Chapter 15 Obsessive-Compulsive & Related Disorders Flashcards
Obsessive Compulsive Disorder (OCD)
Unwanted, recurrent, and intrusive thoughts or images that the person tries to alleviate through repetitive behaviors or mental acts
Obsessions
Unwanted, recurrent, & intrusive thoughts or images
Compulsions
Repetitive behaviors or mental acts that the person uses to alleviate compulsions
Nursing Interventions for OCD
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
Common Compulsions
Touching/rubbing/tapping
Ordering (arranging and rearranging)
Exhibiting rigid performance
Having aggressive urges
Checking rituals
Counting rituals
Washing/scrubbing
Praying/chanting
OCD Diagnosis & Prevalence
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
Excoriation
Skin picking
Trichotillomania
Hair-pulling
Onychophagia
Chronic nail-biting
Body Dysmorphic Disorder (BDD)
Unusual obsession w/ one aspect of the body
Hoarding Disorder
Kleptomania
Compulsive stealing
Oniomania
Compulsive buying
Etiology of OCD & Related Disorders
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
1st Line of Meds for OCD & Related Disorders
SSRIs (fluvoxamine, sertraline)
2nd Line
SNRI (venlafaxine)
Treatment-Resistant OCD Meds
2nd Gen Antipsychotic Meds (risperidone, aripiprazole)
- Anticholinergic Crisis
- Metabolic Syndrome (cholesterol, BG, BMI, BP, and sugar increase)
Behavioral Therapy
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
OCD & Nursing Process: Assessment
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)
Common Problems Associated w/ OCD
Anxiety
Ineffective coping
Fatigue
Low self-esteem
Skin breakdown
