OCD mental health lecture 4 (exam 2)

Obsessive-Compulsive Disorder (OCD)

A disorder characterized by obsessions, compulsions, or both that can interfere significantly with daily functioning.

Obsessions

Excessive, unwanted, intrusive, and persistent thoughts, impulses, or images that cause anxiety and distress.

Control Over Obsessions

Obsessions are not under the patient's control and are incongruent with the patient's usual thought patterns.

Compulsions

Repeatedly performed behaviors done in a ritualistic fashion.

Purpose of Compulsions

The goal is to prevent or relieve anxiety and distress caused by obsessions.

Rituals in OCD

Common compulsions in which objects must be in a certain order, motor activities are performed in a rigid fashion, or things must be arranged in perfect symmetry.

OCD Vicious Cycle

Obsessive thought → anxiety → compulsive behavior → temporary relief → obsessive thought returns.

Temporary Relief in OCD

Compulsive behavior temporarily relieves the anxiety caused by an obsessive thought, reinforcing the OCD cycle.

OCD Diagnostic Criteria

Presence of obsessions or compulsions that cause significant disturbance and are not due to another disorder, substance, or medical condition.

Patient Recognition in OCD

The patient recognizes that the thoughts and actions are unreasonable or excessive.

Functional Impairment in OCD

Thoughts and rituals can severely disturb daily routines, relationships, and occupational functioning.

OCD Time Requirement

Thoughts and rituals are time-consuming, taking longer than 1 hour per day to complete.

OCD and Other Disorders

The thoughts or behaviors must not be the result of another disorder.

OCD and Substances

The thoughts or behaviors must not result from a substance or medical condition.

Typical OCD Onset

OCD commonly has onset in the early 20s to mid-30s, although symptoms often begin in childhood.

OCD Symptom Onset

Symptoms usually have a gradual onset.

Gender and OCD

Females are affected slightly more than males.

Lifetime Prevalence of OCD

Approximately 1.2%.

Age Groups Affected by OCD

All ages can be affected, and OCD is a lifelong illness.

OCD in Children and Adolescents

OCD affects between 1% and 3% or more of children and adolescents.

Psychoanalytic Theory of OCD

Includes underdeveloped egos, regression, and the use of defense mechanisms.

Defense Mechanisms Associated With OCD

Isolation, undoing, displacement, and reaction formation.

Isolation in OCD

A defense mechanism listed in the psychoanalytic theory of OCD.

Undoing in OCD

A defense mechanism listed in the psychoanalytic theory of OCD.

Displacement in OCD

A defense mechanism listed in the psychoanalytic theory of OCD.

Reaction Formation in OCD

A defense mechanism listed in the psychoanalytic theory of OCD.

Learning Theory of OCD

OCD may develop as a conditioned response to a traumatic situation.

Passive Avoidance

A concept listed under the learning theory of OCD.

Active Avoidance

The learning theory associates active avoidance with OCD.

Psychosocial Influences on OCD

Stressful life situations, inability to manage stress following major life stressors, and adverse childhood experiences (ACEs).

Stress and OCD

Inability to manage stress following major life stressors may contribute to OCD.

ACEs and OCD

Adverse childhood experiences are listed as a psychosocial influence associated with OCD.

Biological Factors in OCD

Genetics, neuroanatomy, and biochemical factors.

Genetics and OCD

Genetics are listed as a biological factor contributing to OCD.

Neuroanatomy in OCD

May involve impairment in motor inhibition.

Biochemical Factors in OCD

Dopamine, serotonin, and glutamate are listed as biochemical factors.

Neurotransmitters Associated With OCD

Dopamine, serotonin, and glutamate.

Recovery-Oriented Care for OCD

Uses teamwork and collaboration while working toward recovery.

Advanced Treatments Listed for OCD

Electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and psychosurgery.

ECT for OCD

Electroconvulsive therapy is listed as a recovery-oriented treatment for OCD.

Transcranial Magnetic Stimulation (TMS)

A treatment listed as part of recovery-oriented care for OCD.

Psychosurgery for OCD

Listed as a possible intervention in recovery-oriented care.

Safety Issues in OCD

Safety should be considered as part of recovery-oriented care.

OCD Physical Assessment

Assess physical health, nutrition, medication use, and substance use.

Physical Health Assessment in OCD

Physical health is part of the evidence-based nursing assessment.

Nutrition Assessment in OCD

Assess the patient's nutritional status.

Medication Assessment in OCD

Assess medication use.

Substance Use Assessment in OCD

Assess for substance use.

