26. OCD Flashcards
excessive unwanted intrusive and persistent thoughts impulses or images causing anxiety and distress; not under pt’s control; incongruent w/ pt’s usual thought patterns
obsessions
repeatedly performed behaviors in a ritualistic fashion; w/ goal of preventing or relieving anxiety and distress caused by obsessions
compulsions
common obsessions
- fear of contamination
- need for symmetry and completion
common compulsions
- washing hands
- checking rituals
- counting rituals
- excessive cleaning or arranging of objects
what should you worry about in a pt w/ compulsive hand washing
skin integrity
diagnostic criteria for OCD
- presence of obsessions or compulsions
- pt recognizes thoughts and actions are unreasonable or excessive
- thoughts/rituals cause severe disturbances in daily routines, relationships, or occupational functioning; take longer than 1 hour/day to complete
- not result of another disorder, substance use, or medical condition
describe insight for OCD
- good or fair insight: recognizes beliefs are definitely or most likely not true
- with poor insight: things are probably true
- with absent insight: completely convinced OCD beliefs are true
- tic-related
clinical course of OCD
onset in early 20s to mid 30s w/ sxs often beginning in childhood; gradual onset
epidemiology of OCD
- female slightly more than males
- lifetime prevalence of 1.2%
- all ages affected; lifelong illness
- 1-3% of children and adolescents
biological theories of OCD
- genetic
- neuropathology (hyperactivity in frontal cortex)
- biochemical (low levels of serotonin)
psychological theories of OCD
- defense mechanisms (isolation, undoing, and reaction formation)
- may come from unconsciousness)
- learning theory (conditioned stimuli)
nursing assessment for OCD
- dermatologic lesions (cleaning rituals)
- osteoarthritis (cleaning rituals)
- type and severity of obsessions and compulsions
- distraction by obsessional thoughts
- dressing and grooming
- speech (circumferential speech - excessive details in conversation)
- degree to which sxs interfere w/ functioning
- Yale-Brown Obsessive Compulsive Scale
- Maudsley Obsessive Compulsive Inventory
care priorities for OCD
- anxiety
- impaired skin integrity
interventions for OCD
- skin integrity maintenance
- medications
- ECT (helps w/ depression due to obsessions)
- response prevention
- thought stopping
- relaxation techniques
- cognitive restructuring
- cue cards
- psychoeducation
medications used for OCD
- clomipramine (Anafranil)
- sertraline (Zoloft)
- fluvoxamine (Luvox)
- venlafaxine (Effexor)
- mirtaxapine (Remeron)
goal for pts w/ OCD
- learn new and more adaptive strategies without resorting to obsessive compulsive behavior
- gain independence and greater control over life situations
T/F: you should not interfere w/ a person’s ritual
True (increases anxiety)
pt exposed to object of anxiety and asked to refrain from performing ritual
response prevention
interrupt obsessive thoughts by saying stop
thought stopping
chronic self-destructive hair pulling that results in noticeable hair loss
trichotillomania
epidemiology of trichotillomania
- onset occurs among children before age of 5 and in adolescents
- 1-2% of population
- anxiety, loneliness, anger, fatigue, guilt, frustration, and boredom can trigger hair pulling
goal of trichotillomania
substation of positive behaviors to deal w/ emotions
skin picking disorder; risk for infection; behavior and pharmacology interventions
excoriation disorder
focus on real but slight or imagined defects in appearance; over half also have anxiety; CBT is primary intervention
body dysmorphic disorder
difficulty parting w/ or discarding possessions; may start in childhood; CBT and medication
hoarding disorder
