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Obsessive compulsive disorder

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Obsessive compulsive disorder

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Obsessive compulsive disorder

  1. 1. OCD Presenter Nandini Bhumij M.Sc. Nursing 1st yr.
  2. 2. History  14th & 15th century thought people were possessed by the devil and treated by exorcism  17th century thought people were cleansing their guilt  18th century finally considered medical issue  20th century began treating with behavioral techniques
  3. 3. WHAT IS OCD?  It is an anxiety disorder.  The person has recurring thoughts or images(obsessions) and/or repetitive, ritualistic-type behaviors that the individual is unable to keep from doing(compulsions).  The person may try to suppress these thoughts or behaviors but is unable to do so.  The individual knows that the thoughts or behaviors are irrational but feels powerless to stop.
  4. 4. Definition The DSM-IV-TR describes obsessive- compulsive disorder (OCD) as recurrent obsessions or compulsions that are severe enough to be time consuming or to cause marked distress or significant impairment (APA,2000).
  5. 5. Obsessions  It is defined as unwanted, intrusive, persistent ideas, thoughts, impulses or images that cause marked distress.
  6. 6. Compulsions  It denote unwanted repetitive behavior patterns or mental acts that are intended to reduce anxiety, not to provide pleasure or gratification.
  7. 7. Obsessive-Compulsive Disorder  Affects almost 3% of world’s population  Start anytime from preschool to adulthood  Typically between 20-24  many different forms of OCD – differ from person to person  cause of OCD is still unknown  Better when diagnosed early
  8. 8. Classification ICD 9  F42 OCD  F42.0 Predominantly obsessive thoughts or ruminations.  F42.1 Predominantly compulsive acts.  F42.2 Mixed obsessional thoughts and act.  F42.8 Other obsessive-compulsive disorder.  F42.9 Obsessive compulsive disorder, unsetisfied.
  9. 9. Etiological factors Psychoanalytical Theory Learning Theory Biological Aspects Neuroanatomy Physiology Biochemical Factors
  10. 10. Etiological factors Psychoanalytical Theory OCD pts have:  weak, underdeveloped egos. (Reasons: unsatisfactory parent-child relationship, conditional love etc.).
  11. 11. Psychoanalytical Theory cont…  Regression to the pre-Oedipal anal-sadistic phase, combined with use of specific ego defence mechanisms (isolation, undoing, displacement, reaction formation), produces the clinical symptoms of obsessions and compulsions
  12. 12. Etiological factors  Learning Theory  It explains- OCD pts. as a conditioned response to a traumatic event.  Traumatic event produces anxiety and discomfort.  passive avoidance(staying away from the source)  active avoidance(staying with the source)
  13. 13. Etiological factors  Biological Aspects Neuroanatomy: Neuroimaging techniques have shown abnormal metabolic rates in the basal ganglia and orbital frontal cortex of individuals with the disorder(Hollander & Simeon, 2008).
  14. 14. Etiological factors  Physiology. Electrophysiological studies, sleep electroencephalogram studies, and neuroendocrine studies have suggested that there are commonalities between depressive disorders and OCD (Sadock & Sadock, 2007). Neuroendocrine commonalities were suggested in studies in which about one third of OCD clients show nonsuppression on the dexamethasone-suppression test and decreased growth hormone secretion with clonidine infusions.
  15. 15. Etiological factors  Biochemical Factors. The neurotransmitter serotonin as influential in the etiology of obsessive-compulsive behaviors.  Drugs that have been used successfully in alleviating the symptoms of OCD are clomipramine and the selective serotonin reuptake inhibitors (SSRIs), all of which are believed to block the neuronal reuptake of serotonin, thereby potentiating serotoninergic activity in the central nervous system.
  16. 16. Diagnostic criteria  Specific criteria to be clinically diagnosed  Anxiety disorder with presence of obsessions or compulsions  ego dystonic – realize thoughts and actions are irrational or excessive  Must take up more than 1 hour a day  Must disrupt daily routine  Symptoms can’t result from effects of other medical conditions or substances
  17. 17. Symptoms of Obsessions  Repeated thoughts about contamination(e.g. may lead to fear of shaking hands or touching objects).  Repeated doubts(e.g. repeatedly wondering if they locked the door or turned off an appliance).
  18. 18.  A need to have things in a certain order(e.g. feels intense anxiety when things are out of place).
  19. 19. Obsessions cont…  Thought of aggression (e.g. to hurt a loved one).  Sexual imagery.
  20. 20. Symptoms of Compulsion  Washing and cleaning(e.g. excessive hand washing or house cleaning).  Counting (e.g. counting number of times that something is done).
  21. 21.  Checking (e.g. checking something that one has done, over and over).  Requesting or demanding assurances from others.
  22. 22. Compulsion cont…  Repeating actions(e.g. going in and out of door or up and down from a chair).  Ordering(e.g. arranging and rearranging cloths or other items). 
  23. 23.  Note : the obsessions and compulsions seem to be worse in the face of emotional stress.
  24. 24. Clinical Features  Obsessional thought  Obsessional ruminations  Obsessional doubts  Obsessional impulses  Obsessional rituals  Obsessional slowness
  25. 25. Diagnosis  Suggested by demonstration of ritualistic behavior that is irrational or excessive.  MRI and CT shows enlarged basal ganglia in some patients.  PET scanning shows increased glucose metabolism in part of basal ganglia.
  26. 26. PET scans indicate differences in brain activity of OCD patients versus normal
  27. 27.  OCD found excessive with other diseases  Common diseases: Depression, Schizophrenia…  Depression is the most common  Many people with OCD suffered from depression first  2/3 of OCD patients develop depression  makes OCD symptoms worse and more difficult to treat  People with OCD common diagnosed as Schizophrenic  hard to separate obsessions from delusions
