mental health1 Flashcards
types of interventions for ocd address two primary areas of concern
The physical consequences of the compulsion
The psychosocial components
maintaining skin integrity with ocd
Use tepid water Use mild soap Provide hand cream Create a schedule for hand washing For example: After specific events Time-limited
exposure and response prevention with ocd
Expose the patient to the situation or object, and have them refrain from the ritualistic behavior
Goals:
Decrease stress related to activity
Identify real outcome
Begin with a very short exposure time and gradually increase the length of time
Observe the patient for signs of distress
Ask the patient to identify how they are feeling and any urges they may have for harm to themselves or others during the exposure
The patient may be uncomfortable during exposure which is okay, but the patient shouldn’t feel intense distress
Important to vocalized that even though the patient felt uncomfortable they were able to remain safe
thought stopping with ocd
Interrupt the thought by saying “stop”
Used with obsessive thoughts
Interrupt the autonomic process
This is an outcome associated with mindfulness
Control the downward spiral of obsessional thinking
Delay the response
Creates an opportunity to change the response
The challenge is to recognize the thought in order to interrupt it
relaxation techniques with ocd
Benefits of relaxation techniques
Decrease anxiety
However, the symptoms of OCD remain the same
Distraction
Offers an alternative activity, but does not eliminate the existing compulsions
Improve sleep patterns
Can help with insomnia
Examples
Deep breathing
Meditation
Listening to music
*Most relaxation activities have a rhythmical nature
cognitive restructuring with ocd
Goal is to alter the individuals dysfunctional appraisal of the situation and his/her perceptions of the consequences.
A combination of mindfulness and cognitive behavior therapy (CBT)
Mindfulness interrupts autonomic processes
CBT tests distorted thoughts with reality/evidence
Examples
cue cards
A pros and cons list
medications for ocd
Common medications TCA Clomipramine SSRI Fluoxetine Fluvoxamine Paroxetine Sertraline
Note: antidepressants are given in higher doses for OCD than when given for depression
drug interactions with MAOI
Adverse side effects include: Hypertensive crisis and Serotonin syndrome
patient education for ocd medications
Educate patient and family about medications
Time to work
May take4-6l weeks to see an initial change
May experience side effects with no improvement during this time
Effectiveness
Medication is only part of the solution
Also need behavioral therapy for lasting change
Side effects
Sedation, toxicity, suicidality
four principles for the patient in acute care
Clearly explain unit routines
Decreases fear of the unknown
Initially do not prevent the patient from engaging in rituals
Allow time to settle in without increasing anxiety
Empathize with the individual’s need to perform rituals
Contributes to a positive therapeutic relationship
Balance time between private activities and unit activities
psychoeducation
Educate the patient and family Diagnosis Rationale for interventions Importance of continued behavioral practice Additional resources
evaluation with ocd
Points to consider when evaluating patient progress
Remission of presenting symptoms
Able to complete activities of daily living
Participation in social activities
Absence of self harm behaviors
Knowledge about the disease and treatment
Improved scores on rating scales
purpose of therapeutic relationships
The nature of the therapeutic relationship is to
support the goals of therapy
clarify the boundaries related to roles
difficult to develop therapeutic relationships with eating disorders
Patients tend to be suspicious and mistrustful (Anorexia)
Intense need to be liked and please others (Bulimia)
Patients can be impatient and irritable
Due to starvation
Result of guilt, shame, and embarrassment about their eating disorder or underlying issues (issues about separation)
nursing approach to developing therapeutic relationships
Firm
Accepting
Provide a rationale for interventions (builds trust)
Non-reactive approach (avoids power struggles)