NURS-6670-wk-7-assignment. HPI and clinical impression.

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HPI and clinical impression
The adult in focus for this study is a 32-year-old female Caucasian called Sheila who has displayed an array of symptoms such as compulsions, intrusive thoughts, obsessive ritual and mental preoccupation (Sadock, Sadock, & Ruiz, 2014). She admitted these symptoms are causing her severe misery, especially due to her inability to control the intrusive thoughts and compulsions to an extent they are affecting her work life and career. Sheila has compulsions that make her to repeatedly check if her home taps are locked or dripping. Intrusive thoughts of dripping faucets or the sound recurring in her thoughts have made her leave work several times every day to check if all is well at home, a behavior that has cost her some jobs due to absconding duty. Sheila is otherwise healthy with no pre-existing conditions and a healthy relationship with alcohol which she takes in moderation during family gatherings. However, she reports a history of clinical insanity on both sides of her family a few generations earlier. The clinical impression based on APA (2013) diagnostic criteria suggests she is suffering OCD.
Psychopharmacologic and therapeutic endpoints
The psychopharmacologic recommendation for Sheila is necessary considering the fact that the disorder has severely disrupted her work and home life. This means starting treatment using an SSRI then upgrading to other interventions if this is not producing the desired effect (Sadock, Sadock, & Ruiz, 2014).
It is therefore essential she starts with oral Prozac at a dosage of 40mg daily intake since it’s the most common and effective intervention at this stage. A review in 7 days will be necessary for tolerance assessment which could allow the dosage increase to 80mg which is the recommended level. Typical side effects she may face include anxiety, diarrhea, disturbed sleep, headaches and nausea. However, the end result could be the reduction in Sheila’s intrusive thoughts which rigger her compulsions that disrupt her social life and career.
A combination of behavior therapy and pharmacotherapy is usually sufficient to mitigate the symptoms that such patients experience (Fenske and Petersen, 2015).
Recommended psychotherapy and therapeutic endpoints
Behavior therapy can be just as effective as pharmacotherapy for OCD patients and are probably more beneficial because there is no fundamental alteration of the body’s chemical balance and functioning as a consequence of side effects. It is therefore going to be appropriate to retain Sheila on a form of this therapy, especially because of its flexibility which accommodates inpat...