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Monday, January 23, 2012

Case Presentation: Jake B.

A very happy good morning to all NY Giant fans out there.

As discussed in the first posting, I will speak about cases that I read about or actual patients that I treat. There is no greater feeling in the world than vindication that the field you work in and the techniques you use are a truly successful with the patient and professionally. I had this recently when working with a patient.

**PLEASE NOTE: This posting is in accordance with HIPAA rules and regulations. There are various parts of this case that are changed to protect the identity of the patient. If you would like to learn more about HIPAA. Click the link.

Jake B. is a 15 year old Latino male, who was referred to me by an after school program. He reported "not feeling well and being really lazy with stuff". After making collateral contact with his medical physician to rule out any physiological problems, he and his parents decided entering into therapy would be the best solution. During the initial phase of treatment, Jake was displaying and reporting a lot different symptoms that would fit the criteria for a diagnosis of Dysthymic Disorder. According to the DSM(Diagnostic and Statistical Manual)-TR-IV, which is the bible of mental health that lists all the psychiatric disorders. When someone receives a diagnosis they must fit a certain amount of criteria for them to be clinically appropriate for the disorder. If it doesn't fulfill it a mental health professional cannot give the patient that diagnosis. DSM-IV-TR defines Dysthymia: As a chronic mood disorder with a duration of at least 2 years (1 year in adolescents and children). It is manifested as depressed mood for most of the day, occurring more days than not, and accompanied by at least 2 of the following symptoms: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration, difficulty making decisions, feelings of hopelessness.

The patient reported low energy, low self-esteem, and poor concentration, yet he was not having any of the other symptoms. I was therefore able to give him this diagnosis. As treatment progressed, I noticed that he while he was engaged during our therapy sessions, but his improvement was minimal, and then the patient said to me: "You see my hands? They are all dry and cracked, they bleed because they are so dry. "Shortly after Jake told me that he goes through a little bottle of purell hand sanitizer every two days. Jake went on to tell me about his excessive need to wash his hands after every activity regardless of whether the activity was "dirty" or not. After further assessment, it was clear that not only was Jake suffering from Dysthymia, but also Obsessive Compulsive Disorder aka OCD. The DSM gives a lengthy explanation for OCD, but in short when some has certain obsessive tendencies that they feel the need to act compulsively on those obsessions= OCD.

There is so much to talk about regarding OCD, but that will have to wait for different post. For the purpose of this post, Jake was suffering from it in the very classic sense. Not only the need to feel germ free but it was ritualistic which is also a very classic symptom of OCD. At this point, I felt that this may be the cause to a lot of his problems even the Dysthymia. There are various reasons why someone develops OCD, but a big factor is the need for control. When someone feels out of control or unable to achieve a short term goal, they often tend to look for ways they can gain control and this is can sometimes lead to OCD. When Jake is able to control and keep himself germ free it releases his anxious feelings for the moment and he able to move on. After telling Jake this he said "that makes perfect sense, I don't know where I am going to college, I don't have good relationship with my dad, and i am having girlfriend problems...I feel completely helpless."

When Jake and I realized all these different parts of his life which are unstable, we started to work on trying to take more control of the aspects of life he can. That became the focus of our treatment.

I am happy to say that 4 months later, Jake has decided on a college, re-established the relationship with his dad, decided the girl he was dating was not right for him, and only uses purell after using the bathroom. After taking control of his life, he has gained confidence, improved his self-esteem, and his energy level is age appropriate. While he still has poor concentration and has his good days and bad, he is not the same person I started seeing six months ago.

For those in the mental health field I hope this gives you chizuk that what we do is not always for nothing. For those doubters of the mental health profession, are you really still doubting this?

Have a very good GIANTS NFC CHAMPS MONDAY!!!

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