NRNP 6635 Week 4 Anxiety Disorders, PTSD, and OCD Paper

Subjective:

CC (chief complaint): Patient indicated having strong feelings of shame, embarassment and loss of control.

HPI: The patient is Ms. Zahara Williams, a 23 year old female. She is well nourished and of African-American descent. She has linked her feelings of shame and embarrassment to when she started pulling out her hairs. She started pulling out her hair about 7 years ago. Upon further investigation, she disclosed that she first started with pulling off hairs from her eyebrows. This was a passive habit that she did not realise until when her co-workers drew her attention to it. She could rub through her eyebrows in the course of her work as she did her reports and before long she began plucking of her brows. Despite her co-workers drawing her attention to the matter, she still denied.

NRNP 6635 Week 4 Anxiety Disorders, PTSD, and OCD Paper

Later on a check on the mirror revealed to her that her right eyebrow actually had lesser hairs as compared to the left. She had never pulled her hairs before except when she was doing makeup for parties. She realized that her right eyebrow was bald so she applied some wax to give a different feel and prevent her from picking more hair from it. With time however, she started on the left and eventually both her eyebrows had no hair. Her eyebrows grew back and she never pulled hairs from them again. The habit did not stop as she continued pulling hair from her scalp leaving behind noticeable bald patches on her head.

These were again noticed by her workmates. Ms. Zahara felt sorry for herself for the habit she had developed over time. Apart from her scalp and eyebrows she did not pluck hair from other parts of her body. Ms. Zahara started putting on a scarf over a wig to cover her bald head and save her from the incessant worries of her workmates and others. This became the source of her strong feelings of embarrassment and shame. The patient has some rituals that were discovered upon further inquiry. For instance, when unplugging electrical appliances, she has to unplug and plug back in repeatedly before she finally does it. The same case is exhibited as she turns on or off the light switch, she has to repeat it eleven times.

The patient admits that these rituals eat up significantly into her time. She points out that the habits began since she was a kid as her mother always got mad and yelled at her for taking long in the bedroom or bathroom everytime. The patient constantly has thoughts about cats running through her mind. She believes that cats harbor diseases and having them around babies could make them sick. This particular thought engulfs her everywhere at anytime. She imagines that maybe she might touch an object that was licked or touched by some dirty cat and ultimately carry the cat’s diseases toa pregnant lady or a baby. She generally hates cats.

Past Psychiatric History:

  • General Statement:

Patient has had no previous psychiatric illnesses.

  • Caregivers (if applicable):

Patient is able to look after herself without need of a caregiver.

  • Hospitalizations:

No past hospitalizations on account of psychiatric illnesses.

  • Medication trials:

N/A

  • Psychotherapy or Previous Psychiatric Diagnosis:

N/A

Substance Current Use and History:

Patient has not disclosed any present or past use of drugs and other substances.

Family Psychiatric/Substance Use History:

Her mother has a reported history of anxiety. Her two brothers have a history of using cannabis.

Psychosocial History:

Patient has an associate degree in arts and works for an Amazon warehouse. She is a single lady and admits to be lesbian despite. She has however not disclosed her sexual orientation to her family and does not plan on doing it anytime soon since they would not understand her. It is only her closest co-workers that know about it. Anxiety Disorders, PTSD, and OCD Paper

Medical History:

  • Current Medications:

N/A

  • Allergies:

Patient has no known drug allergies.

  • Reproductive Hx:

N/A

ROS:

  • GENERAL: Patient has no significant changes in weight. Patient complains of body weakness at times. There are also complains of fatigue. On some occasions the patient appears restless and drawn away from the current happenings and discussions. The patient has not experienced night sweats or fever.
  • HEENT: Patient has neither diplopia, epistaxis nor tinnitus. There is no new hearing and visual difficulties. Patient experiences migraines.
  • SKIN: There is no evidence of skin rashes or eruptions. No obvious discolorations and lesions on the skin surface. There is no evidence of pruritis.
  • CARDIOVASCULAR: Ms. Zahara reported having chest pains. There are instances where the patient complained of palpitations. No complaint of orthopnea and no visible lower extremity edema.
  • RESPIRATORY: Ms. Zahara indicated experiencing hyperventilation sometimes. She however has no cough, no wheezing sound on breathing, no sputum and no soreness in the throat.
  • GASTROINTESTINAL: The patient has a good appetite but presents with complaints of nausea , vomiting and diarrhea. The diarrhea is classical of an irritable bowel syndrome.There is some abdominal pain. There is no distension of the abdomen. Patient has no haematemesis. There is no blood present in the stool and patient does not experience reflux symptoms. She empties her bowel on a fairly regular basis.
  • GENITOURINARY: Patient passes urine normally and has not experienced episodes of hematuria or urinary incontinence.Frequency of passing urine is normal.
  • NEUROLOGICAL: Patient has had no convulsive episodes. No complaints of seizures. There is no cerebrovascular accident or transient ischemic disease.
  • MUSCULOSKELETAL: There are complaints of muscle tension and frequent muscular aches. Patient trembles at times and feels twitchy.
  • HEMATOLOGIC: No problems
  • LYMPHATICS: No swollen areas
  • ENDOCRINOLOGIC: Patient has no complains of excessive thirst, urination. Patient has no heat or cold intolerance(Pinto et al., 2015). The patient was diagnosed with diabetes at age 5.

