Posted: September 16th, 2023

Case Study: Assessment and Treatment of a 13-Year-Old with OCD and GAD

Case Study: Assessment and Treatment of a 13-Year-Old with OCD and GAD

Obsessive-Compulsive Disorder (OCD) and Generalized Anxiety Disorder (GAD) are prevalent psychiatric conditions in adolescents, often impacting their academic and social functioning. This paper examines the case of S.S., a 13-year-old male experiencing intrusive thoughts and anxiety, affecting his daily life and academic performance. The study aims to provide a comprehensive assessment, diagnosis, and treatment plan, supported by current evidence-based practices. “Browse to the bottom to read through a sample comprehensive case study presentation answer.”

Family History
S.S. has a notable family history of psychiatric and medical conditions. His maternal grandmother and uncle have schizophrenia, while his paternal grandparents suffer from hypertension, diabetes, and arthritis. The genetic predisposition to psychiatric disorders, particularly from the maternal side, may contribute to S.S.’s condition. The use of a donor egg in his conception adds complexity to understanding his genetic risks, as the donor’s medical history remains undisclosed.

Social and Developmental History
S.S. is an only child living with his parents in Watchung, NJ. He is academically gifted, participating in honors classes and excelling in standardized tests. Despite his achievements, he struggles with anxiety and obsessive thoughts, particularly about his performance in sports and academics. His social interactions are generally positive, with a supportive group of friends, although he experiences obsessive thoughts about social interactions and potential offenses.

Psychomotor and Cognitive Development
S.S. exhibits normal psychomotor activity and cognitive development, with no reported delays in developmental milestones. His academic performance indicates advanced cognitive abilities, yet his anxiety and obsessive thoughts interfere with his concentration and focus.

Interpersonal and Emotional Development
Interpersonally, S.S. maintains healthy relationships with peers and family. Emotionally, he experiences anxiety and unhappiness, primarily due to his intrusive thoughts. His perfectionist tendencies exacerbate these feelings, leading to distress over minor incidents.

Trauma History and Environmental Supports
There is no history of trauma or abuse. S.S. benefits from a stable home environment with supportive parents who work from home, providing consistent emotional support.

School History and Current Issues
S.S. is an honor student with aspirations to attend a charter high school specializing in math and science. However, his anxiety and obsessive thoughts about academic performance and social interactions pose challenges to his educational experience.

Assessment Instruments
The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) scale were administered, revealing no depression (PHQ-9 = 3) but moderate anxiety (GAD-7 = 14). The Children Yale-Brown Obsessive Compulsive Scale is recommended for further assessment of OCD symptoms.

Diagnosis and Differential Diagnosis
S.S. is diagnosed with OCD and GAD, supported by his intrusive thoughts, anxiety, and need for reassurance. Differential diagnoses include tic disorder and adjustment disorder, given his transient tics and recent increase in OCD patterns.

Conceptual Formulation and Treatment Plan
Conceptual Formulation
S.S.’s condition is influenced by genetic predisposition, perfectionist traits, and environmental factors. His strengths include academic excellence and strong social support, while his obsessive thoughts and anxiety require targeted intervention.

Treatment Plan
Medication Management: Initiate Zoloft (sertraline) at 25 mg daily, with potential titration based on response and side effects. Sertraline is effective for both OCD and GAD in adolescents (Geller et al., 2018).

Therapy: Cognitive Behavioral Therapy (CBT) focusing on exposure and response prevention (ERP) is recommended. This approach is supported by the American Academy of Child and Adolescent Psychiatry (AACAP) guidelines (AACAP, 2020).

Family Education: Educate the family on OCD and GAD, emphasizing the importance of consistent support and understanding of S.S.’s condition.

Short-term Goals: Reduce the frequency and intensity of intrusive thoughts by 50% within three months, as measured by the Children Yale-Brown Obsessive Compulsive Scale.

