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.
Symptoms: Compulsive behavior
Obsessive-compulsive disorder is characterised by unreasonable thoughts and fears (obsessions) that lead to compulsive behaviours.
OCD often centres on themes such as a fear of germs or the need to arrange objects in a specific manner. Symptoms usually begin gradually and vary throughout life.
Treatment includes talk therapy, medication or both.
Consult a doctor for medical advice.

1. WELCOME

2. OBSESSIVE-COMPULSIVE DISORDER PRESENTED BY : Mrs. SUHANYA RAJ.V

3. DEFINITION Obsessive compulsive disorder(OCD) is an anxiety disorder characterized by the presence of persistent and recurrent irrational thoughts (obsessions), resulting in marked anxiety and repetitive excessive behaviours (compulsions) as a way to try to decrease that anxiety, in a way which interfere with the individuals’ daily functioning or serve as a source of distress. SUHANYA RAJ V 3

4. HISTORICAL BACKGROUND 1838: Jean Etienne Esquarol – first case of obsessive doubting –grouped with monomanias. Jean Pierre Falret – ‘The illness of the doubt’ 1867: Richard Von Kraft Ebing -- introduced it into German psychiatry 1866: Morel – ‘Obsessive Neurosis’ 1903: Pierre Janet – concept of Psychasthenia SUHANYA RAJ V 4

5. ICD 10 CLASSIFICATION F 42 : Obsessive compulsive disorder F42.0 : Predominantly obsessive thoughts or ruminations F42.1 : Predominantly compulsive acts F42.2 : Mixed obsessional thoughts and acts F42.8 : Other obsessional compulsive disorders F42.9 : Obsessive-compulsive disorder, unspecified. SUHANYA RAJ V 5

6. EPIDEMIOLOGY Unmarried males Upper social strata with high intelligence Late third decades onset Life time prevalence is 2-3% SUHANYA RAJ V 6

7. COURSE AND OUTCOME Classically it has a chronic course but, longitudinal profile shows episodic Long term follow-up study result shows: - 25% unimproved over time - 50% had moderate to marked improvement - 25% had recovered completely SUHANYA RAJ V 7

8. ETIOLOGY Psychodynamic theory Behavioural theory Biological theory SUHANYA RAJ V 8

9. Psychodynamic theory: Sigmund Freud found obsessions and phobias to be psychogenetically related. This theory explains OCD by a defensive regression to anal-sadistic phase of dev elopement with the use of isolation, undoing and displacement to produce obsessive-compulsive symptoms. SUHANYA RAJ V 9

10. Psychodynamic theory: SUHANYA RAJ V 10

11. Behavioural theory: Obsessions : conditioned stimuli to anxiety Compulsions : learned behaviours which decrease the anxiety associated with obsessions. This decrease in anxiety positively reinforces the compulsive acts and they become ‘stable’, learned behaviours. SUHANYA RAJ V 11

12. Biological theory: OCD occurs secondary to illness such as Von Economo’s encephalitis, basal ganglia lesions, Gilles de la Tourette syndrome and hypothalamic and third ventricle lesions. First degree relatives : 5-7% occurrance Biochemically, the central 5-HT system seems to be involved in OCD. SUHANYA RAJ V 12

13. CHARACTERISTICS OCD is characterized by recurrent obsessions and compulsions. Obsession :- An ideas, impulse or image which intrudes into conscious awareness repeatedly. It is recognized as one’s own idea, impulse or image but is perceived as ego-alien. It is recognized as irrational and absurd. Patient tries to resist against it but is unable to. Failure to resist, leads to marked distress. SUHANYA RAJ V 13

14. CHARACTERISTICS Compulsion :- A form of behaviour which usually follows obsessions. It is aimed at either preventing or neutralising the distress or fear arising out of obsessions. The behaviour is not realistic and is either irrational or excessive. Insight is present, so the patient realises the irrationality of compulsion. The behaviour is performed with a sense of subjective compulsions. SUHANYA RAJ V 14

15. THE VICIOUS CYCLE OF OCD SUHANYA RAJ V 15

16. CLINICAL FEATURES Washers Checkers Doubters and sinners Counters and arrangers Hoarders SUHANYA RAJ V 16

17. CLINICAL FEATURES Washers : are afraid of contamination. Checkers : repeatedly check things associated with harm/danger. Doubters and sinners : demands perfectionism, and feared about being punished for not doing things right. Counters and arrangers : obsessed with order and symmetry. Hoarders : compulsively hoard things that they don’t need to use. SUHANYA RAJ V 17

