Patient is 21 years old tells the psychiatrist she has OCD. She explains symptoms "such as walking back and forth, repeating certain phrases, counting steps," etc. Patient said her OCD is becoming unmanageable and she needs medication. Doc asks checklist questions about OCD which you can only answer "yes" or "no" to such as "do you wash hands" "do you arrange objects" "do you have religious obsessions"? Doc asks a bunch of questions about the patient's history. Then he asks to speak to the patient's mother, who is in the waiting room. Patient says no but doc says he needs to ask a few questions. Doc asks questions about history such as marriage, pregnancy, young child, etc. Then mom starts complaining about patient sleeping all day, how her husband started yelling everywhere for something patient did last night, etc. Patient tells mom to be quiet but doc insists she let her mom speak. Doc asks "how old is she?" and patient answers 21 and the doc thought at 21 patient should be independent from parents. He recommends a residential facility because they will set a schedule and rules so patient can't sleep all day. He then says the residential facility might not accept the patient and suggested a supported apartment. He asks the patient about her career plans who she wants to become. He said to call a family service organization that offers a supported apartment and employment training. In the end patient asked doc why he didn't prescribe meds. Doc thought patient didn't need meds. Patient asks what is he going to do about the OCD and he answers with the dismissive gesture that he will treat the OCD.
If you were the patient, what would you do? If you were the psychiatrist, how would you respond to the patient?
I dunno but I would be very surprised if this conversation didn't include a strong recommendation to see a therapist. I can't imagine the doc said "go find a supported living apartment" and that was all they did.
Specializes in Med-Surg/Neuro/Oncology floor nursing..
I dunno but I would be very surprised if this conversation didn't include a strong recommendation to see a therapist. I can't imagine the doc said "go find a supported living apartment" and that was all they did.
I was thinking the same thing. Given so many therapies are out there that are quite effective for OCD. A supportive living apartment while may help the patient in said post gain more independence how is living alone going to help her OCD?
I dunno but I would be very surprised if this conversation didn't include a strong recommendation to see a therapist. I can't imagine the doc said "go find a supported living apartment" and that was all they did.
Exactly! Those facilities are hard to come by, not cheap, and have strict admission criteria. I think there are some other issues wrong with is situation.
Patient is 21 years old tells the psychiatrist she has OCD. She explains symptoms "such as walking back and forth, repeating certain phrases, counting steps," etc. Patient said her OCD is becoming unmanageable and she needs medication. Doc asks checklist questions about OCD which you can only answer "yes" or "no" to such as "do you wash hands" "do you arrange objects" "do you have religious obsessions"? Doc asks a bunch of questions about the patient's history. Then he asks to speak to the patient's mother, who is in the waiting room. Patient says no but doc says he needs to ask a few questions. Doc asks questions about history such as marriage, pregnancy, young child, etc. Then mom starts complaining about patient sleeping all day, how her husband started yelling everywhere for something patient did last night, etc. Patient tells mom to be quiet but doc insists she let her mom speak. Doc asks "how old is she?" and patient answers 21 and the doc thought at 21 patient should be independent from parents. He recommends a residential facility because they will set a schedule and rules so patient can't sleep all day. He then says the residential facility might not accept the patient and suggested a supported apartment. He asks the patient about her career plans who she wants to become. He said to call a family service organization that offers a supported apartment and employment training. In the end patient asked doc why he didn't prescribe meds. Doc thought patient didn't need meds. Patient asks what is he going to do about the OCD and he answers with the dismissive gesture that he will treat the OCD.
If you were the patient, what would you do? If you were the psychiatrist, how would you respond to the patient?
Seriously? There is so much information that is missing .....
1. There are clear recommendations and clinical guidelines with the DSM-5 .
2. You can not just look at an isolated "symptom" or "diagnosis" - the question is: How much do any "symptoms" actually interfere with life or keep people from doing what they want to do? You can have "OC - behavior" without it being considered a "disorder" - for a lot of folks it fluctuates as OC behavior / thoughts can wax and wane.
3. OCD can come in a "package deal" - meaning it can be a co-morbidity to another illness.
4. It is important to learn about people's days and how they function because it can give you more information about how anything interferes or if there is something else going on.
5. It is not uncommon to ask family members more information as self-reporting can be insufficient - however, usually the patient who is of legal age would give permission. And it is normal to ask about family history as some diseases seem to "run in families" etc..
6. It is important to address living situation/ family dynamics. Sometimes people are better off going to a residential treatment facility with more structure and to get a better idea of what is going on. Sometimes not. But it is important to look at the overall situation, which is where social work comes in as well.
7. Medications..... well. The DSM has recommendations for treatment. Medications are not always the answers and something like CBT may be more effective. However, not everybody is able to see a CBT specialist, has access to mental health, or can afford to pay for it. Medications can be "cheaper" and seem "easier" but there are side effects and they might not work the same way CBT does. Most psychiatrists have gotten careful about prescribing medications and will recommend other options first. The main point is that the physician and patient need to have a dialogue and actually talk. Patients should ask for the rational for specific recommendations. Unfortunately, people sometimes expect the healthcare system to cure not only some illness with unrealistic expectations, but also to fix their whole dysfunctional situation around them from family dysfunction to personal dysfunction and to "take care of everything."
Good answers here. I have personally seen OCD be quite debilitating. The CBT treatment that some believe is most effective is "exposure and response prevention", which is not available in many places. It is intense, time consuming, and can be very draining for the clinician as well.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
The only information we have is the patient's self-diagnosis of OCD and the mother's description of a chaotic household and a failure-to-launch child. The psychiatrist would have his own assessment based on meeting the patient and her mother and his own rationale for his recommendations. There is really not much for us to comment on.
Julius Seizure
1 Article; 2,282 Posts
I dunno but I would be very surprised if this conversation didn't include a strong recommendation to see a therapist. I can't imagine the doc said "go find a supported living apartment" and that was all they did.