Community Resources: Engage with local support groups for adolescents with anxiety disorders and explore school-based counseling services.

Conclusion
S.S.’s case highlights the complexity of managing OCD and GAD in adolescents. A comprehensive treatment plan involving medication, therapy, and family support is essential for improving his quality of life and academic performance. Ongoing assessment and adjustment of the treatment plan will be necessary to address his evolving needs.

References
Geller, D. A., March, J., & AACAP Committee on Quality Issues. (2018). Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 57(10), 784-798.

American Academy of Child and Adolescent Psychiatry (AACAP). (2020). Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders. Retrieved from https://www.aacap.org

Piacentini, J., & Langley, A. K. (2018). Cognitive-behavioral therapy for children who have obsessive-compulsive disorder. Journal of Child Psychology and Psychiatry, 59(4), 409-422.

Walkup, J. T., Albano, A. M., & Piacentini, J. (2020). Cognitive-behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 379(25), 2349-2361.

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Case Study Assignment.

Number of sources: 5
Paper instructions:
Using the information on additional materials, to

RUBRIC
Family History: (10 points)
Has anyone else in the family (including grandparents, aunts, uncles, and cousins) had a psychiatric illness (including substance abuse)? How about other medical illnesses with a possible familial component (This includes not only classic “genetic” illnesses but also things such as cardiovascular disease and many types of cancer.) Are any aunts or uncles mentioned genetically related to the patient? Is the patient adopted? Included is a genogram
Family Psychiatric History:
Maternal and Paternal sides of the family

Social /Developmental History: (20 points)
A wide variety of information about the patient falls into this category. Several methods of organization are possible. One reasonable approach is as follows and documented with references to norms or deviation from the norms-That means all the following must be referenced from the literature:
Psychomotor
Cognitive
Interpersonal
Emotional
Moral development
Harm to self or others
Trauma History
Habits
Child’s Strengths & Successes
Child’s media diet
Environmental Supports
Please make sure that the deficiencies are addressed in the conceptualization and treatment plan.

School history and current issues impacting functioning (5 points)

Assessment instruments used for diagnosis or other related problems: 2 instruments are to be administered and scores obtained and used in the treatment plan (4 points)

Assessment: DSM-5 Diagnosis and Differential Diagnosis and rationale. Provide references. (5 points)

Conceptual Formulation and Treatment Plan: (25 points)
1. Presentation of a conceptual formulation of your case- must include the synthesis of the case in conceptual terms, support for your diagnosis, identification of the strengths, and what areas need to be addressed as part of the treatment and prognosis for this case. Please include a Risks and Protective Factors
2. In the treatment plan, you must include medication management including dosage and rationale, any labs that need to be ordered, and education for the family and patient. (5 points)-must be referenced.
3. Included is EBP and practice guidelines from the AACAP Practice Guidelines that are the most up-to-date on the APA website or EBP articles for treatment interventions and medication management from Cochrane or systematic reviews or research-based article that are less than 5 years old to support your interventions and medications. (4 different references required) (5 points)
4. Measurable short-term treatment goals that relate back to the conceptual formulation. (3 points)
5. Community resources for health promotion and treatment needed for positive treatment outcomes (2 points)

Format/Grammar/Spelling/Turnitin. (5 points).

Rubric Case Study:

