As Good as It Gets 1

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As Good As It Gets
Overview

Melvin Udall, from As Good As It Gets, presents today in your clinic. He has a history of obsessive-compulsive disorder (OCD). Although past attempts at treatment were unsuccessful, Melvin wants to try again. He has just begun a relationship with Carol Connelly, a waitress, who has urged Melvin to explore treatment that will help him abandon some of his rituals, improve his social skills, and ultimately manage the anxiety and obsessions that cause his behavioral and interpersonal difficulties.

Client name: Melvin Udall
Psychiatric diagnosis: Obsessive–compulsive disorder
DSM-IV-TR criteria:
Client has either obsessions or compulsions:

Obsessions:
1. Recurrent and persistent thoughts, impulses, or images that, at some time during the disturbance, are intrusive and inappropriate and cause marked distress 2. The thoughts, impulses, or images are not simply excessive worries about real problems. 3. Client tries to ignore, suppress, or neutralize with some other thought or action such thoughts, impulses, or images. 4. Client recognizes that the thoughts, impulses, or images are a product of his or her own mind.

Compulsions:
1. Repetitive behaviors (e.g., handwashing, ordering) or mental acts (e.g., praying, counting) that the client feels driven to perform in response to an obsession, or according to rigidly applied rules 2. The behaviors or mental acts aim to prevent or reduce distress or some dreaded situation; however, they either are not realistically connected with what they are designed to neutralize or prevent or are clearly excessive.

Client recognizes the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children.

Obsessions or compulsions cause marked distress, are time-consuming (more than 1 hour a day), or significantly interfere with occupation, education, activities, or relationships.

If client has another mental disorder, the content of obsessions or compulsions is not restricted to it (e.g., food preoccupation with an eating disorder).

The disturbance is not caused by a substance or a medical condition. Date: MARCH 13, 2007

Your name: GAYLE D. RUDDER

Name of the client you are assessing: Melvin Udall
Name of the movie: As Good As It Gets

What is the chief complaint? (Why, in his/her “own words,” would the client say he or she being assessed?)

Response:
The client's chief complaint is "an ailment"

Based on the above information and a close viewing of the movie, what questions would you raise during history taking? What are some possible answers? You might base your questions on the:
History of your client’s present (and presenting) illness Past psychiatric history, its treatment, and treatment outcomes Psychosocial history
Past significant medical history

Response:
Why are you seeking psychological care today? "I have an ailment". Describe the symptoms of your ailment. "I cannot step on cracks, lines, or patterns on the ground; I have five separate locks on my door; I need to sit in the same seat at the restaurant; I must have the same waitress; I order the same meal each time and I carry my own cutlery". Can you recall the the onset of your ailment?

Do you check things over and over,( light switches, appliances, locks)? Are you overly concerned about details?
Do you take long showers?
Are you overly concerned about contamination and germs?
Do you avoid certain items or situations?
Are you frequently absent or late for important apointments because of your present problem? Has there been any change in you sleep patterns?
Describe you past medical history? I have a history of OCD, and depression Have your seen a doctor or psychiatrist regarding your preent symptoms? Yes. Are you presently on any prescription. OTC or herbal medications? Yes I am presently on prescription pills? How effective is the medication I don't like taking pills, so I rarely...
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