Week 5 - OCD Flashcards
What is OCD?
OCD is characterized by the presence of obsessions (recurrent, persistent thoughts that cause anxiety or distress) and/or compulsions (repetitive behaviors or mental acts) - DSM-5
Who does OCD impact?
1.9-3.3% global lifetime prevalence
78% experience a comorbid
mental disorder
8 years for a person to seek
professional help following onset of symptoms
Typically begins in early 20’s to mid 30’s
What is the DSM-5 criteria?
A. Presence of obsessions, compulsions, or both
B. The obsessions or compulsions are time consuming (e.g., take
more than 1 hour per day), or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., drugs, a medication) or another medical condition
D. The disturbance is not better explained by the symptoms of another medical disorder (e.g., excessive worries as in generalized anxiety disorder)
What is the etiology of OCD?
it is still unknown
Here are theories:
1) Biological
- Hereditary - identical twins lived apart but still developed OCD (Shih, Belmonte, & Zandi, 2004)
- Some gene polymorphisms associated with development of more severe OCD (Vieira-
Fonseca, Fontenelle, & Kohlrausch, 2019)
2) Environmental
- Major traumatic life experience (e.g., loss of job) (Murayama, et al., 2020)
- Maternal stress and smoking during pregnancy (Mahjani, et al., 2020)
3) Behavioral
- Obsession and compulsions thought to be coping mechanisms and learned through negative reinforcement
- Strong link between OCD and other mental health disorders - depression, anxiety, alcohol dependence, or panic disorder (Haraldsson, 2015)
- Many associate objects/behaviours with “fear” and use compulsions/obsessions to reduce the “fear”
What are stigmas associated with OCD? (2)
- Social stigma can cause feelings of shame, can lead to rejection and social isolation
- Self stigma - People with OCD are more likely to experience isolation if they internalize society’s views
How to address stigma? (5)
- Know the facts. Educate yourself about mental illness
- Be aware of your attitudes and behavior. Examine your own judgmental thinking.
- Educate others. Pass on facts and positive attitudes; challenge myths and stereotypes
- Focus on the positive. Mental illness, including addictions, are only part of anyone’s larger picture
- Support people. Treat everyone with dignity and respect; offer support and encouragement
How is a PT assessed for OCD? (3)
Begin by asking indirect questions with more direct follow-up question
Assess type and severity of
patient’s obsessions and compulsions
Assess for any physical symptoms
What is 2 common tools used for OCD assessment?
1) Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) o - Gold standard clinician rated scale
2) Vancouver Obsessional-Compulsive Inventory (VOCI)
- 55-item, rated self-assessment tool
What types of treatment is there? (5)
- Pharmacotherapy
- Selective serotonin reuptake inhibitors (SSRIs) -
first line treatment of choice - Psychosurgery
- Radiotherapy and deep brain stimulation (DBS)
- Electrode is inserted into the brain and an electrical current applied
- Only used in severe SSRI resistant OCD - Exposure with Response Prevention (ERP)
- Patient is exposed to situations or objects known to produce compulsive behaviors and are asked to refrain from performing them - Community treatment
- Partial hospitalization and day treatment programs
- Out-patient clinics
- Day treatment psychotherapy programs
- Self-help groups and self-help books - Cognitive Behavioral Therapy
Nursing interventions:
Assessment Phase
- Establish rapport
- Identify and remove triggers/stimuli
- Acknowledge a patient’s compulsions, rituals,
obsessions or anxiety without directing attention - Allow time for rituals without interfering or
criticizing - Guide patients to uncover their thoughts, feelings
and emotions - Help patients identify things within and out of their
control - Explore constructive activities in which they
feel comfortable and reinforce them often
Nursing interventions:
Treatment Phase
- Support and encourage patients to attempt ERP assignments
- Give recognition when patients challenge ERP assignments
- Educate family members on importance of:
- ERP
- Ignoring and refusing to
participate in rituals - Use of encouragement
- Review with patient’s things that they can
and cannot control - Review progress with patient
Health promotion? (5)
- Make appropriate referrals to community resources (e.g., Canadian Mental Health Association, CMHA)
- Focus on the provision of evidence-based education resources
- CMHA Empowered Carers – 3 part foundational workshop - Recognize symptoms of OCD as many patients diagnosed with OCD have other mental health comorbidities
- Knowledge of common obsessions/compulsions is important to educate clients and families that there are
many types of OCD behaviours