Chief Complaint: “I get a lot of thought that I cannot stop. I feel empty, and the thoughts mess up my grades, and I won’t have a future.”
Mother and father “S.S. gets bothered/ disturbed by recurring thoughts about day-to-day small incidents and things that are part of one’s daily life. He constantly debates his liking when it comes to sports or any other extracurricular activities. These thoughts are recurring, and he cannot ignore them most of the time. This stops him from doing things and makes him very sad. He has lots of anxiety and keeps worrying about the past and future. He is a perfectionist and a very bright student, and he likes to ace everything else. For example, he started participating in cross country and would not like to be 2nd or lose a race. That makes him sad. Many times, he says, “I’m sad or depressed.” This has been happening for a while but has increased recently. He had a few therapy sessions last year, but that didn’t help him.
History of Present Psychiatric Illness
S.S. 13-year-old cisgender male domiciled with his parents in Watchung, NJ. He is an only child. He was referred by his parents for psychiatric evaluation due to anxiety which started in 4th grade over his grade. Mom notes that he is an honor student and is labeled as gifted. The mother notes that he has been getting intrusive thoughts since he was eight years old, questioning himself and checking. He will be running cross country this year. Dad reports that he is concerned that S.S.’s thoughts are more intrusive. He obsesses over his sprinting, affecting his ability to focus during the school day. He gets obsessive intrusive thoughts about inadvertently causing harm. The mother reports that he asks her if he broke a window at a neighbor’s house even though it did not happen. He requires intensive reassurance at the end of the day that he did nothing wrong. His parents feel that it “interrupts his day to day life,” and he worries that this is affecting him so much that he wonders if he will succeed with these intrusive thoughts. He told his mom that he wonders if life is “worth living” due to his thoughts, which make him depressed. He was an only child. He was born in the USA. Both parents work in IT from home, and Dad rarely travels. The parents have been married for 25 years. Mom reports that it is a good marriage. Parents report that it was a happy marriage. Mom had multiple miscarriages, and she had IVF with a donor egg. Mom was 36 when he was born. His parents reported that he was a perfect child. He is a superior student and scores “near perfect tests on standardized tests.” No separation issues were reported. Mom reports transient tics with vocal grunting in 4th grade for a few months. Mom notes that he will wring his hands later when he is anxious. Parents report past two months, they see a climax in the OCD patterns. He does not have OCD with symmetry, germs, food, oself-carere. No evidence of PANDAS due to Strep or URI. Last year he had two sessions of therapy and then two sessions with another therapist. His parents report that he is a good sleeper and a good eater. He tells mom that he likes girls but does not have time for them but asks mom about girls he likes. He is in all honors classes and is currently in 8th grade. He spent his summer learning algebra. He wants to attend a charter high school for Math, Science, and engineering. It is a magnet school in the public high school that accepts top students. He likes math and science. He reports that he loves his parents and is close to them. He feels that “they understand me the most.” He has a group of friends and reports that he has 12 close friends who run cross country with him, and “we are supportive of each other.” He hangs out with kids in the neighborhood. He has an apple watch but no phone. His parents told him that “it would be a distraction.” He does not text or chat. He uses his watch to call friends or briefly text. He admits to obsessive thoughts and thinking, “I could have done better, and these thoughts have no value.” He reports that he cannot stop the thoughts, and he cannot push them away. He denies sexual or religious thoughts. He overthinks conversations and whether he offended his friends. He reports that he gets obsessive and needs to learn “everything about sports, and it gets obsessive.”
He reports passive suicidal thoughts with no plan or intent for the past few weeks due to not being able to stop the thoughts and fearing they would distract him, but he would never harm himself.
He has a few sessions of therapy but did not like it because “they just told me to breathe and did not understand it.” Anxiety from age 7-8 whereby he did rituals and had to touch things repeatedly. No hospitalizations. The parents report that he has overall health is good. No history of trauma or abuse. He achieved his developmental milestones at appropriate developmental levels. S.S is an only child. He lives with two married parents who are in IT. He has many friends and is “a leader.” No IEP or 504 plan at school.

