Amiya Ranjan Behera is an 18-year-old male student who was admitted to the hospital with a diagnosis of obsessive compulsive disorder. He reports symptoms of palpitations, breathlessness, repetitive behaviors like hand washing for 15 minutes and checking things an even number of times. On examination, he appears anxious but is oriented with intact cognition. He reports obsessions about contamination and compulsions to perform behaviors in an even manner. The document outlines his history, mental status exam, physical exam and provides context on obsessive compulsive disorder including potential etiological factors and definitions.
obsessive-compulsive disorder is a mental disorder whose main symptoms include obsessions and compulsions, driving the person to engage in unwanted, often-times distress behaviors or thoughts. The obsessions are usually related to a sense of harm, risk or injury. The common Obsessions include concern about contamination, doubt, fear of loss or letting go, fear of physically injuring someone.It’s treatment is done through a combination of psychiatric medications and psychotherapy.
Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.
An obsession is defined as an idea, impulse, or image which intrude into the conscious aware repeatedly.
obsessive-compulsive disorder is a mental disorder whose main symptoms include obsessions and compulsions, driving the person to engage in unwanted, often-times distress behaviors or thoughts. The obsessions are usually related to a sense of harm, risk or injury. The common Obsessions include concern about contamination, doubt, fear of loss or letting go, fear of physically injuring someone.It’s treatment is done through a combination of psychiatric medications and psychotherapy.
Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.
An obsession is defined as an idea, impulse, or image which intrude into the conscious aware repeatedly.
hii guys this is my ongoing presentation from my speciality class i hope u guys lije that please so i hope it is been useful for u in ur specialities by getting little help with that
SCHIZOPHRENIA:
slide 1: A long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.
slide 14: Types:
• Paranoid-type schizophrenia is characterized by delusions and auditory hallucinations (hearing voices that don't exist) but relatively normal intellectual functioning and expression of emotions. People with paranoid-type schizophrenia can exhibit anger, aloofness, anxiety, and can be argumentative.
• Disorganized-type schizophrenia is characterized by speech and behavior that are disorganized or difficult to understand, and flattening or inappropriate emotions. People with disorganized-type schizophrenia may laugh inappropriately for no apparent reason, make illogical statements, or seem preoccupied with their own thoughts or perceptions. Their disorganized behavior may disrupt normal activities, such as showering, dressing, and preparing meals.
• Undifferentiated-type schizophrenia is characterized by some symptoms seen in all of the above types, but not enough of any one of them to define it as another particular type of schizophrenia.
• Residual-type schizophrenia is characterized by a past history of at least one episode of schizophrenia, but the person currently has no "positive" symptoms (such as delusions, hallucinations, disorganized speech, or behavior). It may represent a transition between a full-blown episode and complete remission, or it may continue for years without any further psychotic episodes.
Catatonic Schizophrenia
This type of schizophrenia includes extremes of behavior, including:
Catatonic excitement - overexcitement or hyperactivity, in which the patient may mimic sounds (echolalia) or movements (achopraxia) around them.
Catatonic stupor - a dramatic reduction in activity in which the patient cannot speak, move or respond. Virtually all movements stops.
Conclusion
It is clear now, through the use of genetic linkage studies and microbiology, that schizophrenia does indeed have a biological explanation. However, the biological explanation is only part of the story. A yet unknown combination of intense stress, sociocultural situations, and cognitive processes may lead to the actual onset of schizophrenia aided by natural precursors. The most compelling explanation seems to be that a genetically inherited biological abnormality gives rise to hallucinations/delusions as a result of intense stress and eventually leads to other negative symptoms in reaction to the hallucinations/ delusions. At any rate, the current understanding of schizophrenia explains that the symptoms, however easily identifiable, are the result of a complex interaction between nature and nurture that can be treated adequately through the use of atypical anti psychotic drugs and psychotherapy.
Electroconvulsive Therapy is still being used. It is a procedure usually done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure.
mania is an alteration in mood that is characterized by extreme happiness, extreme irritability, hyperactivity, little or no need for sleep. the main etiological factors include biological factors, biochemical influences, physiological factors, and psycho social theories. mania is broadly classified into three categories- hypo mania, acute mania and delirious mania. there are three types of treatment for mania- pharmacological treatment, psycho-social treatment and ECT.
