OBSESSIVE COMPULSIVE DISORDER

Management of patient with OCD

1. PREPARED BY MRS. DIVYA PANCHOLI ASSISTANT PROFESSOR, SSRCN, VAPI MRS. DIVYA PANCHOLI 1

2. DEFINITION OBSESSION: an idea or thought that continually preoccupies or intrudes on a person's mind. COMPULSION: the action or state of forcing or being forced to do something; constraint. MRS. DIVYA PANCHOLI 2

3. OBSESSIVE-COMPULSIVE DISORDER: Obsessive - compulsive disorder  is an anxiety disorder in which people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). MRS. DIVYA PANCHOLI 3

4. ETIOLOGY Genetic Factors higher concordance rate for monozygotic twins than for dizygotic twins. Family studies of these patients have shown that 35% of the first degree relatives of obsessive-compulsive disorder patients are also affected with the disorder. Biochemical Influences neurotransmitter serotonin (5-HT) may be abnormal in individuals with obsessive-compulsive disorder. MRS. DIVYA PANCHOLI 4

5. Conti.. Psychoanalytic Theory The psychoanalytic concept (Freud) views patients with obsessive-compulsive disorder (OCD) as having regressed to developmentally earlier stages of the infantile superego, whose harsh exacting punitive characteristics now reappear as part of the psychopathology. Freud also proposed that regression to the preoedipal anal sadistic phase combined with the use of specific ego defense mechanisms like isolation, undoing, displacement and reaction formation, may lead to OCD MRS. DIVYA PANCHOLI 5

6. Conti… Behavior Theory This theory explains obsessions as a conditioned stimulus to anxiety. Compulsions have been described as learned behavior that decreases the anxiety associated with obsessions. This decrease in anxiety positively reinforces the compulsive acts and they become stable learned behavior. This theory is more useful for treatment purposes. MRS. DIVYA PANCHOLI 6

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9. CLINICAL PICTURE 1. Obsessional thoughts : These are words, ideas and , beliefs that intrude forcibly into the patient's mind. They are usually unpleasant and shocking to the patient and may be obscene. MRS. DIVYA PANCHOLI 9

10. 2. Obsessional images : These are vividly imagined scenes, often of a violent or disgusting kind involving abnormal sexual practices. Conti… MRS. DIVYA PANCHOLI 10

11. 3. Obsessional ruminations : These involve internal debates in which arguments for and against even the simplest everyday actions are reviewed endlessly. Conti… MRS. DIVYA PANCHOLI 11

12. 4. Obsessional doubts: These may concern actions that may not have been completed adequately. The obsession often implies some danger such as forgetting to turn off the stove or not locking a door. It may be followed by a compulsive act such as the person making multiple trips back into the house to check if the stove has been turned off. Sometimes these may take the for doubting the very fundamentals of beliefs, such as, doubting the existence of God and so on. Conti… MRS. DIVYA PANCHOLI 12

13. 5. Obsessional impulses : These are urges to perform acts usually of a violent or embarrassing kind, such as injuring a child, shouting in church etc. Conti… MRS. DIVYA PANCHOLI 13

14. 6. Obsessional rituals: These may include both mental activities such as counting repeatedly in a special way or repeating a certain form of words, and repeated but senseless behaviors such as washing hands 20 or more times a day. Sometimes such compulsive acts may be preceded by obsessional thoughts; Conti… MRS. DIVYA PANCHOLI 14

15. 7. Obsessive slowness: Severe obsessive ideas or extensive compulsive rituals characterize obsessional slowness in the relative absence of manifested anxiety. This leads to marked slowness in daily activities. Conti… MRS. DIVYA PANCHOLI 15

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17. COURSE AND PROGNOSIS Course -usually long and fluctuating . Prognosis appears to be worse when the onset is in childhood, the personality is obsessional, symptoms are severe, compulsions are bizarre, or there is a coexisting major depressive disorder. MRS. DIVYA PANCHOLI 17

18. TREATMENT Pharmacotherapy Antidepressants (e.g.fluvoxamine, sertraline, etc.) Anxiolytics (e.g.benzodiazepines) MRS. DIVYA PANCHOLI 18

