Chapter 15 Obsessive-Compulsive & Related Disorders

Question 1

Obsessive Compulsive Disorder (OCD)

Answer 1

Unwanted, recurrent, and intrusive thoughts or images that the person tries to alleviate through repetitive behaviors or mental acts

Question 2

Obsessions

Answer 2

Unwanted, recurrent, & intrusive thoughts or images

Question 3

Compulsions

Answer 3

Repetitive behaviors or mental acts that the person uses to alleviate compulsions

Question 4

Nursing Interventions for OCD

Answer 4

Initially, allow time for rituals
- Interrupting increases anxiety

Encourage gradual decrease in time devoted to rituals

Help identify causes of anxiety & alleviate anxiety

Avoid increasing anxiety

Teach effective coping immediately after a ritual

Draw attention to safety

Meds: SSRIs, TCAs

Question 5

Common Compulsions

Answer 5

Touching/rubbing/tapping
Ordering (arranging and rearranging)
Exhibiting rigid performance
Having aggressive urges
Checking rituals
Counting rituals
Washing/scrubbing
Praying/chanting

Question 6

OCD Diagnosis & Prevalence

Answer 6

Have awareness that it is an issue

OCD is diagnosed once thoughts or behaviors consume the person to the point where the thoughts or actions interfere with personal, social, and/or occupational functioning.

The person realizes that the thoughts/behaviors are unreasonable, but he or she cannot stop/control them.

Can start in early childhood; in females, more commonly begins in the 20s

Periods of waxing and waning symptoms over lifetime

Question 7

Excoriation

Answer 7

Skin picking

Question 8

Trichotillomania

Answer 8

Hair-pulling

Question 9

Onychophagia

Answer 9

Chronic nail-biting

Question 10

Body Dysmorphic Disorder (BDD)

Answer 10

Unusual obsession w/ one aspect of the body

Question 11

Hoarding Disorder

Question 12

Kleptomania

Answer 12

Compulsive stealing

Question 13

Oniomania

Answer 13

Compulsive buying

Question 14

Etiology of OCD & Related Disorders

Answer 14

Cognitive model (based on Aaron Beck’s cognitive approach to emotional disorders)
Focuses on childhood and environmental experiences of growing up
Heredity
Complex network of several genes may contribute to the genetic risk for OCD

Question 15

1st Line of Meds for OCD & Related Disorders

Answer 15

SSRIs (fluvoxamine, sertraline)

Question 16

2nd Line

Answer 16

SNRI (venlafaxine)

Question 17

Treatment-Resistant OCD Meds

Answer 17

2nd Gen Antipsychotic Meds (risperidone, aripiprazole)
- Anticholinergic Crisis
- Metabolic Syndrome (cholesterol, BG, BMI, BP, and sugar increase)

Question 18

Behavioral Therapy

Answer 18

Exposure Therapy: Deliberately confronting situation & stimuli that client usually tries to avoid
- Biofeedback

Response prevention: Delaying or avoiding performing rituals, learning to tolerate the thoughts and anxiety

Question 19

OCD & Nursing Process: Assessment

Answer 19

Screening tool for OCD (see Box 15.1)
History
General appearance and motor behavior (tense, anxious; embarrassed)
Mood and affect (overwhelming anxiety)
Thought processes and content (describe obsessions as rising out of nowhere)
Judgment and insight (recognizes obsessions as irrational but unable to stop them)
Self-concept (powerlessness, low self-esteem)
Roles and relationships

Physiological and self-care considerations (sleeping problems, appetite and weight changes)

Question 20

Common Problems Associated w/ OCD

Answer 20

Anxiety
Ineffective coping
Fatigue
Low self-esteem
Skin breakdown