Alcoholics Anonymous AA
Alcoholics Anonymous, often referred to simply as AA, is an international fellowship of people working together to overcome their addictions to alcohol.
hii guys this is my ongoing presentation from my speciality class i hope u guys lije that please so i hope it is been useful for u in ur specialities by getting little help with that
SCHIZOPHRENIA:
slide 1: A long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.
slide 14: Types:
• Paranoid-type schizophrenia is characterized by delusions and auditory hallucinations (hearing voices that don't exist) but relatively normal intellectual functioning and expression of emotions. People with paranoid-type schizophrenia can exhibit anger, aloofness, anxiety, and can be argumentative.
• Disorganized-type schizophrenia is characterized by speech and behavior that are disorganized or difficult to understand, and flattening or inappropriate emotions. People with disorganized-type schizophrenia may laugh inappropriately for no apparent reason, make illogical statements, or seem preoccupied with their own thoughts or perceptions. Their disorganized behavior may disrupt normal activities, such as showering, dressing, and preparing meals.
• Undifferentiated-type schizophrenia is characterized by some symptoms seen in all of the above types, but not enough of any one of them to define it as another particular type of schizophrenia.
• Residual-type schizophrenia is characterized by a past history of at least one episode of schizophrenia, but the person currently has no "positive" symptoms (such as delusions, hallucinations, disorganized speech, or behavior). It may represent a transition between a full-blown episode and complete remission, or it may continue for years without any further psychotic episodes.
Catatonic Schizophrenia
This type of schizophrenia includes extremes of behavior, including:
Catatonic excitement - overexcitement or hyperactivity, in which the patient may mimic sounds (echolalia) or movements (achopraxia) around them.
Catatonic stupor - a dramatic reduction in activity in which the patient cannot speak, move or respond. Virtually all movements stops.
Conclusion
It is clear now, through the use of genetic linkage studies and microbiology, that schizophrenia does indeed have a biological explanation. However, the biological explanation is only part of the story. A yet unknown combination of intense stress, sociocultural situations, and cognitive processes may lead to the actual onset of schizophrenia aided by natural precursors. The most compelling explanation seems to be that a genetically inherited biological abnormality gives rise to hallucinations/delusions as a result of intense stress and eventually leads to other negative symptoms in reaction to the hallucinations/ delusions. At any rate, the current understanding of schizophrenia explains that the symptoms, however easily identifiable, are the result of a complex interaction between nature and nurture that can be treated adequately through the use of atypical anti psychotic drugs and psychotherapy.
Electroconvulsive Therapy is still being used. It is a procedure usually done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure.
mania is an alteration in mood that is characterized by extreme happiness, extreme irritability, hyperactivity, little or no need for sleep. the main etiological factors include biological factors, biochemical influences, physiological factors, and psycho social theories. mania is broadly classified into three categories- hypo mania, acute mania and delirious mania. there are three types of treatment for mania- pharmacological treatment, psycho-social treatment and ECT.
Alcoholics Anonymous AA
Alcoholics Anonymous, often referred to simply as AA, is an international fellowship of people working together to overcome their addictions to alcohol.
Every Child is Important , and Baal Saathee is working on academic performance and skill based health education of every child by identifying their intelligence, learning style, personality pattern, behaviors along with tracing of their performances in examinations and building resilience and coping skills in every child to help them make informed choices in future and adapt better.
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A curriculum Plan is the advance arrangement of learning opportunities for a particular population of learners.
Curriculum guide is a written curriculum.
Curriculum Planning is the process whereby the arrangement of curriculum plans or learning opportunities are created.
Master rotation plan is the overall plan of rotation of all students in a particular educational institution, showing the placement of the students belonging to total programme (4 years in B.Sc.(N) and 3 years in GNM) includes both theory and practice denoting the study block, partial block, placement of student in clinical blocks, team nursing, examinations, vacation, co-curricular activities etc.
Curriculum Evaluation is the process of collecting data on a programme to determine its value or worth with the aim of deciding whether to adopt, reject, or revise the programme.
