Exam 2-Care of clients with obsessive-compulsive and related disorders Flashcards
(19 cards)
obsessions
excessive, unwanted, intrusive, and persistent thoughts, impulses, or images causing anxiety and distress.
-not under the patient’s control; incongruent with the patient’s usual thought patterns.
compulsions
repetitive behaviors performed in a ritualistic fashion.
-goal of preventing or relieving anxiety and distress caused by obsessions.
-still may second guess
TREATMENT IS TO SLOW THE CYCLE, EASE THE COMPULSIONS AND MANAGE THEM, THEY WILL NOT STOP COMPLETELY.
-may impair ADLs
obsessive-compulsive disorders
-obsessions and compulsions are characteristic of obsessive-compulsive and related disorders
-closely related to anxiety disorders
include:
-obsessive compulsive disorder
-body dysmorphic disorder (BDD)
-hoarding disoder
-trichotillomania
-excoriation disorder
-substance/medication-induced obsessive compulsive disorder (OCD symptoms related to intoxication or withdrawal of substances)
epidemiology
-average onset is 19 but can occur into the 20s to mid-30s with symptoms often beginning in childhood
-gradual symptom onset
-chronic disorder
-men affected more as children, most commonly affected by obsessions
-women with higher incidence of checking and cleaning rituals, with onset typically in the early 20s
-the most common obsession is fear of contamination; leads to compulsive handwashing
-females slightly higher rate than males, less common among african americans than non-hispanic whites
-early onset increases chances of OCD in relatives and predicts poorer treatment outcomes
-may be related to infection with beta-hemolytic streptococci and OCD
-high rates in individuals that are young, divorced, separated, and unemployed.
diagnostic criteria for OCD
-presence of obsessions or compulsions
-some patients recognize that thoughts and actions are unreasonable or excessive; others have limited insight
-recurrent obsessions and/or compulsions consume more than an hour per day, or cause considerable stress for the individual
-those who hoard are more compelled to check their belongings repeatedly to see that all is accounted for
-thoughts or behaviors not a result of the presence of a substance or a medical condition.
-may have circumferential speech
OCD in children
-1-3% or more of children and adolescents
-children may be superstitious, and engage in magical thinking, so obsessive and ritualistic behaviors may go unnoticed
-grades may decline due to reduced concentration and time spent performing rituals
-OCD typically manifests in childhood and the second decade of life, and can be a lifelong illness
older adults and OCD
late onset OCD is more likely to occur in females with a history of subclinical obsessive-compulsive symptoms, co-occurrence of PTSD after age 40, and a history of recent pregnancy for self or significant others.
common comorbidities with OCD
-depression
-social phobia
-generalized anxiety disorder
-specific phobias
-bipolar disorder
-cyclothymic disorder
-panic disorder
-mood disorder
-eating disorder
-impulse control disorders
-tourette syndrome
-substance use disorder
-personality disorders
etiology of OCD
predominantly neurologic basis for OCD
-genetic factors: occurs more often in those with first-degree relatives with OCD, twin studies suggest genetic factor
-neuropathologic theories: hyperactivity in specific regions of the brain
-possibly dysfunction in the frontal cortex and in information processing
-biochemical theories: serotonin plays a role in OCD
-psychological theories: possible use of defense mechanisms- isolation, undoing, reaction formation, regression; learning theory such as obsessions viewed as conditioned stimuli that are linked to unpleasant events and consequently become anxiety-provoking; leads to activities to avoid the anxiety (compulsions)
cycle of OCD
-obsessions
-anxiety
-compulsions
-relief (temporary)
nursing assessment for OCD
-physical health assessment
-type and severity of obsessions and compulsions
-degree to which symptoms interfere with daily functioning
-dressing and grooming
-speech filled with irrelevant details
-rating scales, such as Yale-Brown obsessive compulsive scale
teamwork and collaboration
OCD is treated with:
-medications, CBT, supportive therapy
-ECT (electroconvulsive therapy) may be considered
-psychosurgery may be considered for very severe cases
-overall goal is for patient to recover and to decrease symptoms!!
-a suicide assessment must be completed: patient may feel hopeless, helpless, high probability of co-morbid major depression, possible feeling of need for self-punishment for intrusive thoughts.
nursing management and medications
-skin integrity maintenance: hydration, lotion, signs of infection
-clomipramine (TCA)
-sertraline
-fluvoxamine
-paroxetine
-fluoxetine
-medication education: SSRIs side effects include anxiety, restlessness, headache, vomiting, insomnia, transient nausea, sedation (especially paroxetine), sexual dysfunction
psychosocial nursing management
-exposure and response prevention
-thought stopping
-relaxation techniques
-cognitive restructuring: monitoring automatic thoughts and recognizing connection between thoughts, emotional response, and behaviors.
-cue cards: positively oriented statements that reinforce belief that patient is safe and can tolerate anxiety
-psychoeducation: medication teaching, skin care, alternatives to ritualistic behavior, recovery strategies, community resources
social nursing management
-explain unit routines
-if needed, help person ADLs to ensure that they are completed
-monitor medication effects, provide teaching
-ensure adequate caloric intake
-promote integration into unit activites
-psychoeducation regarding diagnosis and treatment
-family education
-educate patient about local support groups
trichotillomania
chronic self-destructive hair pulling that results in noticeable hair loss
-the individual has an increase in tension immediately before pulling out the hair
-afterward, the person feel sense of relief
-hair ingestion may lead to hair ball (trichobezoar) which can lead to anorexia, stomach pain, anemia, intestinal obstruction, and peritonitis
-other medical complications include infection at the hair-pulling site
-diagnosed when recurrent pulling out of hair with hair loss occurs and the individual is unable to decrease or stop such hair pulling, causing considerable distress
medications: olanzapine (antipsychotic), and clomipramine (TCA)
-CBT and habit reversal training, behavior intervention: may improve symptoms
excoriation disorder
repetitive and compulsive picking of skin causing tissue damage
-may need anti-histamine, mood stabilizer, anticonvulsant.
-prevalence varies from 1.4-5.4%, occurring more frequently in those with OCD and related disorders
-treatment data are limited, possible efficacy of but lamotrigine (mood stabilizer/anticonvulsant agent)
-nursing care is like caring for a person with trichotillomania
body dysmorphic disorder
-focus is on real, but slight, or imagined defects in appearance
-preoccupation with the perceived defect causes significant distress and interferes with ability to function socially, avoiding work or public situations
-surgical correction does not correct preoccupation and distress
-BDD usually begins in adolescence and continues throughout adulthood. occurs in men and women
-may also have anxiety disorder
-the risk of depression and suicide is high!!!
-possible etiology: unrealistic cultural expectations and generation predisposition
-
hoarding disorder
-difficulty parting with or discarding possessions, regardless of actual value
-2-6% prevalence
-hoarding may begin in childhood with an increase in severity throughout lifespan
-disorder tends to be familial and present in different generations
-depression is common
-can create public health and/or safety risks, home safety may be compromised!
