Obsessive Compulsive Disorder

Obsessive-Compulsive Disorder (OCD) is a common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and/or behaviors (compulsions) that he or she feels the urge to repeat over and over.

1. Obsessive Compulsive Disorder EARNEST LAMUEL

2. Definition

3. Definition Obsessive-compulsive disorder ( OCD ) is a  mental illness  that causes repeated unwanted thoughts or sensations (obsessions) or the urge to do something over and over again (compulsions). Some people can have both obsessions and compulsions.

4. Classification

5. Classification F42.0 Predominantly obsessional thoughts or ruminations F42.1 Predominantly compulsive acts [obsessional rituals] F42.2 Mixed obsessional thoughts and acts F42.8 Other obsessive-compulsive disorders F42.9 Obsessive-compulsive disorder, unspecified

6. Signs & Symptoms

7. Signs & Symptoms Recurrent unwanted thoughts referencing contamination, sexuality, aggression, need for perfection, or abnormal doubt. Attempts to reduce the effect of the thoughts with other thoughts. Repetitive acts, impulses or rituals such as washing hands, checking, rearranging things for perfect alignment, repeating words or phrases. Recognition that the thoughts are produced in his or her own mind. Lack of concentration and task completion. Impaired social or work functioning.

8. Etiology

9. Genetic Factors Twin studies have consistently found a significantly higer 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.

10. Biochemical Influences A number of studies suggest that the neurotransmitter serotonin (5-HT) may be abnormal in individuals with obsessive compulsive disorder.

11. Psychoanalytic Theory The psychoanalytic concept views patients with obsessive compulsive disorder as having regressed to developmentally earlier stages of the infantile superego, whose harsh exacting punitive characteristics now reappear as part of the psychopathology.

12. 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.

13. Clinical Features

14. 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 or blasphemous.

15. Obsessional Images These are vividly imagined scenes, often of a violent or disgusting kind involving abnormal sexual practices.

16. Obsessional Ruminations These involve internal debates in which arguments for and against even the simplest everyday actions are reviewed endlessly.

17. 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 the 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 form of doubting the very fundamentals of beliefs, such as, doubting the existence of God and so on.

18. Obsessional Impulses These are urges to perform acts usually of a violent or embarrassing kind, such as injuring a child, shouting in church , etc.

19. Obsessional Rituals These may include both mental activities such as counting repeatedly in a special way or repeating but senseless behaviors such as washing hands 20 or more times a day. Sometimes such compulsive acts maybe preceded by obsessional thoughts, for example, repeated handwashing may be preceded by thoughts of contamination. These patients usually believe that the contamination is spread from object to object or person to person even by slight contact and may literally rub the skin off their hands by excessive hand washing.

20. Obsessional 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.

21. Diagnosis

22. Diagnosis Suggested by demonstration of ritualistic behavior that is irrational or excessive MRI and CT shows enlarged basal ganglia in some patients Position – emission tomography scanning shows increased glucose metabolism in part of the basal ganglia Based on ICD 10 Criteria.

23. Treatment

24. Pharmacotherapy Antidepressants (for example, fluvoxamine, sertraline, etc.) Anxiolytics (for example, benzodiazepines)

25. Behavior Therapy Exposure and response prevention Thought stoppage Relaxation techniques Desensitization Aversive conditioning

26. Nursing Management

27. 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. The defense mechanisms used, thought content or process potential for suicide, ability to function and social support systems available should also be noted.

28. Nursing Interventions Work with patient to determine types of situations that increase anxiety and result in ritualistic behaviors. Initially meet the patient’s dependency needs. Encourage independence and give positive reinforcement for independent behaviors. In the beginning of treatment, allow plenty of time for rituals. Do not judgemental or verbalize disapproval of the behavior.

29. Nursing Interventions Support patient’s efforts to explore the meaning and purpose of the behavior. Provide structured schedule of activities for patient, including adequate time for completion of rituals. Gradually begin to limit amount of time allotted for ritualistic behavior as patient becomes more involved in unit activities. Give positive reinforcement for non – ritualistic behaviors.

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