Indian citizens possessing foreign nursing qualification are examined individually & after examination the syllabi and conformation from concerned foreign authorities, the nurses are granted approval for registration in India with the recommendation of equivalence committee under Section 11(2)(a) INC Act. 1947.
A model is a three-dimensional representation of a person or thing or of a proposed structure, typically on a smaller scale than the original:"a model of St. Paul's Cathedral“
A Model is a pattern of something to be made or reproduced and means of transferring a relationship `or process from its real (actual) setting to one which it can be more conveniently studied.
Curriculum development is a process in which participants at many levels make decisions about the purposes of learning, teaching- learning situation.
It is the process of gathering, setting, selecting, balancing and synthesizing relevant information from many sources in order to design the goals of curriculum.
Let’s examine what happens in each step of the curriculum development/revision cycle. This cycle is a dynamic system that helps each school re-vitalize and replenish what is taught to its students.
Determinants of curriculum are the factors that affect the process of assessing needs, formulating objectives and developing instructional opportunities and evaluations.
The term philosophy is derived from the Greek word Philein meaning to love, to strive after or search for and from the word Sophia which means wisdom.
Therefore, Philosophy is the search for wisdom by philosophers.
Teachers use curricula when trying to see what to teach to students and when, as well as what the rubrics should be, what kind of worksheets and teacher worksheets they should make, among other things.
It is actually up to the teachers themselves how these rubrics should be made, how these worksheets should be made and taught; it's all up to the teachers.
Perception (from the Latin perceptio) is the organization, identification, and interpretation of sensory information in order to represent and understand the presented information, or the environment.
The somatoform disorders are a group of psychological disorders in which a patient experiences physical symptoms that are inconsistent with or cannot be fully explained by any underlying general medical or neurologic condition. Medically unexplained physical symptoms account for as many as 50% of new medical outpatient visits. [1] Physical symptoms or painful complaints of unknown etiology are fairly common in pediatric populations. [2] Many healthy young children express emotional distress in terms of physical pain, such as stomachaches or headaches, but these complaints are usually transient and do not effect the child's overall functioning. The somatoform disorders represent the severe end of a continuum of somatic symptoms.
Somatization in children consists of the persistent experience and complaints of somatic distress that cannot be fully explained by a medical diagnosis. They can be represented by a wide spectrum of severity, ranging from mild self-limited symptoms, such as stomachache and headache, to chronic disabling symptoms, such as seizures and paralysis. These psychological disorders are often difficult to approach and complex to understand. It is important to note that these symptoms are not intentionally produced or under voluntary control.
In somatoform disorders, somatic symptoms become the focus of children and their families. They generally interfere with school, home life, and peer relationships. These youngsters are more likely to be considered sickly or health impaired by parents and caretakers, to be absent from school, and to perform poorly in academics. Somatization is often associated temporarily with psychosocial stress and can persist even after the acute stressor has resolved, resulting in the belief by the child and his or her family that the correct medical diagnosis has not yet been found. Thus, patients and families may continue to seek repeated medical treatment after being informed that no acute physical illness has been found and that the symptoms cannot be fully explained by a general medical condition. When somatization occurs in the context of a physical illness, it is identified by symptoms that go beyond the expected pathophysiology of the physical illness.
Recurrent complaints often present as diagnostic and treatment dilemmas to the primary care practitioner (PCP) who is trying to make sense of these symptoms. The PCP may feel poorly prepared and/or may have little time to assess or treat the somatic concerns. While the more disabling somatic complaints are more likely to be referred to a mental health professional, these youngsters presenting with these disabling physical symptoms bridge both medical and psychological domains and present a puzzling quandary for professionals from either field if working with them alone. [3] The nature of these symptoms requires an integrated medical and psychiatric treatment approach to successfully decrease the impairment caused by these disorders.
Schizophrenia is a mental disorder that usually appears in late adolescence or early adulthood. Characterized by delusions, hallucinations, and other cognitive difficulties, schizophrenia can often be a lifelong struggle. In this article, we will cover the causes, symptoms, and treatment of schizophrenia
American psychologist Henry Murray developed a theory of personality that was organized in terms of motives, and needs. Murray described a need as a potentiality or readiness to respond in a certain way under certain given circumstances.
