great detail when answering questions 3-5.

Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources within the past 5 years.
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. (150 Words each reply) You need at least 1 academic sources within the past 5 years for each reply. (I WILL SEND YOU 2 POST AFTER I SUBMIT MY WORK FOR YOU TO COMPLETE THIS STEP)
All replies must be constructive and use literature where possible.
Late work policies, expectations regarding proper citations, acceptable means of responding to peer feedback, and other expectations are at the discretion of the instructor.

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