  28. 28. Treatment  Only completely curable in rare cases  Most people have some symptom relief with treatment  Treatment choices depend on the problem and patients preferences  Most common treatments:  Behavioral Therapy  Cognitive Therapy  Medication
  29. 29. Cognitive-Behavioral Therapy  Cognitive: change the way they think to deal with their fears  Behavioral: change the way they react to “anxiety- provoking” situations  Exposure and Response Prevention  Slowly learning to tolerate anxiety associated with not performing ritual behavior  Psychotherapy  Talking with therapist to discover what causes the anxiety and how to deal with symptoms  Systematic Desensitization  Learning cognitive strategies to deal with anxiety then gradual exposure to feared object
  30. 30. Cognitive-Behavioral Therapy  Should be done when people are ready for it  Must be customized for each person’s specific form of OCD and their needs  No side affects except increased anxiety with exposure to fear  Often lasts about 12 weeks  Positive effects off CBT last longer than those of medication  If OCD returns can successfully treat again with same therapy  Best treatment approach for most is CBT combined with medication
  31. 31. Medication  Anxiolytic benzodiazepine such as chloradiazepoxide or diazepam  give temporary relief from anxiety but not really effective on obsessions and compulsions  Antidepressants because of common depression  Selective Serotonin Reuptake Inhibitors (SSRIs): alter the levels of neurotransmitter serotonin in the brain which helps brain cells communicate with one another  Prevents excess serotonin from being pumped back into original neuron that released it  Then can bind to receptor sites of nearby neurons and send chemical message that can help regulate anxiety and obsessive compulsive thoughts  Most effective drug treatment helping about 60% of patients  Ex: Prozac, Zoloft, Lexapro, Paxil
  32. 32. Nursing Management
  33. 33. Nursing assessment  Assessment should focus on the collection of physical, psychological and social data.  The nurse should be particularly aware of the impact of obsessions and compulsions on physical functioning, mood, self-esteem and normal coping ability.
  34. 34. Nursing assessment  Nurse should also note: the defence mechanism used thought content or process potential for suicide, ability to function and social support systems.
  35. 35. The following criteria may be used to measure outcomes in the care of the client with OCD. The Client: ● Is able to maintain anxiety at a manageable level without resorting to the use of ritualistic behavior. ● Is able to perform activities of daily living independently. ● Verbalizes understanding of relationship between anxiety and ritualistic behavior. ● Verbalizes specific situations that in the past have provoked anxiety and resulted in seeking relief through rituals. ● Demonstrates more adaptive coping strategies to deal with stress, such as thought stopping, relaxation techniques, and physical exercise. ● Is able to resume role-related responsibilities because of decreased need for ritualistic behaviors.
  36. 36. Nursing diagnosis1  Ineffective coping  Related to under developed ego,  Punitive superego; avoidance learning; possible biochemical changes evidence by ritualistic behavior and or obsessive thoughts.
  37. 37. Nursing management cont…  Objective : client will demonstrate ability to cope effectively without restoring to obsessive compulsive behaviors or increased dependency.
  38. 38. Nursing diagnosis 2  Ineffective role performance  Related to: need to perform rituals.  Evidence by: inability to fulfill usual pattern of responcibility.
  39. 39. Nursing management cont…  Objective: Client will be able to resume role- related responsibilities.
  40. 40. Evaluation Reassessment is conducted in order to determine if the nursing actions have been successful in achieving the objectives of care. Evaluation of the nursing actions for the client with OCD may be facilitated by gathering information using the following types of questions: ● Can the client refrain from performing rituals when anxiety level rises? ● Can the client demonstrate substitute behaviors to maintain anxiety at a manageable level?
  41. 41. Cont… ● Does the client recognize the relationship between escalating anxiety and the dependence on ritualistic behaviors for relief? ● Can the client verbalize situations that occurred in the past during which this strategy was used? ● Can the client verbalize a plan of action for dealing with these stressful situations in the future? ● Can the client perform self-care activities independently? ● Can the client demonstrate an ability to fulfill role related responsibilities? ● Can the client verbalize resources from which he or she can seek assistance during times of extreme stress?
  42. 42. Summarization  Definition of OCD  Diagnostic criteria  Etiology  Clinical features  Sign and symptoms  Diagnosis  Treatment  Nursing management  Evaluation
  43. 43. Conclusion  OCD is a complicated issue  Most cases are incurable  Best form of treatment is CBT in combination with medication  Most important thing that can be done to discover more about OCD and its treatments is to research the brain
  44. 44. Bibliography 1. Townsend Mary.C. psychyiatric mental health nursing concepts of care. 4th edition. F. a. davis company publishers. Philadelphia USA. P 526-530. 2. Townsend Mary.C. psychyiatric mental health nursing concepts of care. 5th edition. F. a. davis company publishers. Philadelphia USA. P 449-454. 3. R. sreevani. A guide to mental health and psychiatric nursing. 3rd edition.jaypee brother medical publishers(p) delhi. P179-182 4. Clinical correlates of functional impairment in children and adolescents with obsessive Joshua M. Nadeau | Adam B. Lewin | ... 5.
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Obsessive compulsive disorder


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