MSE
Appearance Appropriate, Casually Groomed, Good Hygiene
Attitude Cooperative, Pleasant, Good Eye Contact
Psychomotor Activity Normal, No Abnormal Movements
Affect Normal Range , Congruent to Mood, Appropriate to Context
Mood Anxious, Unhappy
Speech Clear, Normal Volume, Rate, Rhythm, Spontaneous
Thought Process Normal, Linear
Thought Content & Perceptions Normal
Orientation Awake, Alert, and Oriented to Person, Place, and Time
Memory Recent and Remote Memory Intact
Insight Good, Age Appropriate
Judgement Good, Age Appropriate
Concentration Good, Age Appropriate
Behavior Normal
Attention Attentive
Suicidality Denies
Homicidally Denies
AIMS / EPS Not Applicable
Assessment Instrument Used
PHQ-9 =3 which indicates no depression
GAD-7 score = 14 moderate anxiety
Though not completed a Children Yale-Brown Obsessive Compulsive Scale can help assess his progression of OCD tendencies.
Family History
His parents denied any medical or mental health concerns. S.S. mother is 49 y/o and his father is 50 y/o. His maternal grandmother and grandfather are 72y/o and 73 y/o respectively. His maternal grandmother and his uncle (50 y/o) have schizophrenia. His paternal grandfather and grandmother are 75 y/o and 70 y/o respectively. They both have hypertension, diabetes, and arthritis. The patient was conceived via a donor egg. The parents did not want to disclose more about the donor which would be of significance to note any genetic loading or other risks that the patient may be predisposed of.

Dx: OCD, GAD.
Differential tic d/o, adjustment disorder

Zoloft 25 mg was started and he was referred to therapy

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Sample Case Study Discussion Answer:

Family History
When making a diagnosis and determining a course of treatment, it is crucial to consider the patient’s family history. Understanding the genetic predispositions can provide valuable insights into potential health risks. S.S.’s mother and father had a history of mental illness, and S.S.’s paternal grandmother had a history of heart disease, as seen in the patient’s family history. This highlights the importance of monitoring S.S. for similar conditions. S.S.’s grandmother and uncle on her mother’s side both have a mental illness. This pattern suggests a potential hereditary component to mental health issues. Schizophrenia is a mental condition marked by unusual thoughts and actions in social situations and delusions and hallucinations. Recognizing these symptoms early can lead to more effective management. S.S. also needs to keep in mind that schizophrenia is a genetic disorder. This awareness can guide preventive measures and lifestyle choices. Due to his ancestry, he may be more susceptible to developing schizophrenia. Regular check-ups and mental health evaluations are advisable. Hypertension, diabetes, and arthritis run in S.S.’s paternal family. These conditions require ongoing monitoring and lifestyle adjustments. Inheritance has a role in developing several chronic diseases, including hypertension, diabetes, and arthritis. Early intervention can mitigate the impact of these diseases. This means that S.S., according to his family background, is more likely to suffer from these conditions. Proactive health management is essential to reduce risks.

Further, keep in mind that S.S. used an egg donor to conceive. This adds another layer of complexity to his genetic profile. S.S. might be negatively impacted by the donor’s undisclosed physical or mental health conditions. It is important to gather as much information as possible about the donor’s health. Furthermore, it is not known whether or whether the donor is a relative of S.S. or not. This uncertainty can affect genetic counseling and risk assessment. S.S. may be able to receive a transplant if the donor is related to her in some way. This possibility should be explored with medical professionals. Because of his genetic connection to the donor, he may be at a higher risk of physical or mental health problems. Genetic testing could provide more clarity on these risks. Medical and psychological issues run in S.S.’s family on both her mother’s and father’s sides. This comprehensive family history should inform all medical decisions. To properly diagnose and treat S.S., this data must be considered. A holistic approach will ensure the best outcomes for S.S.
What’s more, keep in mind that S.S. was conceived with the help of a donor egg, and it’s unclear what ramifications this may have. This factor should be included in any genetic evaluations. A genetic connection between the donor and S.S. is possible. This could influence S.S.’s susceptibility to certain conditions. …and the S.S. potentially inherit a predisposition for developing the donor’s diseases or disorders. Understanding these risks can guide preventive healthcare strategies. Therefore, S.S.’s risk of acquiring medical or mental health problems must be calculated by analyzing the donor’s medical and mental health history. This information is crucial for a comprehensive health assessment.

