NUR 114 #3 OCD

What are obsessions?

Recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses that cause marked anxiety and interfere with interpersonal, social, or occupational function

what are some common compulsions?

Checking rituals, counting rituals, washing & scrubbing until skin is raw, praying or chanting, touching, rubbing, or tapping, ordering & rearranging, exhibiting rigid performance, having aggressive urges

What are compulsions?

Ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety

What is excoriation?

Skin picking also known as dermatillomania

What is trichotillomania?

Chronic repetitive hair pulling

What is onychophagia?

Chronic nail biting

What is oniomania?

Compulsive buying

Med Treatment?

1st gen SSRIS: (fluvoxamine & sertraline are 1st line) then Venlataxine 2nd gen SSRIS: risperidone & aripiprazole

What’s behavioral therapy?

Exposure & response prevention

What is response prevention?

Focuses on delaying or avoiding performance of rituals

Nursing actions for a patient with OCD?

Observes their eating, drinking, sleeping, & elimination patterns, prepare them for bedtime by decreasing stimuli, allow extra time for ADLs, encourage them gradually, build trust → decreases anxiety, help them with alternatives for dealing with anxiety, be honest, provide activities enjoyed by patient, teach them social skills & active listening

SSRI contraindications?

Altered hepatic/renal function, severely depressed (kids especially) → increased suicidality, pregnancy (pulmonary & cardiac problem in fetus)

Adverse effects of SSRIS?

CNS effects (headache, drowsiness, dizziness, insomnia, anxiety, activation of mania/hypomania, tremor, agitation, & seizures. N/V, diarrhea, dry mouth, anorexia, constipation, changes in taste, cough, dyspnea, respiratory infections, pharyngitis, painful periods, sexual dysfunction, increased IOP, sweating, rash, fever, pruritus

How does serotonin syndrome manifest?

Confusion, agitation, disorientation, hallucinations, delirium, seizures, tachycardia, labor bloop pressure, diaphoresis, fever, hyperflexia, tremors, nausea, vomiting, diarrhea, abdominal pain, coma

What should be avoided when taking SSRIS?

MAOIS, TCAS (serotonin syndrome), other SSRIS, SNRIS, St. John’s wort, & triptans, aspirin, NSAIDS, anti platelets (bleeding)

Fluvoxamine usage?

Reduces the severity and frequency of obsessive thoughts and compulsive behaviors, improves mood & reduces anxiety

Fluvoxamine MOA?

Increased levels of serotonin, inhibits the reuptake of serotonin into presynaptic neurons, making more serotonin available

Risk factors?

Genetics, family hx, childhood trauma, hx of abuse/neglect, anxiety or depressive disorder, neuro chemical imbalances, personality traits (rigidity, perfectionism)