A CASE PRESENTATION

ON
OBSESSIVE COMPULSIVE DISORDER (OCD)

PRESENTED BY:
V.PRAVALLIKA
PHARM-D
INTERNSHIP
14441T0024
PATIENT DETAILS:
Pt. Name: Mr X
Age/ Gender: 26 Years/ Male
Admission Number: 35295
Department: Psychiatry IP
Admission Date: 18-4-19
Discharge Date: 27-4-19
Consultant Doctor: Dr.Venkata Ramudu sir
 SOAP NOTES:
SUBJECTIVE EVALUATION:
A 26 years male patient of weight 62 kgs was admitted in the
Psychiatric ward with the chief complaints of getting fear when ever
he see a sharp object and he gets doubt weather “I might have harmed
opposite persons with the object”. He was repeatedly checking the
doors at night , to check weather locked or not & He was
unnecessarily washing his washed clothes again & again , repeatedly
washing his hands since 2 months.
• Patient had no significant past medical and medication history.
• Personal history shows he completed B.Tech and worked as
 lecturer, had mixed diet & normal appetite ,normal bowel &
bladder habits and decreased sleep.
• Family history shows irrelevant family history

OBJECTIVE EVALUATION;
• On general examination the patient was conscious & coherent
• On Physical examination B.P-110/70 mm Hg , P.R-71 bpm,R.R-
22cpm,Temp-Afebrile.
• On systemic examination all systems were normal , CNS-
Responding to questionaires
• No laboratory investigations were performed
ASSESSMENT:
Based on the subjective( Chief complaints) and objective
evaluation (On questioning the patient about the symptoms and his
thoughts and daily activities)
the patient was diagnosed with
OBSESSIVE COMPULSIVE DISORDER
• The condition is moderate
• It is managable with medications
PLANNING:
PROGNOSIS TREATMENT
DAY 1: Rx
BP: 110/70 mmHg Tab. Resperidone 2mg 0-0-1
Tab. Escitalopram 10mg 0-0-1

DAY 2: Rx
Tab. Sertaline 50mg 2-0-0
BP: 120/70 mmHg Tab. Olanzapine 5mg 0-0-1
Tab. Diazepam 5mg 1-0-0

DAY 3: Rx
BP: 110/70mmHg Tab. Sertaline 50mg 2-0-0
Tab. Olanzapine 5mg 0-0-1
Tab. Diazepam 5mg 1-0-0
DAY 4: Rx
Tab. Sertaline 50mg 2-0-0
BP: 120/80 mmHg Tab. Olanzapine 10mg 0-0-1
Tab. Diazepam 5mg 1-0-0
DAY 5:
BP: 110/80 mmHg Rx
Tab. Sertaline 50mg 2-0-0
Tab. Olanzapine 10mg 0-0-1
DAY 6: Tab. Diazepam 5mg 1-0-0
BP:120/70 mmHg
Rx
Same treatment was
continued.
Tab. Sodium Valproate
200mg 1-0-1
 Rx
DAY 7: Tab. Sertaline 50mg 2-0-0
BP: 110/80 mmHg Tab. Olanzapine 10mg 0-0-1
Tab. Sodium Valproate 200mg 1-
0-1
Tab. Diazepam 5mg 1-0-0
DAY 8: Rx:
BP: 120/70 mmHg CST

DAY 9: Rx:
BP: 120/90 mmHg CST

DAY 10: Rx:

The patient has been discharged
with the following medications
for 30 days and asked to review
after 30 days.
Tab. Sertaline 50mg 2-0-0
Tab. Olanzapine 10mg 0-0-1
Tab. Sodium Valproate 200mg 1-
0-1
Tab. Diazepam 5mg 1-0-0
 DRUG CHART:
S DRUG INDICATI CATEGORY DOSE ROA FRE No. Of Normal
. NAME ON QUE Days Doses
N NCY
o
1 T.Resperidone To calm Atypical 2mg P/O OD Day 1 0.02-
the patient anti- 0.06mg/kg
Psychotic
2 T.Escitalopra To treat SSRI 10mg P/O OD Day 1 Max.
m OCD 20mg/Day

3 T.Sertaline To treat SSRI 50mg P/O OD Day2- Max.

OCD Day10 200mg/Day

4 T.Olanzapine To reduce Atypical 10mg P/O OD Day2- Max.20mg/

fear Anti- Day 10 Day
Psychotic
5 T.Sod.Valproa To sedate Anti- 200mg P/O BD Day 9- 15mg/kg
te the patient Convulsant Day 10