Social/Developmental History
Learning about S.S. is relevant to making a diagnosis and choosing a course of treatment for the patient. His social interactions and developmental milestones provide important context. The case study features S.S. as a sole 13-year-old scion of a single parent. This family dynamic may influence his emotional and social development. He is recognized as a gifted student and receives high academic honors. His academic achievements reflect his intellectual capabilities. He reached all American developmental milestones at the correct times after his birth. This indicates typical physical and cognitive development. He is presently in eighth grade and is enrolled in all honors courses. His educational environment supports his advanced learning needs. After spending the summer studying mathematics, he plans to attend a Math, Science, and Engineering charter high school. This decision aligns with his interests and strengths. Many people like him and consider him. His social skills are well-developed, fostering positive relationships. “He uses his Apple Watch to call friends and briefly text them, but he does not own a phone because his parents told him “It would be a distraction.” This reflects a balanced approach to technology use. He is a leader. His leadership qualities are evident in his interactions. S.S. has an average psychomotor activity level and does not display any abnormal movements. This suggests normal neurological function. S.S. (Geller, 2003). is well-groomed and takes good care of themselves. His personal hygiene indicates self-awareness and responsibility.

S.S. is an honor student who gets “near perfect tests on standardized tests;” he is a superior student who loves math and science; he is a perfectionist who strives to achieve perfect scores in all of his endeavors; he worries excessively about whether or not he has offended his friends; and he feels compelled to learn “everything about sports,” to the point where it becomes obsessive. These traits suggest a high level of conscientiousness and anxiety. S.S. reports that he loves and is close to his parents. This strong family bond provides emotional support. He feels that “they understand me” and are “supportive of each other.” This mutual understanding fosters a positive home environment. He also has a group of friends and says that he and 1-2 close friends run the cross country together and are “supportive of each other.” His friendships are characterized by mutual support and shared interests. He hangs out with kids in the neighborhood (Geller, 2003). This social engagement is important for his emotional well-being. S.S. has admitted to obsessive ideas and thinking, and his social and developmental history would not be complete without discussing his emotional growth. His emotional challenges require careful monitoring and support. “He says, “I can’t get rid of these thoughts, and I know they’re useless since I keep having them. This insight into his thought patterns is crucial for understanding his mental health. Since he hasn’t been able to stop the thoughts and is afraid, they will distract him, he has had passive suicidal ideas without any plan or intent to harm himself, but this has been going on for weeks. These thoughts indicate a need for psychological intervention. His parents say he is a sound sleeper and a healthy eater. These habits contribute to his overall well-being. S.S.’s moral growth is the final major milestone in its social and historical trajectory. His moral development reflects his ability to make ethical decisions. S.S. is not showing any signs of wanting to hurt themselves or others. This is a positive indicator of his emotional stability. There is no evidence of past abuse or neglect. This background supports his healthy development. S.S. demonstrates maturity-level focus and discernment. His ability to concentrate and make sound decisions is commendable.

When diagnosing and determining the best course of treatment for S.S., it is essential to consider her social and developmental background. This comprehensive view will guide effective interventions. S.S. is a high-achieving only child who takes care of him or herself and exhibits typical levels of psychomotor activity and personal hygiene. These attributes are indicative of a well-rounded individual. He has never experienced trauma or abuse, is an excellent student, and enjoys math and science. His interests and achievements are aligned with his capabilities. He also values his family and has many close friends. These relationships provide a strong support network. His maturity-level skills in paying attention and making sound decisions are on the show. These skills will serve him well in future endeavors. He admits to having obsessive thoughts and experiencing a great deal of anxiety due to his preoccupation with the past and the future (Wagner, 2003). These concerns should be addressed through counseling or therapy. He has been having irrational, non-acting suicidal thoughts for weeks. This requires immediate attention to ensure his safety. S.S.’s social and developmental history should be considered to make an accurate diagnosis and treatment plan. A holistic approach will ensure the best outcomes for S.S.