Theories of personality based upon needs and motives suggest that our personalities are a reflection of behaviors controlled by needs.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
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Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
2. Identification Data
• Name - Amiya Ranjan Behera
• Age - 18yr
• Gender - male
• Marital status - Unmarried
• Religion - Hindu
• Education - +2 Science
• Occupation - Student
• Address - At- Panchapada, Bhadrak, Odisha
• Date of admission – 23/10/2018
• Diagnosis – Obcessive Compulsive Disorder
• Ip no:- -- 181022128
3. • .INFORMANT’S NAME – Saudamini Behera
• Relationship with the patient - Mother
• Reliability of the information - Reliable
4. Chief complaint
• According to patient
• I am having palpitation since 1 year
• I feel like breathlessness most of the time.
• If I do something I feel like I should do it again. I do everything for even
times.
• I do my hand wash upto elbow for about 15 minutes since 1year.
• I am facing difficulty in swallowing since 4 days.
• I think that if people get to know about my condition they may mock at
me so I keep myself isolated.
• I feel like dryness of mouth since 4 days.
• I check everything even time before doing.
5. • According to Informants
• My son was washing his hands frequently.
• He was checking everything for twice.
• He was sitting alone.
• He always become anxious.
• If I advice something he always ask questions frequently related to
that matter.
• He suspects every thing.
6. • According to observer
• He is checking everything for twice or more even times
• He was checking side and also walking like in square shape( he stops at the
point of changing direction while walking then walk straight.)
• He checks his his side and way while walking.
• He checks bed before sitting.
• He has some particular position for particular work, if he don’t do that work
according to his position he became anxious.
• He thinks that if he write something in others paper his knowledge may be go
away.
•
7. HISTORY OF PRESENT ILLNESS
Patient was apparently alright before 1 ½ year back.
He had fight with his step brother. Some family disturbance was also
there due to his fathers 2nd marriage.
He joined +2 Science college, as he was a Odia medium student , he
faced difficulty in understanding his subjects, he got very less marks
in class tests in the coaching centre.
He was feeling stressed for the study. He used have palpitations,
breathlessness whenever he got stressed.
He had excessive sweating during these episode.
8. • Later he keep himself away from the friends. Because he was feeling that they
may mock at him.
• He started suspecting in everything.He had repeated thoughts of
contaminations of hand so he was washing his hands for 15 mins
• . He was checking 6-10 times before eating in hostel.
• He was feeling that he may get harmed if he does not carry out the thoughts
repetitively.
• His friends started laughing at him.
• This was continued for 4-5 months,. Then his coaching centre informed to the
family member regarding his condition.
• His family member consulted a local doctor he gave some medications.
Although patient was not fully cured as he was continuing his daily activities
his family members thought that gradually the behaviour will change.
9. •Before four days back patient did not took any food , he was
complaining something is there in his throat.
•He was feeling difficulty in breathing . so his family
member brought him to the IMS and Sum hospital now he
is admitted in ward-1.
10. Treatment history
• He was taking medication for the mental illness from a
local doctor.
• He was taking following medications
• Exam(300) 1 tab. BD (Amisulpride,)[Atypical
antipsychotics],
• Kerad(5) 1 tab.BD(Diazepam)[Anti anxiety],
• Lurastar(40) 1 tab. BD (Lurasidon) [Antipsychotic],
• Zymocat 1 tab. OD (Pancreatin+Dimethicon)[Digestive aids]
11. Personal history
• (A) Perinatal history
• No history of any infection or exposure to radiation during
antenatal period. His mother has no habits of takingany alcohol and
smoking. Amiya was born with normal delivery. He was cried
immediately after birth. There was absence of any birth defect.
According to his informant he was given all the vaccines according to
the schedule.
12. • (B) Childhood history
• Amiya’s primary caregiver was his mother. He was given breast milk
upto 4-5 months and gradually he was given semisolid diet. He had
achieved all the developmental milestone appropriately. He was not
mixing with his friends at first, but when anyone approach to him he
became friend with them. He had general diseases like fever, sinusitis
etc. Once he was drowned in a pond from that incident he had some
fear regarding pond and river.