18. Washers Checkers Doubters and sinners Hoarders Counters and arrangers SUHANYA RAJ V 18

19. DIAGNOSIS Demonstration of irrational or excessive ritualistic nehaviours MRI and CT shows enlarged basal ganglia PET scan shows increased glucose metabolism in part of basal ganglia ICD 10 criteria Yale Brown Obsessive Compulsive Scale(Y-BOCS) SUHANYA RAJ V 19

20. DIFFERENTIAL DIAGNOSIS Schizophrenia Depression Phobic disorder Obsessive compulsive personality disorder Obsessive compulsive spectrum disorders Physical illnesses Others SUHANYA RAJ V 20

21. TREATMENT Psychotherapy Behaviour and cognitive behaviour therapy Pharmacotherapy Electroconvulsive therapy Psychosurgery SUHANYA RAJ V 21

22. TREATMENT Psychotherapy Psychoanalytic psychotherapy Supportive psychotherapy SUHANYA RAJ V 22

23. TREATMENT Behaviour and cognitive behaviour therapy Modelling Thought-stopping Systematic desensitisation Relaxation techniques Aversive conditioning Exposure and response prevention SUHANYA RAJ V 23

24. TREATMENT Pharmacotherapy Benzodiazepines [Alprazolam, Clonazepam] Antidepressants(SSRIs) - Clomipramine(75-300/day) - Fluoxetine(25-80mg/day) - Fluvoxamine(50-200mg/day) - Paroxetine(20-40mg/day) - Sertaline (50-200mg/day) Antipsychotics [Haloperidol, Risperidone, Olanzapine, Aripiprazole, Pimozide ] SUHANYA RAJ V 24

25. TREATMENT Electroconvulsive therapy Indicated in severe depression with OCD and a risk of suicide along withpoor response to other modes of treatment. SUHANYA RAJ V 25

26. TREATMENT Psychosurgery Stereotactic limbic leucotomy Stereotactic subcaudate tractotomy SUHANYA RAJ V 26

27. SELF-TREATMENT GUIDELINES : SUHANYA RAJ V 27

28. NURSING MANAGEMENT Nursing Assessment : Nurse should detail into the following: Physical, psychological and social data Impact on physical functioning, mood, self esteem and normal coping ability Defense mechanisms used, thought process and content, risk for suicide, ability to function, available social support systems. SUHANYA RAJ V 28

29. NURSING MANAGEMENT Nursing Diagnosis : Severe anxiety related to earlier life conflicts as evidenced by repetitive actions/recurring thoughts/decreased social functioning. Ineffective coping related to under developed ego/punitive super ego as evidenced by ritualistic behaviour/obsessive thoughts/inability to meet basic needs. Impaired role performance related to the need to perform rituals as evidenced by inability to fulfil usual patterns of responsibility. SUHANYA RAJ V 29

30. SUMMARY Obsessive compulsive disorder is an anxiety disorder in which a person has intrusive ideas, thoughts, or images that occur repeatedly, and in which he or she feels driven to perform certain behaviours over and over again. Having an OCD may cause a person to have trouble carrying out daily activities. Negative comments or criticism can make OCD worse, while a calm, supportive environment with a combination of different therapies can help improve the outcome of treatment. SUHANYA RAJ V 30

31. RECAPITULATION SUHANYA RAJ V 31

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33. CONCLUSION SUHANYA RAJ V 33

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35. BIBLIOGRAPHY Banjamin James Sadock and Virgina Sadock . Kaplan Sadock Synopsis of Psychiatry.Lippincott . Mary C.Townsend.Psychiatric Mental health Nursing.Concepts of care in evidence based practice.Jaypee . Niraj Ahuja.A short text book of Psychiatry.Jaypee . M.S. Bhatia.Essentials of Psychiatry.CBS publishers. R.R.Kavitha.Mental Health Nursing.Frontline publishers. WHO.ICD 10 Classification of mental behavioural disorders. SUHANYA RAJ V 35

36. BIBLIOGRAPHY http://www.helpguide.org/obsessive-compulsive disorder/ http://haznos.org/2015/ocd-an-introduction/ http://en.m.Wikipedia.org/wiki/obsesseive-compulsive disorder http://www.lifeextension.com/protocols/emotional-health/obsessive-compulsive-disorder/ http://www.nhs.uk/conditions/obsessive-compulsive-disorder-ocd/ SUHANYA RAJ V 36

37. BIBLIOGRAPHY Jedidiah Siev.Perceived decision making styles among individuals with obsessive compulsive and hoarding disorder[internet]:Journal of obsessive compulsive related disorders;volume 23,October 2019. Availablefrom:http ://www.sciencedirect.com/science/article/pii/s2211364919300582 SUHANYA RAJ V 37

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