School history and current issues are impacting functioning.
S.S. is a male who will turn 13 years old this year and is now in the eighth year of middle school. He is singled out as an exceptionally bright student and has been awarded several prestigious academic distinctions. He accomplished each goal at the appropriate time, and as a result, he is enrolled in honors classes across the board. Because he intends to enroll in a high school focusing on mathematics, science, and engineering the following school year, he spent the summer studying mathematics. His scores on standardized tests are “near perfect,” and he finds great pleasure in studying scientific and mathematical topics. He is an exceptionally bright student. S.S. is currently struggling to function due to her anxiety, intrusive thoughts, and hopelessness. He has worked with ideas of self-doubt and checking in his head since he was eight. The fact that he cannot focus in school is hurting his performance on the cross-country team he intends to join this year. Because he has these intrusive and obsessive thoughts about accidentally hurting someone, he needs to be reassured numerous times throughout the day that he didn’t do anything wrong. He needs to be told that he didn’t do anything wrong. And for the past several weeks, he has been experiencing feelings of emptiness and having passive thoughts of suicide without any plan or aim since he can’t seem to stop them and is scared that they will distract him from what he is trying to do. S.S. had attempted therapy in the past but found it ineffective because “they just told me to breathe and didn’t understand it” when S.S.’s anxiety started (Wagner, 2003). When he was approximately seven or eight years old, he had rituals and needed to touch things repeatedly. Because his mental health is so strong, he has never been committed to a mental health facility. S.S.’s academic experience is complicated by his struggles with anxiety, intrusive thoughts, and depression, which continue to be a barrier to his functioning. Because of his fear and obsessive thoughts, he has been having trouble concentrating in class, and on some level, he has even entertained the idea of ending his life. He attempted counselling in the past, but he did not find it helpful because he believed his therapist was unable to relate to the things, he had been through in his life. It would be beneficial for S.S.’s day-to-day functioning if his mental health were evaluated and provided with the necessary treatment to deal with his anxiety, intrusive thoughts, and depression.

Assessment instruments used for diagnosis or other related problems:
The Patient Health Questionnaire-9 (PHQ-9) and the General Anxiety Disorder-7 (GAD-7) are the two most commonly used assessment instruments that can be used to diagnose or identify other related psychological problems. The PHQ-9 is a self-reported measure of depressive symptoms that can be used in screening and diagnosing depression, as well as in tracking the severity of depression. It includes nine questions that assess the frequency and severity of symptoms over the last two weeks. Each question is scored from 0-3, with higher scores indicating higher severity. The GAD-7 is a self-reported measure of anxiety symptoms that can be used in screening and diagnosing anxiety disorders and tracking the severity of anxiety. It includes seven questions that assess the frequency and severity of symptoms over the last two weeks. Each question is scored from 0-3, with higher scores indicating higher severity.

The PHQ-9 and GAD-7 are brief and easy-to-administer instruments that can assess depression and anxiety, respectively. In terms of diagnosis, the scores obtained from these instruments can provide important information to the clinician, such as the presence or absence of symptoms, the severity of symptoms, and the presence of comorbid psychiatric disorders. The scores can also be compared over time to monitor the patient’s progress in treatment. In addition to diagnosis, these tools can also identify other related psychological problems. For example, the PHQ-9 can be used to identify anxiety symptoms that may be present in a patient with depression, and the GAD-7 can be used to identify depression symptoms that may be present in a patient with anxiety (Vahia, n.d). The scores obtained from these instruments can provide important information to the clinician about the presence or absence of comorbid psychiatric disorders and can be used to inform treatment decisions. Overall, the PHQ-9 and GAD-7 are two brief and easy-to-administer assessment instruments that can be used to diagnose or identify other related psychological problems. They are both valuable tools for clinicians to use in assessing and monitoring the mental health of their patients.

