Psychiatric Nursing

Presented by :kevin
OBSESSIVE COMPULSIVE DISORDER
  Obsessive compulsive disorder is a serious anxiety related
condition
 Where person experiances frequent intrusive and unwelcome
obsessional thoughts ,commonly referred to as obsessions .
 Obsessions are very distressing and result in a person carrying Out
repetative behaviour or rituals in order to prevent perceding harm
Introduction of and worry .

ocd  Obsessive compulsive disorder presents itself in many guises and

certainly goes far beyond the common perception that ocd is
merely a little hand washing ,checking light switches .
 someone who is a Little fastidious .
 The condition can be so disabling that back in 1990 the world
health organization ranked ocd in the global top ten leading
causes of disability in terms of loss of income and quality of life .
 More recently the world health organization went on to state that
anxiety disorders (including ocd)are the sixth largest cause of
disability,and that more woman than men are affected.
 Ocd disorderis actually disrupts normal physical activity or mental
functions and is is fair to say ocd does exactly that!
 The disorder may begin child hood ,but more often begins in
adolescense or early adulthood .
 It is equally common among men and women .
 The course is usally chronic.
 Many ocd suffers also have major depressive disorder ,panic
disorder ,social phobia,specific phobia ,eating disorder,substance
abuse or personality disorders
  Obsessive compulsive disorder is a Mental
anxiety disorder in which people have
Defination unwanted and repeated thoughts ,feelings
of ocd ,ideas ,sensations ,and behaviours that drive
them something over and over .
 1. Predominantly obsessive thoughts or
ruminations
2. Predominantly compulsive acts
Tyes of ocd 3. Mixed obsessional thoughts and acts
4. Other obsessive compulsive disorders
5. Obsessive compulsive disorder ,unspecified
  They are ideas ,impulses or images ,which intrude into conscious
awareness repeatedly
 They are recognized as the individuals own thoughts or impulses
Characteristic  They are unpleasant and recognized as irrational

of ocd  Patient tries to resist them but is unable to do so

 Failure to resist leads to marked distress
 Rituals are performed with a sense of subjective compulsion ( urge
to act )
Etiology
1.Genetic factors .
Higher concordance rate
for monozygotic twins
than for dizygotic twins

First degree
relatives -35%
2.Biochemical
influences
 3.Behaviour
theory
• This theory explains
obsessions as a
conditions stimulus to
anxiety .
• Compulsions have been
described as learned
behaviour that decreses
the anxiety associated
with obsessions .
• this theory is more
useful for treatment
purposes .
Multiple signs of
ocd
 Obsessional words which are
intrude forcibly into the patient
mind . Obsessional confusions

Clinical
features

1. Obsessional
thoughts
 Imagined scenes Obsessional violent

Obsessional
images
 Disgusting Disgusting

Obsessional
images
 Internal debates Arguments

Obsessional
ruminations
 Actions that may not have Forgetting to turn off the
been completed adequately stove

Obsessional
doubts
 Sometimes these may take form of
doubting the vary fundamentals of
Forgetting locking door beliefs ...such as existence of god

Obsessional
doubts
 Act violent behaviour or
injuring the child Sometime shoting in church

Obsessional
impulses
 Repeating hand washing
more than 20 times per day

Obsessional
rituals
 To wash the face. Till 30
To slow for choose the shoes. minutes

Obsessive
slowness
 To thoght very slow ..for
chooseing the detergent Think to very long ......or take
powder very time to decision making

Obsessive
slowness
 1. Suggested by demonstration of ritualistic behaviour
2. MRI and CT scan shows enlarged basal ganglia in
some patients
Diagnosis of
3. Positron emission tomography scannining shows
the ocd increased glucose metabolism in part of the basal
ganglia
  Pharmacotherapy
1. Antidepressants
 Fluvoxamine
Treatment
 Sertaline
 2.Anxiolytics
 Benzodiazepines
  Behaviour therapy
1. Exposure and response prevention
 This is the exposure and response prevention combined
Treatment techniques .
 Example.compulsive handwasher are encouraged to touch
contaminated objects and then refrain from washing in order to
break the negative reinforcement .
 2.Thought stoppage
 this technique help to individual stop thinking unwanted thoughts
.following this steps .
1. Sit in comfortable chair
2. Bring unwanted thought
3. Concentrate only one thought oer procedure
4. Give the command “stop”.
5. Calm and relaxation of muscles and diversion
of thoughts to sometging pleasant
6. Repeat the procedure
 3.Relaxation techniques
 Deep breathing exercise
 Progressive muscle relaxation
 Medication
 Music
 3.Desensitization of the stimulus
 This can either be done in reality or through imagination .
 At first the lowest item in hierarchy is confronted .
 The patient is advised to signal whenever anxiety is produced .
 With each signal he is asked to relax .
 After a few trials ,patient is able to control his anxiety gradually
 4.Aversion therapy
 Pleasant stimulus with an unpleasant response ,so that even in
absence of the unpleasant response the pleasant stimulus
becomes unpleasant by association .
 Punishment is presented immediately after a specific behavioral
response and the response is eventually inhibited
 Unplesant response is produced by electric stimulus ,drugs ,social
disapproval or even fantasy .
Other therapy

 Supportive therapy
1. Ventilation
2. Reeducation
3. Explanation
4. Guidance
 ECT therapy
  Nursing assessment
 Physical ,psychological and social data collection
Nursing  Nurse is aware of impact of obsessions and compulsions on
physical functioning ,mood ,self esteem and normal coping abillity
management  The defense mechanism used thought content or process
potential for suicide ,abillity to function and social support
systems available should also be noted
  1.Ineffective individual coping related to
possible biochemical changes ,evidenced by
obsessive thoughts .
Nursing
diagnosis
 2.Ineffective role performance related to the
need to perform rituals evidenced by inabillity
to fulfill usual patrerns of responsibilty .
 1. Food and mood.
 Nuts and seeds, which are packed with healthy nutrients

Home care for Protein like eggs, beans, and meat, which fuel you up slowly
obsessive to keep you in better balance
 Complex carbs like fruits, veggies, and whole grains, which
compulsive help keep your blood sugar levels steady
disorder  Steer clear of caffeine, the stimulant in tea, coffee, soda, and
energy drinks. It can kick up your anxiety levels a few notches.

 2.Sleep

 sleep is important for good mental health.

 Swap the time you spend looking at screens for 10 minutes of
relaxing music or a warm bath.
 Swap the time you spend looking at screens for 10 minutes of
relaxing music or a warm bath.
 3. Get active
 When you feel anxious, your body releases a hormone called
cortisol.
 It's helpful in small doses but harmful at high levels
 Regular exercise keeps your cortisol levels in check and
benefits everything from your bones and organs to the
numbers on your scale.

 4Learn to relax
 Your body can't relax if it doesn't know how. Relaxation
techniques like yoga, meditation, taking a walk in nature, or
drawing a picture teach your body how it feels to be calm. Try
a few to find what works best for you, and spend 30 minutes
a day on it.