13. • (C) Educational history:
• Amiya had started his schooling at the age of five years. He was a
good student and secured positions among top three. He has not got
any extracurricular achievement. He had a good relationship with the
teacher and teacher also love him. He had no conduct disorders like
stealing. He had no school phobia, he loves to study. He is continuing
his study and currently he is in 12th standard.
14. • (D) Play history
• He played cricket, and carrom with his friends.
• Very good relationship was there among his playmates.
• (E) Emotional problems during adolescence
• Sometimes he could not handle stress, he cries whenever he faces
some problem.
15. • (H) Occupational history
• He is still dependant on his family members.
• (I) Sexual and marital history
• He is unmarried.
16. (J) Premorbid personality
• Amiya is an introvert. He had a good relationship with his family
members especially hwith his mother, but he did not like his father as
he had marriage for the 2nd time. He spends his leisure time by
watching television and roaming with friends. His mood changes
according to the situation. He become depressed in stressful
situation. He had a positive attitude towards self and others. He does
his homework perfectly but sometimes he get stressed. He believes in
god. He is looking forward to become a teacher. He sometimes
hesitate to eat. Normal elimination pattern. Sometimes he could not
sleep because of his thoughts. Ho has never used any drugs or
alcohol.
17. Family History
• Patients grandfather had history of diabetes and patients
father has high blood pressure. But there is no family history
of any mental illness.
18. Mental Status Examination
• Appearance:
• Patients height is 170cm and weight is 66 kg.
• He has thin body built. His grooming was appropriate to the
time of the day.
19. Behavior:
• He Well behaved and followed the command.
• He has normal motor activity. But he follows a definite pattern
for every action.
• For eg. He checks his shoes before wearing , he wear shoes and
remove it , and continue it for 6-8 times till he became satisfied.
• He checks both sides and road before walking. He checks
medicine for even times and take it in particular direction.
20. • Attitude
• When I first interviewed him he was very anxious . After
sometime he was very open, cooperative and friendly.
• Level of consciousness:
• He was Conscious and alert as patient is answering to the
question appropriately.
21. •Orientation:
•He is fully oriented to time, place and person.
•Speech and Language:
•The patient was talking normal speed with adequate
volume and there was fluctuation in speech.
22. Mood
• Subjective
• Student nurse : How are you feeling?
• Patient : I feeling tensed
• Student Nurse : Why do you feel tensed.
• Patient : Various thoughts are coming to my mind like I am feeling
some thing is there in my throat, to clear it I have to cough for 4-6
times, if I don’t do this I feel something is going to happen to me.
• objective : Patient is looking anxious.
24. Thought
• Stream
• Student Nurse : How much you love your mother?
• Client : She is my best friend I love him very much.
• Form
• Student Nurse : what do you do when you feel stressed?
• Client : When I feel stressed that problem come to
my mind repetitively and suddenly my heart started beating
faster.
25. • Content
• Student nurse : Why do you check before eating
anything?
• Client : I suspect that something may mix
with the food if I don’t check it I may lost my life.
26. Inference of thought
• Thought stream is Normal, goal-directed, no thought block, circum-
stantiality, tangentiality, perseveration, flight of ideas or stereotypy.
F
• Form is Well-structured, understandable, no loosening of
association, is seen.
• Possession Recognizes his thoughts as his own.
• Patient gets obsessions about checking everything and compulsions
about performing some acts in even times. Content Ideas of
persecution are present.
27. Perception
• Hallucinations
• Student Nurse : Sometimes some of the people listen
various sounds and visualize the things when they are alone
which are not recognized by others, do you have any of the
problem like those?
• Client : No I don’t listen or visualize the things like you
said..
28. •Illusion
•Student Nurse: if this type of thing happens to you that,
you saw a material but another person told you that your
thought is wrong regarding this material. For e.g. you saw a
snake but another person told you that it was a rope.
•Client: No this type of thing never happen to me.