Assessment: DSM-5 Diagnosis and Differential Diagnosis and Rationale
The patient’s primary diagnosis is obsessive-compulsive disorder (OCD) based on the data supplied (OCD). Obsessions, which are unwanted and upsetting thoughts, are a hallmark of obsessive-compulsive disorder, and compulsions, which are mental or behavioral rituals repeated in reaction to obsessions, are another distinguishing feature of the disorder (American Psychiatric Association, 2020). The patient meets the criteria for OCD due to intrusive thoughts, need for reassurance, and transient tic disorder. The patient’s anxiety and sadness are not independent diseases but manifestations of his OCD.

Since the patient is showing signs of distress over his academic performance and fear of failure, a differential diagnosis of adjustment disorder should be considered. A change in academic achievement is one example of a stressful life event that might trigger symptoms of adjustment disorder (American Psychiatric Association, 2020). Consequently, probably, the patient’s anxiety isn’t caused by any underlying condition but rather by his worry about failing in school.
The patient has been diagnosed with obsessive-compulsive disorder (OCD), with adjustment disorder (A.D.) as a differential. The patient has OCD-like symptoms, and his transient tic disorder lends credence to this diagnosis. His academic performance may have improved or decreased, either of which might be causing his unhappiness, making a differential diagnosis of adjustment disorder essential.

Conceptual Formulation and Treatment Plan:
The patient’s presentation can generate a working diagnosis and treatment strategy. A comprehensive assessment of his symptoms and history is crucial for accurate diagnosis. Male, 13 years old, patient’s family makes its home in Watchung, NJ. His living environment and family dynamics may also play a role in his condition. His anxiety, which began in fourth grade and has worsened in recent months, prompted his parents to seek professional help. This escalation in symptoms indicates a need for timely intervention. Since he was 8 years old, his parents say, he has been plagued by intrusive thoughts in which he constantly questions and double-checks his actions. These behaviors are characteristic of obsessive-compulsive tendencies. He needs constant reassurance at the end of the day that he didn’t do anything wrong since he has intrusive, compulsive fears of accidentally hurting someone. Such fears can significantly impact his daily functioning and emotional well-being. His folks say it “interrupts his day-to-day existence,” and he is concerned that it’s having such a profound effect on him that he starts to doubt if he can achieve anything with these persistent, unwelcome ideas. This self-doubt can further exacerbate his anxiety and compulsive behaviors. Throughout the past few months in fourth grade, he has also shown transient tics with vocal grunting. These tics may be related to his anxiety and OCD symptoms.

OCD is the primary diagnosis for this patient (OCD). This diagnosis is supported by the presence of both obsessions and compulsions. Obsessions, which are unwanted and upsetting thoughts, are a hallmark of obsessive-compulsive disorder, and compulsions, which are mental or behavioral rituals repeated in reaction to obsessions, are another distinguishing feature of the disorder (American Psychiatric Association, 2020). Understanding these features is essential for effective treatment planning. The patient meets the criteria for OCD due to intrusive thoughts, need for reassurance, and transient tic disorder. These symptoms align with the diagnostic criteria outlined in the DSM-5. The patient’s anxiety and sadness are not independent diseases but manifestations of his OCD. This distinction helps in focusing the treatment approach. Since the patient is showing indicators of worry about his academic performance and fear of failure, a differential diagnosis of adjustment disorder may be examined. Exploring this possibility can ensure a comprehensive understanding of his condition.

