What screening or diagnostic tools would you use for Rupesh? Explain your rationale and interpretation of chosen tool
What screening or diagnostic tools would you use for Rupesh? Explain your rationale and interpretation of chosen tool
Case sudy
Today, Rupesh Shetty, a 34-year-old nurse, presents to your office.
Rupesh: Hi, I’m Rupesh, my pronoun is he, and this is Duncan, my partner, pronouns also he. No, we aren’t married. Yes, we live together—we have a life commitment, and I’m asexual. Just wanted to get that out there upfront because I know you are going to ask.
Rupesh: [sighs deeply] Remember your first months as a new nurse? I just finished orientation and I’m struggling to keep up now. I’m… I’m having trouble clocking in on time because I have to be certain my hands are clean before I start my shift.
Duncan: He’s told me he sometimes washes his hands six times in a row. Maybe even seven or eight to be sure. He does this at home, too.
Rupesh: Yeah, he’s right. And after seeing a patient, I also have to clean the desk and computer with wipes just as many times, before I can finish the chart. My charge nurse says I’m overdoing the cleanliness a bit, but I just have to do it. And it’s not just cleanliness. At home, I’m the last to bed because I have to check the doors at night five to six times at night.
Duncan: Even if I’ve already locked up and he saw me do it.
Rupesh: Well, I feel like I have to have some control over my world. And, um, Duncan doesn’t know this, sometimes I get up after he falls asleep because I worry to the point that I will have to get up and go check one or two more times before I can go to sleep.”
Duncan: Actually, I did know about that, Rupesh. I’m also concerned because Rupesh will get focused on something and then not be able to shut his mind down. He perseverates and I cannot distract him for anything.”
Rupesh: I, uh, well, I think I’ve pretty much always had these kinds of symptoms, but they seem to be getting worse recently. I do feel kind of depressed, mainly because of the OCD symptoms that are causing so much trouble. I know you’re going to ask, so I can head this off!I don’t have any SI, HI, or auditory or visual hallucinations.
- What screening or diagnostic tools would you use for Rupesh? Explain your rationale and interpretation of chosen tool. Include an APA-formatted reference for at least one.
- What are at least three questions you need to ask that will help you know what the best treatment options are for Rupesh?
Clinical pearls
When taking a thorough history of a patient to evaluate for obsessive-compulsive disorder (OCD), one must ask if they have any ruminations or incessant intrusive thoughts that consume more time than they would like (less than one hour) or interfere with their life in any way. The same must be inquired about compulsions or repetitive behaviors such as desires to tap, count, reorganize, or behave in any manner that might put their mind at ease. Look for rigid habits, aggressive outbursts, or coercive behavior such as easily triggered angry reactions by trivial incitements.
Because there is a heritable component of the disorder, it is also essential to ask if any family members have been diagnosed or experience similar symptoms.
Those with OCD may present with evidence of their rituals, such as chapped hands from compensatory over-washing, or underweight from food restrictions secondary to contamination fears. It is important to have a keen eye for signs of OCD as patients are unlikely to seek treatment early on as they may be ashamed of their obsession and compulsions.
People’s obsessions are ego-dystonic, and they may appear anxious when unable to neutralize their “fear.” This discomfort may appear to be similar to a panic disorder.
What is your final diagnosis? (Select two.)
Top of Form
Generalized Anxiety Disorder (GAD)
Obsessive Compulsive Disorder (OCD)
Panic DisorderPost-Traumatic Stress Disorder (PTSD)
Social Anxiety Disorder
Bottom of Form
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