Obsessive Compulsive Disorder Student Version.pptx

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1. Obsessive Compulsive Disorder

2. Learning Outcomes Demonstrate assessment of individual stress and coping Discuss physiological indicators of stress Discuss psych emotional indicators of stress Apply the nursing process to individuals with alterations in stress and coping Apply the concept of stress and coping to exemplar of Obsessive-Compulsive disorder

3. Obsessions Recurrent and persistent thoughts, impulses, or images experienced as intrusive and stressful. Recognized as being excessive and unreasonable even though they are a product of one’s mind. The thought, impulse, or image cannot be expunged by logic or reasoning.

4. Compulsions Repetitive ritualistic behavior or thoughts, the purpose of which is to prevent or reduce distress or to prevent some dreaded event or situation. The person feels driven to perform such actions in response to an obsession or according to rules that must be applied rigidly, even though the behaviors or thoughts are recognized to be excessive or unreasonable.

5. Manifestations The presence of obsessions, compulsions, or both. Significant enough to cause distress or impairment in social, occupational, or other important areas of functioning. The individual recognizes that the behavior is excessive or unreasonable. Individuals feel relieved from the discomfort that it promotes, and is compelled to continue the act.

6. Common Compulsions Hand washing Ordering Checking Praying Counting Repeating words silently

7. OCD Equally common among men and women. Most often begins in adolescence or early adulthood. The course is usually chronic. Depression or substance abuse complicates the course. Single people are affected more that married people.

8. Predisposing Factors Psychoanalytic theorist purpose that individuals with OCD have weak, underdeveloped egos for many reasons: Unsatisfactory parent-child relationship Conditional love Provisional gratification

9. Predisposing Factors Learning Theorist explain obsessive-compulsive behavior as a conditioned response to a traumatic event. Traumatic event produces anxiety and discomfort. The individual learns to prevent anxiety by avoiding the situation with which they are associated

10. Predisposing Factors Learning theory: This type of learning is called passive avoidance (staying away from the source). When passive avoidance is not possible, the individual engages in active avoidance. Active avoidance: Behavior that provides relief from the anxiety and discomfort associated with the traumatic situation.

11. Predisposing Factors Biological Aspects Genetics: Trichotillomania has commonly been associated with obsessive-compulsive disorders among first-degree relatives. Researchers believe that the disorder has a possible hereditary or familial predisposition. Structural abnormalities in the brain and alterations in the serotonin and endogenous opioid systems, have been noted.

12. Biological Aspects Neuroanatomy: Functional neuroimaging techniques have shown abnormal metabolic rates in the basal ganglia and orbital frontal cortex of individuals with OCD. Physiology: Electrophysiological studies, sleep electroencephalogram studies, and neuroendocrine studies have suggested that there are commonalities between depressive disorders and OCD.

13. Biological Aspects Biochemical factors: Many studies have implicated the neurotransmitter serotonin as influential in the etiology of obsessive-compulsive behaviors. Drugs that have alleviated symptoms of OCD include, clomipramine and the selective serotonin reuptake inhibitors (SSRIs)

14. Assessment Scales Self-rating scales include: The Beck Anxiety Inventory The Zung Self-Rated Anxiety Scale Clinician-Administered Scale: The Human Anxiety Rating Scale (HAM-A), is the most widely used scale. The scale consist of 14 items and measures both psychic and somatic anxiety symptoms (psychological distress and physical complaints associated with anxiety).

15. Nursing Diagnosis Panic anxiety Powerlessness Fear Social Isolation Ineffective coping Ineffective role performance Ineffective impulse control

16. Client/Family Education Nature of the illness: What is the cause of anxiety? What is OCD Management of the illness: Medication management Adverse effects of medication What to expect from medication For OCD: SSRIs, Clomipramine

17. Client/Family Education Support Services: Crisis hotline Support groups Individual psychotherapy

18. Treatment Modalities Individual Psychotherapy: Individuals are given the opportunity to discuss their difficulties with a concerned and sympathetic therapist. Cognitive Therapy: strives to assist the individual to reduce anxiety responses by altering cognitive distortions

19. Treatment Modalities Behavior Therapy: Types include; Systematic Desensitization and implosion therapy (flooding). They are commonly used to treat clients with phobic disorders and to modify the stereotyped behavior of clients with OCD.

20. Behavior Therapy Systematic Desensitization: The client is gradually exposed to the phobic stimulus, either in a real or imagined situation. Emphasis is placed on reciprocal inhibition or counterconditioning. Reciprocal inhibition: restriction of anxiety prior to the effort of reducing avoidance behavior.

21. Behavior Therapy Implosion Therapy (Flooding): A therapeutic process in which the client must imagine situations or participate in real-life situations that he or she finds extremely frightening for a prolonged period of time. Relaxation training is not a part of this technique. Plenty of time must be allowed for these sessions.

22. Psychopharmacology Obsessive Compulsive Behavior Antidepressants Clomipramine (TCA): the first drug approved by the FDA in the treatment of OCD. It is more selective for serotonin reuptake than any of the other TCAs. The SSRIs fluoxetine, paroxetine, sertraline, and fluvoxamine have been approved by the FDA for the treatment of OCD.

23. Psychopharmacology Common side effects for SSRIs: Sleep disturbances Headache Restlessness Common side effects for Tricyclics: Blurred vision Constipation Urinary retention Orthostatic hypotension Weight gain Tachycardia

24. Summary Intervention focuses on assisting clients to learn techniques with which they may interrupt the escalation of anxiety before it reaches unmanageable proportions, and to replace maladaptive behavior patterns with new, more adaptive, coping skills.

25. Do you have any Questions??