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Obsessive Compulsive Disorder Assessment

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Randal initially sought a psychological assessment for the presenting problem of depression. He began by stating that he had been having a difficult time with simple tasks and was easily overwhelmed. After further questioning, Randal began to elaborate on some of the thoughts that occupied his time and led to difficulty concentrating. He was constantly absorbed in anxiety about himself, or his family, coming into contact with a microbial disease. This thought pattern led to him compulsively washing his hands, obsessively cleaning surfaces and doorknobs, and throwing out perfectly fine clothing due to fear of contamination. He went on to further state that he often avoided places due to anxiety about their cleanliness. Also, Randal explained that often just when thinking about dirt and germs, he would take a shower, as a result of feeling contaminated. When prompted, Randal intimated that this behavior has occurred for several years, but recently has begun to interrupt his day-to-day functioning.

As a first step, a mental status exam of Randal was taken. Clad in business-casual attire, Randal was physically appearance appropriate. His thought processes were reasonable and he displayed proper affect. He had stated that his mood was depressed and anxious. Intellectually Randal had an extensive vocabulary and seemed extremely bright. In regards to Randal’s sensorium, he was oriented times three. Although falling in the overweight category, Randal otherwise appeared healthy and had no adverse health history. Randal was asked to get lab work assessing the functioning of his thyroid, as that often can influence anxiety levels. It was decided that Randal was neither a candidate for psychological and personalit...

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...hrough on their compulsions. In Randal’s case a therapist may have Randal simply think about getting dirty, but not be allowed to wash his hands or take a shower. The therapist would then slowly work up until Randal was presented with something contaminated, but still denied the ability to follow through on his cleaning compulsions. It is unlikely that Randal’s OCD is severe enough to call for any neurosurgery.

Randal’s prognosis if only taking medicine alone is not very good, as is common with the average individual with OCD. If Randal were to take an SSRI, Anafranil, and/or a Benzodiazepam he would most likely see some positive results. These improvements would most likely decrease if Randal stopped his medication. Fortunately, with the right form of therapy, the prognosis improves. When medicine is coupled with therapy, the prognosis does not increase.
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