She spends several hours each day engaging in these behaviors and lately, has started to use undiluted bleach to clean her hands. The skin on her hands is red, raw, cracked, and dry.

·         Blood pressure: 90/60 mmHg

·         Respiratory rate: 22 breaths/minute

·         Temperature: 37.5°C

·         Oxygen saturation: 97% on room air

Situation: A 42-year-old woman with a history of obsessive-compulsive disorder (OCD) is presenting to the mental health ED with exacerbated symptoms. She engages in ritualistic behaviors such as compulsive hand washing, checking locked doors, and hoarding cleaning supplies. Recently, she has been using undiluted bleach to clean her hands, resulting in red, raw, cracked, and dry skin.

Background: The patient has a longstanding history of OCD characterized by intrusive thoughts and compulsive behaviors. She struggles to leave her house due to fear of germs and spends several hours each day engaged in these behaviors, impacting her daily functioning.

Assessment: The patient is experiencing an exacerbation of her OCD symptoms, resulting in severe distress and functional impairment. Her compulsive behaviors are causing significant physical harm, as evidenced by the raw and damaged skin on her hands.

Recommendation:

1. Provide immediate medical attention for the patient's hand injuries, including wound care and assessment for infection.

2. Initiate psychiatric evaluation and treatment to address the exacerbation of OCD symptoms, including medication management and therapy.

3. Collaborate with the patient and her daughter to develop a comprehensive treatment plan that includes coping strategies, exposure therapy, and support resources.

4. Educate the patient and her daughter about the risks associated with using undiluted bleach and provide guidance on safe hygiene practices.