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OBSESSIVE-COMPULSIVE DISORDER OCD (CONSEQUENCES (Impaired functional…
OBSESSIVE-COMPULSIVE DISORDER
SCOPE
Moderate OCD
Yale-Brown Obsessive Compulsive Scale Score: 16-23
Severe OCD
Yale-Brown Obsessive Compulsive Scale Score 32-40
Mild OCD
Yale-Brown Obsessive Compulsive Scale Score: 8-15
PHYSIOLOGICAL PROCESS
Disordered Serotonin transmission
Low levels can cause OCD symptoms
Dopaminergic Neurotransmission
Imbalance in the dopaminergic system
Glutamate levels
High level in OCD causes neuron damage
Environmental Stressors
stressful life events
VARIATION AND CONTEXT
Adult OCD
Checking
The need to check is the compulsion, the obsessive fear might be to prevent damage, fire, leaks, or harm
Rumination
Obsessional intrusive thoughts
Contamination
fear of being dirty is the obsessional worry, the compulsion might be to wash, clean or avoid
Symmetry and Orderliness
The need to have everything lined-up symmetrically "just right"
Hoarding
Inability to discard useless or worn out posessions
OCD in Children
may develop overnight in rare cases
Rapid change in behavior, mood and severe anxiety
A sub-type of pediatric OCD caused by infection called Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS)
CONSEQUENCES
Impaired functional ability
Depression or suicidal thoughts
Interfere with family and social relationships
Unstable finances
Substance abuse
Contact dermatitis from handwashing
Other anxiety disorders (e.g. social and separation anxiety, panic disorder)
RISK FACTORS
Equally affects men, women, children of all races
Genetics
Brain structure and functioning
Environment
Other mental health diagnosis (e.g. depression, tic disorder, substance abuse)
ASSESSMENT
Comprehensive clinical assessment
History of present illness
Co-morbid symptoms
Past Psychiatric History
Medication and Drug allergies
Mental Status exam
Structured Diagnostic Interviews
Anxiety Disorder Interview Scale Child and Parent version
Anxiety Disorder Interview Scale DSM-V (adult)
Clinician Rated Instruments
Adult Yale-Brown OC Scale (Y-BCOS)
Children's Yale-Brown OC Scale
Self-Report Instruments
Obsessive-Compulsive Inventory-Revised (OCI-R)
Yale-Brown Obsessive-Compulsive Scale Self-report
Other measures
Child Obsessive-Compulsive Impact Scale
Children's Obsessional Compulsive Inventory
CLINICAL MANAGEMENT
Acceptance and Commitment Therapy
Cognitive Behavioral Therapy
Exposure and Response Prevention
Anxiety Measurement Techniques
Slow breathing techniques
Mindfulness Meditation
Hyperventilation Control
Relaxation Training
Medications
Monoamine Oxidase Inhibitors
Clomipramine
Selective Serotonin Reuptake Inhibitors (SSRI)
Collaborative Interventions
Group Psychotherapy
Phase 2: Pattern Interruption
Phase 3: Self-Redefinition/Self-Authenticity
Phase 1:Engagement & Pseudoattachment
Termination
Individual Psychotherapy (The triangles of adaptation and object relations)
Collaborative Care Team
Primary Care Giver
Nurse Practitioner
Internist
Family Physician
Physician Assistant
Care Management Staff
Social Worker
Nurse
Psychologist
Psychiatric consultant
INTERRELATED HEALTH AND ILLNESS CONCEPTS
Anxiety
Obsessions and compulsions to seek temporary relief of anxiety
Interpersonal Violence (PTSD)
Biased attention orienting to threats
Mood and Affect
negative self-review of being vulnerable and defective
ANXIETY
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Clark, D. & Radomsky, A. (2014). Introduction: A global perspective on unwanted intrusive thoughts. Journal of Obsessive-Compulsive and Related Disorders. DOI: 10.1016/j.jocrd.2014.02.001. Retrieved from
http://www.sciencedirect.com/science/article/pii/S2211364914000128
Craighead, W. E., Miklowitz, D. J., & Craighead, L. W. (Eds.). (2017). Psychopathology : History, diagnosis, and empirical foundations. Retrieved from
https://ebookcentral-proquest-com.ezproxy.lib.ryerson.ca
Fenske, J. & Pettersen, K. (2015). Obsessive-compulsive disorder diagnosis and treatment. American Academy of Family Physicians. Retrieved from
https://www.aafp.org/afp/2015/1115/p896.pdf
Giddens, J. F. (2017). Concepts for Nursing Practice (with Pageburst Digital Book Access on VST), 2nd Edition. Mosby, 022016. VitalBook file.
https://youtu.be/7X8AGl2NGVk
Koran, L. & Simpson, B.H. (2013). Practice Guideline for the treatment of patients with obsessive-compulsive disorder. American Psychiatric Association. Retrieved from
http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/ocd-
watch.pdf
Rapp, A. M., Bergman, R. L., Piacentini, J., & McGuire, J. F., Evidence-Based Assessment of Obsessive-Compulsive Disorder. Journal of Central Nervous System Disease, 2016. 8: p. 13-29. PMC4994744.
National Institute for Health and Care Excellence. (2005). Obsessive-compulsive disorder and body dysmorphic disorder:treatment : treatment. Retrieved from
https://www.nice.org.uk/guidance/cg31/evidence/cg31-obsessivecompulsive-disorder-full-guideline2
National Institute of Mental Health. (2020). Obsessive-Compulsive Disorder. Retrieved from
https://www.nimh.nih.gov/health/topics/obsessive-
compulsive-disorder-ocd/index.shtml
Owen, K. (2019). The types of obsessive compulsive disorder. Verywell mind. Retrieved from
https://www.verywellmind.com/what-are-the-different-types-of-ocd-2510663
Unutzer, J., Harbin, H., Schoenbaum, M., & Druss, B. (2013). The collaborative care model: An approach for integrating physical and mental health care in medicaid health home. Retrieved from
https://www.chcs.org/media/HH_IRC_Collaborative_Care_Model__052113_2.pdf
Riskind, J. & Calvete, E. (2019). Anxiety and the dynamic self as defined by prospection and mental simulation of looming future threats. Journal of Personality. Retrieved from
https://onlinelibrary-wiley-com.ezproxy.lib.ryerson.ca/doi/full/10.1111/jopy.12465
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