OCD

Obsessive compulsive disorder

Symptoms

Etiology
Etiology -The cause of obsessive-compulsive disorder isn't fully understood. Main theories include:

Biology. OCD may be a result of changes in your body's own natural chemistry or brain functions. OCD may also

have a genetic component, but specific genes have yet to be identified.

Environment. Some environmental factors such as infections are suggested as a trigger for OCD, but more

research is needed to be sure.

Cost to society
Cost to societyObsessive-compulsive disorder (OCD), classified as a severe mental illness by
the National Advisory Mental Health Council, affects 2.1% of the population
annually, as shown by the Epidemiological Catchment Area surveys. This
study, using the human capital approach, estimated the direct and indirect
costs of OCD. The total costs of OCD were estimated to be $8.4 billion in 1990,
5.7% of the estimated $147.8 billion cost of all mental illness, and 18.0% of the
costs of all anxiety disorders, estimated to be $46.6 billion. The indirect costs of
OCD, reflecting lost productivity of individuals suffering from or dying from the
disorder, were estimated at $6.2 billion.

Nursing Implications

Approach the patient unhurriedly.

Provide an accepting atmosphere; don't show shock, amusement, or criticism of the ritualistic behavior.
Allow the patient time to carry out the ritualistic behavior (unless it's dangerous) until he can be
distracted into some other activity. Blocking this behavior raises anxiety to an intolerable level.
Keep the patient's physical health in mind. For example, compulsive hand washing may cause skin
breakdown, and rituals or preoccupations may cause inadequate food and fluid intake and exhaustion.
Provide for basic needs, such as rest, nutrition, and grooming, if the patient becomes involved in
ritualistic thoughts and behaviors to the point of self-neglect.
Let the patient know you're aware of his behavior. For example, you might say, I noticed you've made
your bed three times today; that must be very tiring for you. Help the patient explore feelings associated
with the behavior. For example, ask him, What do you think about while you are performing your
chores?
Make reasonable demands, and set reasonable limits; make their purpose clear. Avoid creating
situations that increase frustration and provoke anger, which may interfere with treatment.

Treatment
International OCD-not many large help groups
Star of the sea ocd
Medical: Anxiety Medication: What You Need to Know About AntiAnxiety Drugs
Therapy for Anxiety Disorders: Cognitive Behavioral Therapy,
Exposure Therapy, and Other Options
Antidepressants (Depression Medication):

Cultural
Judaism is one of many religions that demand cleanliness and exactness, inculcate the performance
of rituals from childhood and view their non-performance as wrong or sinful. Rituals concerning
cleanliness and exactness are the commonest presentations of OCD. In a sample of 34 psychiatric
out-patients with OCD in north Jerusalem, religious symptoms were found in 13 of the 19 ultraorthodox patients, and in one of the 15 non-ultra-orthodox patients. Nine of the 15 OCD patients with
religious symptoms also had non-religious symptoms. Four main topics of religious symptomatology
were found: prayer, dietary practices, menstrual practices and cleanliness before prayer. The dictates
of religious codes regarding these topics are presented and the law is rigorous in its demands, in
many cases encouraging repeating rituals. Nevertheless, repetitive performance of religious rituals is
recognized by OCD sufferers and their rabbis as expressing psychopathology rather than heightened
spirituality. The forms of the religious obsessions and the associated rituals in this sample were similar
to the presentation of OCD in non-religious patients. Religion appears not to be a distinctive topic of
OCD, rather it is the setting for the condition in very religious patients.

What are we doing about it?

Current state-of-the-art psychological treatments for OCD provide promise for those with the disorder,
with effectiveness rates for exposure with ritual prevention (ERP) ranging from 60% to 85%
(Abramowitz, 1997), but the treatment is not without its limitations. In addition to the 4015% of
individuals who do not respond to ERP, approximately 25% of individuals will refuse ERP and another
3% to 12% will drop out of treatment (Foa, Steketee, Grayson, & Doppelt, 1983). Although treatment
acceptability is not typically formally measured in ERP, poor motivation and compliance on the part of
the client is problematic in ERP and has been associated with poor outcomes (Foa, Franklin, & Kozak,
1998a). Additionally, certain types of compulsions have been found to be particularly difficult to treat
with ERP, including covert compulsions (Salkovskis & Westbrook, 1989) and hoarding (Clark, 2004).

Is it working?
Increasing number of OCD diagnosis
Studies and treatments only started in the 80s
Obsession forming drugs increasing prevalence
ADHD treatment correlates with OCD

Questions to ask OCD PT

1-How much time is it costing you
2-Have you ever had any violent thoughts?
Have you ever acted on them?
3 avoidance questions (to be used in context of
persons lifestyle)