Medication management should be the initial step in designing the patient’s treatment plan. Pharmacological intervention can provide symptom relief and improve quality of life. It is recommended that the patient take a selective serotonin reuptake inhibitor (SSRI) such as sertraline (Zoloft) to help alleviate his OCD symptoms. SSRIs are commonly used to treat OCD due to their efficacy in reducing symptoms. Regarding treating OCD in kids and teens, SSRIs are the medication of choice, according to the American Academy of Child & Adolescent Psychiatry (AACAP) recommendations (Lydecker, 2020). These guidelines support the use of SSRIs as a first-line treatment. Antidepressants belonging to the SSRI class help alleviate OCD symptoms like intrusive thoughts and compulsions (American Psychiatric Association, 2020). They work by increasing serotonin levels in the brain, which can help regulate mood and anxiety. When increasing the dose, it’s best to do it slowly and steadily to prevent unwanted side effects (Lydecker, 2020). Careful monitoring is essential to ensure the patient’s safety and well-being.

Reducing the patient’s OCD and anxiety symptoms is best accomplished through medication management and psychotherapy. A combined approach can address both the biological and psychological aspects of OCD. When treating OCD in young people, cognitive behavioral therapy (CBT) is by far the most popular method now available (Lydecker, 2020). CBT is effective in helping patients develop coping strategies and change maladaptive thought patterns. The patient can benefit from CBT by learning to recognize his obsessions and compulsions and developing coping mechanisms for his intrusive thoughts and anxiety. Therapy sessions can be tailored to his specific needs and challenges. It is recommended that the patient’s loved ones participate in therapy to learn more about OCD and how they can help the patient (Lydecker, 2020). Family involvement can provide additional support and understanding.

Additional laboratory tests should be ordered to rule out any underlying medical conditions causing the patient’s symptoms. This step ensures that no other health issues are contributing to his condition. It is recommended that the patient be submitted for blood tests to rule out metabolic or endocrine abnormalities. These tests can help identify any physiological factors affecting his mental health. A urine toxicology check can help identify substance abuse; therefore, he should also be referred for that. This precautionary measure can rule out any substance-related issues.
The patient can benefit from health promotion by being encouraged to participate in physical activity and other activities, such as sports and music, that help him relax and unwind (Walter et al., 2020). Engaging in enjoyable activities can improve his overall mood and reduce stress. To further boost his mood and combat his feelings of isolation, he should be encouraged to participate in group activities with his peers. Social interaction can enhance his sense of belonging and support.

The patient’s treatment should incorporate medication management, psychotherapy, laboratory tests, and health promotion activities. A holistic approach can address multiple facets of his condition. It is essential to include intermediate objectives in the treatment plan that are tied to the theoretical framework (Walter et al., 2020). Setting clear goals can guide the treatment process and measure progress. The patient’s short-term aims should be to lessen his OCD symptoms, boost his academic achievement, and encourage him to participate more actively in his social life. Achieving these goals can significantly improve his quality of life. The patient and his loved ones must also be aware of obsessive-compulsive disorder (OCD) and its various treatment options. Education can empower them to make informed decisions about his care.

Case Study: Assessment and Treatment of a 13-Year-Old with OCD and GAD – Obsessive-Compulsive Disorder (OCD) and Generalized Anxiety Disorder (GAD).

References.
Lydecker, J. A., Ivezaj, V., & Grilo, C. M. (2020). I am testing the validity and clinical utility of the severity specifiers for binge-eating disorder for predicting treatment outcomes. Journal of consulting and clinical psychology, 88(2), 172.
O’Leary, K. B., & Khan, J. S. (2024). Pharmacotherapy for Anxiety Disorders. Psychiatric Clinics.
Syros, I., & Anastassiou-Hadjicharalambous, X. (2024). Implementation of Cognitive Behavioral Therapy in a Child with Obsessive-Compulsive Disorder: A Pharmacotherapy Case Study Help. OBM Neurobiology, 8(3), 1-25.
Walter, H. J., Bukstein, O. G., Abright, A. R., Keable, H., Ramtekkar, U., Ripperger-Suhler, J., & Rockhill, C. (2020). Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 59(10), 1107-1124.
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Tags: Adolescent Psychiatry, Cognitive Behavioral Therapy, Family History, Generalized Anxiety Disorder, Genetic Predisposition