•Derealization
•Student Nurse: Have you felt that your soul has come out of
your body and observing your body from outside.
•Client: Laughed, No this also never happen to me.
29. • Cognitive Functions
• Orientation
• Person
• Student Nurse : Who is sitting near by you?
• Client : My mother
• Student Nurse : Who are you?
• Client : I am Amiya Kumar Jena.
• Student Nurse : What do you do.
• Client : I am a student and studying in Class 12th.
• Place
• Student Nurse : Where are you now?
• Client : At Hospital
• Inference: Patient is oriented to time place and person.
30. • Attention
• Student Nurse : Can you say 5 words in English which starts with T.
• Client : Tiger, Time, Timber, Truck, Tractor.
• Student nurse : Can you say 1-5 in backward?
• Client : told correctly
• Concentration
• Student Nurse : Name the months in backward?
• Client : Told correctly.
• Memory
• Immediate
• Student Nurse : Repeat the word what I say bucket, Pen, mobile, ball,
soil.
• Client : Pen, mobile, ball, soil.
• Remarks : Immediate memory intact.
31. • Recent
• Student Nurse : Have you taken your morning medication?
• Client : Yes I have taken.
• Remarks : Patient’s Mother said that he has taken medication. So
Recent memory intact.
• iii. Remote
• Student Nurse : Who was the previous prime minister?
• Client : I don’t know
• Student Nurse : Can you name some of your school friends of
childhood?
• Client : Raja, Samir, pawan, kailash, Jatin.
• Remarks : Remote memory intact.
32. •Abstraction
•Student Nurse : What is the similarity and dissimilarity
between bird and Aeroplane.
•Client : Both can fly , Bird has life but aeroplane has no
life.
•Student Nurse : Can you identify meaning of odia
proverb “ Gaan Kania Singani Naki.”
•Client: : People do not value qualities of their own
people.
• Remark : Abstraction is appropriate to
socio educational status.
33. •Insight:
•Student Nurse : Do you accept your illness and
require treatment?
•Client : Yes I am having repetitive thoughts in my
mind , I require treatment.
•Remark : Grade 5 insight.
34. • Judgment:
• Test:-
• Student Nurse : What will you do if there is fire in this room?
• Client : I will poor water.
• Personal test:-
• Student Nurse :what will you do after discharge?
• Client:- :I will go to my home.
• Social:-
• Student nurse :what will you do when a marriage party is there in
your neighbor.
• Client :I will go there and eat food.
• Remarks :judgment is intact.
35. • Amiya Kumar Behera is a 18 year old male patient. He
was well groomed.
• He well behaved and followed command. He is open
and cooperative. He was conscious and alert.
• He is oriented to time place and person. He was
talking normal spped with adequate volume and there
was fluctuation in speech.
36. • Patient was looking worried and anxious while talking.
• He has broad range, dysphoric, and congruent affect with the mood.
• Thought stream is Normal, goal-directed. Form is Well-structured,
understandable, no loosening of association, is seen.
• Possession Recognizes his thoughts as his own. Patient gets obsessions
about checking everything and compulsions about performing some acts
in even times.
• Content Ideas of persecution are present.
• The patient has no hallucination, illusion, derealization, depersonalization.
Concentration and memory is intact with the patient.
• Insight of the patient is grade-5.
• Abstraction is according to socio educational status. Judgement is also
intact with the patient.
37. Physical examination
• Patient is well nourished with moderate body built.
• He looks healthy and active. He was anxious.
• His scalp was clean.
• Normal visual acuity.
• There was absence of any redness and any sign of jaundice in sclera.
• his hearing was also normal and absence of perforation of tympanic
mebrane.
• Normal bowel movement no dischare or impaction of cerumen in the
ear.
• Symmetrical chest expansion.
• All the joints are movable .
38. Neurological examination
•Patient was conscious and alert.
•He was able to smell perfectly.
•Visual acuity and visual field examination was also found
normal.
•Pupil reacted to the light and both the pupil size was
equal.
•corneal and facial reflex was present.
•mandibular strength was adequate.
•No abnormality was found in facial expression.
39. • Gag reflex was present.
• Normal tongue movement was found.