OCD Functional Assessment

Includes rating scales, quality of life, strengths assessment, and clinical judgment.

Rating Scales for OCD

Rating scales can be used as part of the functional assessment.

Quality of Life Assessment in OCD

Assess how OCD affects the patient's quality of life.

Strengths Assessment in OCD

Identify the patient's strengths as part of the functional assessment.

OCD Psychosocial Assessment

Assess mental status and appearance, self-concept, stress and coping patterns, and social network/support systems.

Mental Status and Appearance in OCD

Part of the psychosocial assessment for OCD.

Self-Concept Assessment in OCD

Assess the patient's self-concept.

Stress and Coping Assessment in OCD

Assess the patient's stress and coping patterns.

Social Support Assessment in OCD

Assess the patient's social network and support systems.

Biologic Nursing Interventions for OCD

Include maintaining skin integrity and psychopharmacology.

Skin Integrity Maintenance in OCD

A biologic-domain nursing intervention, especially important when compulsive behaviors affect the skin.

Medications Listed for OCD

Clomipramine, sertraline, fluvoxamine, fluoxetine, paroxetine, citalopram, escitalopram, and venlafaxine.

Clomipramine

A medication listed for OCD treatment.

Sertraline

A medication listed for OCD treatment.

Fluvoxamine

A medication listed for OCD treatment.

Fluoxetine

A medication listed for OCD treatment.

Paroxetine

A medication listed for OCD treatment.

Citalopram

A medication listed for OCD treatment.

Escitalopram

A medication listed for OCD treatment.

Venlafaxine

A medication listed for OCD treatment.

OCD Medication Education

Education about medications is an important biologic-domain nursing intervention.

Other Biologic Interventions for OCD

ECT and psychosurgery are listed as interventions.

Psychological Assessment of OCD

Assess the type and severity of obsessions and compulsions, distraction by obsessional thoughts, dressing and grooming, speech, and the degree symptoms interfere with daily functioning.

Type and Severity of OCD Symptoms

Assess the type and severity of the patient's obsessions and compulsions.

Distraction by Obsessional Thoughts

Assess how much the patient's obsessional thoughts distract them.

Dressing and Grooming in OCD

Assess dressing and grooming as part of the psychological-domain assessment.

Speech in OCD

Assess for circumferential speech.

Circumferential Speech

A speech pattern listed for assessment in patients with OCD.

Daily Functioning in OCD

Assess the degree to which symptoms interfere with the patient's daily functioning.

Yale-Brown Obsessive Compulsive Scale

A rating scale used in the psychological assessment of OCD.

Maudsley Obsessive Compulsive Inventory

An inventory used in the psychological assessment of OCD.

Psychological-Domain Nursing Diagnoses for OCD

Hopelessness, powerlessness, loneliness, and chronic low self-esteem.

Hopelessness

A nursing diagnosis listed for OCD.

Powerlessness

A nursing diagnosis listed for OCD.

Loneliness

A nursing diagnosis listed for OCD.

Chronic Low Self-Esteem

A nursing diagnosis listed for OCD.

Psychosocial Nursing Interventions for OCD

Response prevention, thought stopping, relaxation techniques, cognitive restructuring, cue cards, psychoeducation, and Acceptance and Commitment Therapy.

Response Prevention

Delay engagement in the compulsive behavior.

Thought Stopping

A psychosocial intervention listed for OCD.

Relaxation Techniques

A psychosocial intervention used in OCD management.

Cognitive Restructuring

A psychosocial intervention used in OCD management.

Cue Cards

A psychosocial intervention listed for OCD.

Psychoeducation in OCD

An intervention that provides education to help the patient understand and manage OCD.

Acceptance and Commitment Therapy (ACT)

A psychosocial intervention listed for OCD.

Behavioral Interventions for OCD

Establish routines, assess anxiety, monitor comorbidities and suicide risk, initially allow rituals, avoid increasing frustration, encourage discussion, balance private and social time, identify triggers, and use self-talk and cognitive restructuring.

Routines in OCD

Routines are used as part of behavioral interventions.

Anxiety Assessment in OCD

Assess the patient's level of anxiety.

OCD Comorbidities and Suicide Risk

Monitor the patient for comorbidities and suicide risk.

Rituals During Initial OCD Care

Initially allow the patient's rituals.

Why Are Rituals Initially Allowed in OCD?

The nursing approach should avoid increasing the patient's frustration while care is being established.

Frustration in OCD

Avoid increasing the patient's frustration.

Communication With a Patient With OCD

Encourage discussions.