6 T.Diazepam To treat Sedative- 5mg P/O OD Day 2- 0.3mg/kg

Anxiety Hypnotic 10
CLINICAL PHARMACIST CARE ISSUES:
• The prescription was found to be rational
• No significant ADRs & Medication Errors were observed in
patient
The prescription consists of the following potential drug-drug
interactions but not actual
Resperidone + Diazepam – Neuroleptic Malignant Syndrome.
Resperidone + Sertaline – Sertaline moderately increases the
Resperidone levels when taken at high doses.
Resperidone + Sodium Valproate – Resperidone reduces the
levels of sodium valproate .
Sodium Valproate + Diazepam – Sodium Valproate increases the
serum levels of Diazepam
Olanzapine + Sertraline – Increased serum olanzapine levels
Olanzapine + Sodium Valproate – Decreases the Olanzapine levels
PATIENT COUNSELLING (Provided To The Care-
Taker):
REGARDING DISEASE:
Obsessive-Compulsive Disorder (OCD) is a common,
chronic and long-lasting disorder in which a person has
uncontrollable, reoccurring thoughts (obsessions) and behaviours
(compulsions) that he or she feels the urge to repeat over and over.
This condition is in-curable but can be managed with Cognitive-
Behavioural therapy, Pharmacological therapy and by proving
guidance to the patient and care-takers.
REGARDING MEDICATIONS:
Tab. Sertraline 50mg:
• I educated the care taker this drug is used to treat OCD in the
patient.
• I advised that the drug should be given orally once a day at
morning before or after food with glass full of water without
breaking or crushing the tablet. It should be given for 30 Days.
• I advised the care taker that the dose shouldn’t be skipped or
mixed dose shouldn’t be taken.
• I educated the care-taker that on usage of this drug the patient may
experience the side effects like Drowsiness, Dizziness, tired feeling
and constipation.
• I instructed the care taker that they have to consult the physician
before taking any OTC drugs.
• I advised the care taker that if the patient experience any of the allergic
or severe side effects consult the doctor immediately.
• I instructed the care taker to review the prescription before completion
of course.
Tab. Olanzapine 5 mg:
• I educated this drug is used to treat the Psychotic anxiety& OCD
I advised that the drug should be given once a day at night time
after food with glass full of water for 30 days. After completion
of the course the drug shouldn’t be stopped suddenly as it may
cause withdrawal symptoms like Sweating, unable to sleep,
tremor, anxiety.
• I advised to consult the physician before completion of the
prescribed course.
• I educated that the patient may experience side effects like Weight
gain, increased appetite, head ache, dizziness, drowsiness, memory
problems, constipation, loss of bladder control, elevates body
temperature(Avoid exposure to high temperature).
• I advised to follow caution while sudden standing or sitting to avoid
Orthostatic Hypotension.
• I advised the care taker to monitor LFT of the patient.
• I advised to consult the doctor immediately if patient experiences any
of the allergic reactions or side effects before the drug stoppage.
Tab. Diazepam 5 mg:
• I educated the carer that this drug is used to calm down the
patient.
• I instructed that the drug should be given in the morning times
after food with glass full of water for 30 days and care to be
taken that the tablet shouldn’t be crushed or broken or chewed.
• I counselled that the dose shouldn’t be skipped or double doses
shouldn’t be taken.
• I instructed the carer to consult the doctor before the stoppage of
drug, as the drug may cause physical and physiological dependence
with long term usage.
• I advised the carer to make the patient to dangle the leg for a few
minutes before he getting down from the bed.
• I educated the carer that the patient may experience the side effects
like Memory problems, drowsiness, tired feeling, muscle weakness,
nausea, constipation, dry mouth, slurred speech, blurred or double
vision.
Tab. Sodium Valproate 200 mg:
• I educated the care taker that the drug is used to reduce the
excitation of the patient.
• I advise the care taker to administer the drug twice a day in the
morning and night times after food with glass full of water, only
after food to avoid GI Irritation and care to be taken to administer
the drug wholly without crushing, broken or chewed.
• I instructed the care taker that the dose shouldn’t be skipped or
double dose shouldn’t be taken if the previous dose is missed.
• I educated that the patient may experience side effects like Nausea,
Abdominal Cramps, Abnormal Liver function, Weight gain and
Diarrhoea, sedation, dizziness and Confusion are often observed.
• I instructed the care taker that the patient have to avoid the activities
like weight lifting and driving which requires the mental alertness.
• I advised the care taker that if the patient experiences any of allergic or
adverse drug reactions consult the physician immediately.
REGARDING LIFE STYLE MODIFICATIONS:
 Take steps to administer the medications regularly without missing the dose.
 Avoid factors that causes stress to the patient.
 I advised the carer to make the patient to practise mood stabilizing and mind
calming activities like meditation, listening songs to reduce stress.

 Advised the care taker to encourage the patient to practise sports.

 Try delay therapy- Advise the patient to concentrate on the other activities and tasks
to stop thinking about suicide etc.,
 Advise the patient to get adequate sleep to reduce the repetitive thinking and to
reduce Stress
 Advise the care taker to provide brain healthy foods.
 Advise to try Acupuncture.
 Promote the patient to use relaxing oils.
DISCUSSION:
OCD is the condition where the people feels the need to check the
things repeatedly, perform certain routines repeatedly, or have
certain thoughts repeatedly.
Common activities include hand
washing, counting of things, and
checking to see if a door is locked.
The condition is associated with
anxiety disorder, and an increased
risk of suicide.
 SYMPTOMS:
OBSESSIONS:
o Fear of germs/ Contamination.
o Unwanted thoughts involving religion, sex and harm.
o Aggressive thoughts towards others and self.
o Having things symmetrical or in a perfect order
COMPULSIONS:
o Excessive cleaning or hand washing.
o Ordering or arranging things in a particular,
precised way.
o Repeatedly checking the things like door, gas.
o Continuous counting.
CAUSES:
• Genetics
• Brain structural changes
• Environmental factors
• Auto immune Neuropsychiatric disorders

RISK FACTORS:
• History of child abuse
• Other stress-inducing event.
DIAGNOSIS:
o Based on the signs and symptoms.
o Past medical history.
o Family history.
o Questionnaries
TREATMENT:
GOALS:
 To reduce patient symptoms.
 To reduce Severity, Duration, Frequency of the diseased
condition.
 To prevent re-occurrence
 To improve memory.
 To improve Socio-Economic status.
 To minimize the side effects.
 To improve Quality Of Life.
 PHARMACO THERAPY:
 Psycho therapy
 Anti- Depressants
 Anti- Psychotics
 Benzodiazepines
 ECT
 Psycho Surgery

 Relaxation Techniques
 Reduce Stress
 Cognitive – Behavioural Therapy
THANKING YOU