• No abnormality was found in sensory motor assessment.
• Patient was not able to maintain balance during tandem
walk test.
• Assessment in reflexes was found normal.
• No abnormality was found in deep tendon reflex.
40. Definition:
•Obsessive-compulsive disorder (OCD) is
represented by a diverse group of symptoms that
include intrusive thoughts, rituals,
preoccupations, and compulsions.
•These recurrent obsessions or compulsions cause
severe distress to the person. The obsessions or
compulsions are time-consuming and interfere
significantly with the person's normal routine,
occupational functioning, usual social activities,
or relationships. A patient with OCD may have an
obsession, a compulsion, or both.
41. Etiological Factor:
Book Pictures:
• Neurotransmitters
• SEROTONERGIC SYSTEM.: The many clinical drug trials that
have been conducted support the hypothesis that
dysregulation of serotonin is involved in the symptom
formation of obsessions and compulsions in the disorder.
• NEUROIMMUNOLOGY. Some interest exists in a positive
link between streptococcal infection and OCD. Group A/3-
hemolytic streptococcal infection can cause rheumatic
fever, and approximately 1 0 to 30 percent of the patients
develop Sydenham's chorea and show obsessive-
compulsive symptoms.
42. • Genetics
• Relatives of probands with OCD consistently have a
threefold to fivefold higher probability of having OCD
or obsessive compulsive features .
43. Behavioral Factors
• According to learning theorists, obsessions are conditioned
stimuli.
• A relatively neutral stimulus becomes associated with fear or
anxiety through a process of respondent conditioning by being
paired with events that are noxious or anxiety producing.
• Thus, previously neutral objects and thoughts become
conditioned stimuli capable of provoking anxiety or
discomfort.
• Compulsions are established in a different way.
• When a person discovers that a certain action reduces anxiety
attached to an obsessional thought, he or she develops active
avoidance strategies in the form of compulsions or ritualistic
behaviors to control the anxiety.
44. Psychosocial Factors
• Personality Factors:. OCD differs from obsessive-
compulsive personality disorder, which is associated
with an obsessive concern for details, perfectionism, and
other similar personality traits. Most persons with OCD
do not have premorbid compulsive symptoms, and such
personality traits are neither necessary nor sufficient for
the development.
• Even though the symptoms of OCD may be biologically
driven, psychodynamic meanings may be attached to
them. Patients may become invested in maintaining the
symptomatology because of secondary gains.
45. Psychoanalytical Theory:
• In classic psychoanalytic theory, OCD was termed obsessive-
compulsive neurosis and was considered a regression from the
oedipal phase to the anal psychosexual phase of development.
• When patients with OCD feel threatened by anxiety about
retaliation for unconscious impulses or by the loss of a
significant object's love, they retreat from the oedipal position
and regress to an intensely ambivalent emotional stage
associated with the anal phase.
• The ambivalence is connected to the unraveling of the smooth
fusion between sexual and aggressive drives characteristic of
the oedipal phase. The coexistence of hatred and love toward
the same person leaves patients paralyzed with doubt and
indecision.
46. Patient Picture
• Behavioral Factors
• Patient is repeating his behaviour to reduce anxiety.
• He had also stress factors like studying and
disturbance with his siblings.
49. Clinical Features:
•Book Picture:
•Sign of obsessons
•Fear of contamination
•Repeated unwanted ideas
•Aggressive impulses
•Persistent sexual thoughts
•Thoughts that you might cause others harm
50. Sign of compulsion
•Constant checking
•Constant counting
•The repeated cleaning of one or more items
•Repeatedly washing hands
•Constantly checking the stove or door locks
•Arranging items to face a certain way
51. Emotional symptoms:
•Signs of depression
•Excessive worry
•Extreme tension
•Constant feeling that nothing is ever
right
52. Patient pictures
• He is checking everything for twice or more even times
• He was checking side and also walking like in square shape( he
stops at the point of changing direction while walking then
walk straight.)
• He checks his his side and way while walking.
• He checks bed before sitting.
• He has some particular position for particular work, if he don’t
do that work according to his position he became anxious.
• He thinks that if he write something in others paper his
knowledge may be go away.