19. Behavior Therapy Exposure and response prevention Thought stoppage Desensitization Aversive conditioning Supportive psychotherapy. ECT- for patients refractory to other forms of treatment . MRS. DIVYA PANCHOLI 19

20. EXPOSURE AND RESPONSE PREVENTION This is vivo exposure procedure combined with response prevention techniques. For example compulsive handwashers are encouraged to touch contaminated objects and then refrain from washing in order to break the negative reinforcement chain (hand washing reducing the anxiety i.e. negative reinforcement). MRS. DIVYA PANCHOLI 20

21. THOUGHT STOPPAGE Thought stopping is a technique to help an individual to learn to stop thinking unwanted thoughts. Following are the steps in thought stopping: Sit in a comfortable chair, bring to mind the unwanted thought concentrating on only one thought per procedure. As soon as the thought forms, give the command 'Stop!' Follow this with calm and deliberate relaxation of muscles and diversion of thought to something pleasant. Repeat the procedure to bring the unwanted thought under control. MRS. DIVYA PANCHOLI 21

22. NURSING MANAGEMENT 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. The defense mechanisms used, thought content or process, potential for suicide, ability to function and social support systems available should also be noted. MRS. DIVYA PANCHOLI 22

23. Problems Anxiety Chronic low self-esteem Fear Ineffective coping Ineffective role performance Impaired social interaction Risk for injury Social isolation MRS. DIVYA PANCHOLI 23

24. Nursing Interventions Approach the patient unhurriedly. Provide an accepting atmosphere; don't show shock, amusement, or criticism of the ritualistic behavior. Allow the patient time to carry out the ritualistic behavior (unless it's dangerous) until he can be distracted into some other activity. Blocking this behavior raises anxiety to an intolerable level. Keep the patient's physical health in mind. For example, compulsive hand washing may cause skin breakdown, and rituals or preoccupations may cause inadequate food and fluid intake and exhaustion. Provide for basic needs, such as rest, nutrition, and grooming, if the patient becomes involved in ritualistic thoughts and behaviors to the point of self-neglect. MRS. DIVYA PANCHOLI 24

25. Let the patient know you're aware of his behavior. For example, you might say, I noticed you've made your bed three times today; that must be very tiring for you. Help the patient explore feelings associated with the behavior. For example, ask him, What do you think about while you are performing your chores? Make reasonable demands, and set reasonable limits; make their purpose clear. Avoid creating situations that increase frustration and provoke anger, which may interfere with treatment. Conti… MRS. DIVYA PANCHOLI 25

26. Explore patterns leading to the behavior or recurring problems. Listen attentively, offering feedback. Encourage the use of appropriate defense mechanisms to relieve loneliness and isolation. Engage the patient in activities to create positive accomplishments and raise his self-esteem and confidence. Encourage active diversional resources, such as whistling or humming a tune, to divert attention from the unwanted thoughts and to promote a pleasurable experience. Conti… MRS. DIVYA PANCHOLI 26

27. Assist the patient with new ways to solve problems and to develop more effective coping skills by setting limits on unacceptable behavior (for example, by limiting the number of times per day he may indulge in obsessive behavior). Gradually shorten the time  allowed . Help him focus on other feelings or problems for the remainder of the time. Identify insight and improved behavior (reduced compulsive behavior and fewer obsessive thoughts). Evaluate behavioral changes by your own and the patient's reports. Identify disturbing topics of conversation that reflect underlying anxiety or terror. Observe when interventions don't work; reevaluate and recommend alternative strategies. Monitor effects of pharmacologic therapy. Conti… MRS. DIVYA PANCHOLI 27

28. You can refer following link also https://www.youtube.com/watch?v=07-oawGxLQc https://www.youtube.com/watch?v=I8Jofzx_8p4&t=30s https://www.youtube.com/watch?v=5E5APvjMlOw https://www.youtube.com/watch?v=epDVMBNXsXY https://www.youtube.com/watch?v=B46EdJApFmI https://www.youtube.com/watch?v=TD-xPiwtyHA MOVIES REALTED TO OCD Matchstick Men –OCD The Aviator-OCD MRS. DIVYA PANCHOLI 28

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