OCD, GAD, Panic disorder, Phobias

OCD patho

Malfunction in cortico- striato-thalamo-cortical circuit in brain may be cause
- Neurotransmitters
- No specific gene has been isolated, but genetic linkage
suspected
- Neurobiology of OCD involves several brain areas
- Mounting evidence that increased immune system activation plays important role

GAD clinical manifestations

- Intense tension and worry
- Anticipate disaster
- Preoccupied
- May be diagnosed when ______
- Person cannot rid self of anxious state
- Difficulty relaxing, startle easily, have trouble falling asleep
- Somatic symptoms

- High co-morbidity
- Can manifest in children with same symptoms as adults
- Intense worry over a long period of time
- Significant distress
- Common among children, adolescents
- Treated mostly with psychotherapy to build up healthy responses to anxiety

Panic disorder clinical manifestations

- Sudden attacks of terror
- Fear of one’s own unexplained symptoms is a symptom
- The person may worry intensely about next attack
- Can occur any time of day, even during sleep
- Can be debilitating if treatment not sought
- In severe cases, the person ______
- One of most treatable anxiety disorders

Phobias 

Intense, persistent fear or anxiety associated with a particular object or situation (stressor)
Three primary categories
- Specific phobia
- Agoraphobia
- Social anxiety disorder - fear others will judge them
- Often comorbid with other psychiatric alterations
- Treatment focuses on teaching coping strategies
- May be combined with pharmacologic interventions, psychotherapy

Specific phobia

Persistent fear of clearly discernible, circumscribed objects or situations leading to avoidance behavior

Exposure therapy

Agoraphobia

• An intense fear of being in open spaces, closed-off
areas, alone, or being in public places where
escape might be difficult or help unavailable.
• The listed situations are avoided, require help
from a loved one, or are endured with a strong fear.
• The fear or avoidance is persistent. The individual
knows that the fear is irrational
• An individual has extreme anxiety about 2 or
more of the following situations: Fear of public transport, open space with a crowd, closed off areas, standing in a line or a crowd, being alone outside of the house 

Social anxiety disorder 

• Also known as social phobia
• Includes fear of public speaking or eating and …
• Exposure to the phobic situation usually results in feeling of panic anxiety with sweating tachycardia, and dyspnea
• To meet DSM-5 criteria, fear, anxiety or avoidance is persistent, typically lasting 6 or more months

OCD clinical manifestations

Disabling anxiety disorder characterized by obsessive thoughts and compulsive, repetitive behaviors that dominate the person’s life
Most frequently reported obsessions
- Repeated thoughts about contamination
- Need to have things in certain order
- Repeated doubts with fear
Common themes of obtrusive thoughts
Aggressive impulses
Awareness
Most frequently reported compulsions
- Hoarding is a distinct, separate disorder
Compulsive behavior does not produce sense of pleasure
Person is driven to perform the compulsion to reduce anxiety produced by obsession

Assessment of OCD

Observation and patient interview
Current, past medical history
- Family history
- Age at onset of symptoms
- How symptoms interfere with life
- How much time spent dealing with obsessions, compulsions
- Current level of distress
Activities of daily living
- Typical day’s activities
- How disorder affects health, relationships, spirituality, emotional well-being
Thorough physical assessment

Panic implementation 

- Active supervision
- Provide reassurance
- Use clear and direct communication
- Other:

Phobias implementation

- Assist patient to describe his/her feelings prior to a response to phobic object
- Encourage patient to identify alternative coping strategies
- Other:

OCD implementation

Convey acceptance of the patient; supportive, nonjudgmental
demeanor essential to working with patients with OCD
- Other:
Alleviate fear
- Provide calm presence that will encourage patient to verbalize fears
- Provide reality-based facts related to patient’s fears
- Teach patients to remove triggers from home, work environments
Promote effective coping
Promote effective role performance
- Encourage patient to have healthy conversations with family about the disorder
- Listen to patient describe how behaviors disrupt ability to perform normal roles
- Promote self-awareness
Promote social interaction
- Teach time management techniques to help patient plan timely
participation in social activities
- Encourage patient to be open with friends about the disorder,
enlist their support

Evaluation of OCD

Expected outcomes may include
- Patient verbalizes reduction in anxiety associated with compulsive need to perform behaviors
- Patient demonstrates understanding of appropriate coping behaviors, verbalizes successful use of healthy coping behaviors to reduce need to perform compulsive behaviors
- Patient demonstrates ability to effectively perform expected roles
- Patient verbalizes increased social interaction, decrease in missed events due to performance of ritualistic behaviors
Complete healing likely to take many years
- Nurse should continually reevaluate patient, suggest changes in treatment modalities depending on success or failure of previous treatment plans
- May need to teach additional coping skills or advocate for different medication or counseling
- Encourage patient to continue treatment, not give up, not see disorder as normal