55. Nursing Management
• According to book:
• Anxiety related to obsessive thoughts as evidenced by patients
verbalization.
• Disturbed thought processes physical environment
• Social isolation related to lack of faith on others.
• Impaired verbal communication related to lack of interest.
• Disturbed family process related to disease process
56. According to patient
• Anxiety related to perceived threat to biological integrity as evidenced by
patients facial expression
• Fear related to perceived threat to life as evidenced by acknowledge and
discuss of the fear by patient.
• Ineffective coping related to obsessional thoughts as evidenced by ritualistic
behaviour.
• Social isolation related to threat of being mocked as evidenced by patient sit
alone on his bed and never talk with other patient or family members.
• Disturbed family process related to mental disorder of a family member as
evidenced by knowledge deficit regarding health care support.
57. Anxiety related to perceived threat to biological
integrity as evidenced by patients facial expression
• Patients family members of other patients are adviced to stay one
attendant with one patient.
• Staff members are adviced not to force the patient to do anything
• While discussing the client accept the symptoms of patient.
• Client thought process is given priority with rational approach.
• Staff members are adviced to keep eye on the patient.
• He is taught various relaxation techniques to apply when levels of
anxiety are high.
58. Fear related to perceived threat to life as
evidenced by acknowledge and discuss of the fear
by patient.
• Safety security provision of the ward is discussed with the client and he was
reassured.
• Client is helped to understand that his perception of fear is unreal by exploring
his thoughts.
• Thought stopping technique is taught to the client and adviced to substitute
positive thoughts whenever he is getting any negative thoughts in his mind.
• Client is encouraged to share his perceived threat and feelings so that others
can help him to get out of that situation.
• Systematic desensitization approach is applied to reduce his fears
59. Ineffective coping related to obsessional thoughts
as evidenced by ritualistic behaviour.
• Hamilton score was 23 which indicates moderate anxiety.
• Various situations are identified and listed down which increase
clients anxiety and ritualistic behaviour.
• Client his helped to recognise his obsessional thoughts and apply
thought stopping as well as relaxation techniques.
• Client is allowed to go outside for some time as a reinforcement to
non ritualistic behaviour
60. Social isolation related to threat of being mocked
as evidenced by patient sit alone on his bed and
never talk with other patient or family members.
• Ward incharge is adviced to plan a group activity with other patient.
• Staff members are adviced to be with the client as group activity may
increase patient anxiety.
• Staff members are adviced not to give anny false promise like discharge will
be done today to the client as it may decrease trust on them.
• Client is adviced to use relaxation and thought stopping techniques
whenever he feels anxious.
• Student nurses are adviced to use laugh and cautiously
61. Disturbed family process related to mental
disorder of a family member as evidenced by
knowledge deficit regarding health care support.
• Family members knowledge is assessed through questionnaire.
• Family coping ability is identified (e.g., experience of loss, caregiver
burden, needed supports).
• Information is provided regarding bipolar disorder according to family
members understanding.
• Information is provided on client and family community resources for
the client and family after discharge: day hospitals, support groups,
organizations ,psychoeducational programs,
62. Home care and follow up
• Client is adviced to use relaxation and thought stopping techniques
whenever he get anxious.
• Patient is adviced to talk with the friends and family members.
• He is encouragde to share his feelings.
• Improve the self care needs (personal hygiene) independently.
• Sleep hygiene techniques.
• Instruct to use relaxation technique when getting aggressive.
• Taught about the positive coping methods.
• Advice to do meditation.
• Patient and his family member is adviced not to stop medication without
consulting doctor.
• Advice the patient for regular checks up and follows up.
63. References:
• Sadock Benjamin james, Synopsis of psychiatry,Virginnia, , Wolters
Kluwler, 2015
• https://www.mentalhealth.com/home/dx/ocd.html] cited on
November 10 2018
• [https://psychopharmacologyinstitute.com/antipsychotics/risperido
ne/mechanism-of-action-pharmacodynamics-risperidone/]cited on
November 10, 2018
• https://www.ncbi.nlm.nih.gov/pubmed/2418652 [Cited on
November 10 2018]