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OCD in children

 A 13-year-old adolescent girl is brought to a psychiatrist by her mother. The patient states that for the past 6 months she has been showering for long periods, up to 5 hours at a time. She says she is unable to stop this behavior although it is distressing to her and causes her skin to crack and bleed. She reports that the symptoms started after she began to have recurrent thoughts of being dirty or unclean. These thoughts occur many times a day. She states that she grows increasingly anxious until she is able to take a shower and clean herself. The patient claims that the amount of time she spends in the shower is increasing because she must wash herself in a particular order to avoid getting the “clean suds” mixed up with the “dirty suds.” If this happens, she must start the whole showering process over again. The patient states that she knows that she “must be crazy,” but she seems unable to stop herself. The patient’s mother verifies the patient’s history. She claims that her daughter has always been popular in school and has many friends. She emphatically states that her daughter has never used drugs or alcohol. The patient’s only medical problem is a history of asthma, which is treated with an albuterol inhaler. The patient’s mental status examination is otherwise unremarkable except as noted earlier. What is the most likely diagnosis for this patient? The most likely diagnosis for this patient is OCD. What would be the best type of psychotherapy for this condition? The best psychotherapy for this condition would be cognitive behavioral therapy and exposure therapy. What would be the best type of pharmacotherapy for this patient? I propose that the best pharmacotherapy would be an SSRI. Distill the salient elements that contribute to diagnosis and treatment planning of children Review the evidence-based literature based upon the case data and provisional diagnosis. Compare and contrast the two non-pharmacologic treatment approaches that could be employed, one should be a web-based treatment Propose interventions which reflect inter professional collaboration, integrating ethical, legal social factors in clinical decision-making. Identify measurable outcomes expected as a result of optimizing care based upon the knowledge gained through the case, and the proposed interventions for care.

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