Anxiety Disorders, PTSD, and OCD Paper Objective:

Physical exam: if applicable

Diagnostic results:

Assessment:

Mental Status Examination: Patient presented fully conscious. The patient looks a little bit older than their stated age. The patient is somewhat thin and is in a seated position that looks threatening. The patient keeps darting her eyes from one object to another across the room. The patient has their hair well kempt however, the clothes are heavily creased.The patient seems to be preoccupied by her worries and burdens more than with the current ongoings. In some instances, Ms. Zahara looked agitated and was compelled to repeatedly pluck a few strands of hair from her eyebrows.She spoke rapidly and seemed to be under pressure to communicate making her almost incomprehensible (“NIMH » Post-Traumatic Stress Disorder“, 2021). She also exhibited some level of hyper-talkativeness. She could sometimes interrupt the history taking session spontaneously. The patient looked anxious and was easily irritated. She was constantly obsessed about cats and the diseases they harbored and the fact that any association with cats could transmit these diseases to babies. She couldn’t stop thinking about how much she hated cats. She is easily distracted and one has to keep drawing her back to the matter at hand(Lee & Kim, 2019). She however has not experienced any sensory hallucinations of any nature. Despite her anxiousness she still has a connection to her inner self and is not depersonalized. She exhibits sound judgement and accurate problem solving skills.

Differential Diagnoses: Ms. Zahara Williams could be suffering from Obsessive Compulsive Disorder. This is evidenced through the history taken as she has been burdened by some thoughts that seem not to make any sense. Constantly she keeps thinking about cats and how she hates them. She alludes that she thinks about cats everywhere, imagining that they harbor diseases and could actually transmit these diseases to babies. Anytime she sits she imagines she could touch an object that had been licked or touched by a dirty cat. The patient has admitted that she has the habit of going over some activities severally for her to get the satisfaction that it has been done. She has to turn off and on the light switch upto 11 times for her to be sure that she has actually turned it off. Another compulsive trait she exhibits is unplugging and plugging back her electrical appliances.

Unless she repeats it her record number of time, she is not satisfied at all. These two activities made her feel that she spends more time on them than is necessary. It even resulted in tussles with her mother as she was always mad at her for taking too long in her room or in the bathroom when she was already waiting for her in the car. Ms. Zahara also presented with trichotillomania. This is a disorder characterized by an incessant, irresistible temptation to pluck out body hair. One can pull out the hairs from their scalp, brows, groin, armpits or any other part of their bodies. For this patient’s case her trichotillomania only manifested on the hair of her scalp and brows. Probably if the bald patches on her head or bald brows had not been spotted, she would have maintained the habit. She had to dorn a scarf and a wig to conceal the effects of this condition.

Reflections:

The patient requires proper management to restore them back to a stable condition free from the anxiety attacks (Samartzis & Talias, 2019). For the obsessive compulsive behaviors, some counselling sessions would go a long way in toning down the repetitive habits (“Anxiety Disorders: Types, Causes, Symptoms & Treatments”, 2021). Pharmacotherapy would include use of selective serotonin reuptake inhibitors  such as clomipramine(“How Trauma-Related OCD Can Be Treated”, 2021). Studies have indicated a good prognosis in skin and hair picking patients undergoing selective serotonin reuptake inhibitors.

Anxiety Disorders, PTSD, and OCD Paper References 

  • Anxiety Disorders: Types, Causes, Symptoms & Treatments. Cleveland Clinic. (2021). Retrieved 24 June 2021, from https://my.clevelandclinic.org/health/diseases/9536-anxiety-disorders.
  • How Trauma-Related OCD Can Be Treated. Verywell Mind. (2021). Retrieved 24 June 2021, from https://www.verywellmind.com/trauma-ptsd-and-ocd-2797516.
  • Lee, H., & Kim, Y. (2019). Development and effectiveness of NLP group counseling program for PTSD symptom reduction and PTG enhancement in PTSD risk group elementary school students. The Korean Journal Of Elementary Counseling18(2), 181-210. https://doi.org/10.28972/kjec.2019.18.2.181
  • NIMH » Post-Traumatic Stress Disorder. Nimh.nih.gov. (2021). Retrieved 24 June 2021, from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/.
  • Pinto, A., Greene, A., Storch, E., & Simpson, H. (2015). Prevalence of childhood obsessive–compulsive personality traits in adults with obsessive compulsive disorder versus obsessive compulsive personality disorder. Journal Of Obsessive-Compulsive And Related Disorders4, 25-29. https://doi.org/10.1016/j.jocrd.2014.11.002
  • Samartzis, L., & Talias, M. (2019). Assessing and Improving the Quality in Mental Health Services. International Journal Of Environmental Research And Public Health17(1), 249. https://doi.org/10.3390/ijerph17010249