NEUROSIS DISORDER [OCD]

1. OCD
KARISHMA SINGH RAJPUT

3.  – The term first used by Morel in 1866. Jean Pierre
Falret named it as “The illness doubt”.
 DEFINITION:
 It is a recurrent thoughts or ideas (obsessions)
that an individual is unable to put out of his or her
mind,and action that an individual is unable to
refrain from performing (compulsions). The
obsessions and compulsions are severe enough to
interfere with social and occupational functioning.
“Obsessive Compulsive neuroses”

5.  Of general population,0.05% suffers from this
disorder at a particular time.Obsessive
compulsive disorder constitutes less than 5% of
psychiatric inpatients and outpatients.
 This disorder usually begins in
adolescence or early adulthood.Sex prevalence
is usually equal.
INCIDENCE:

6.  There are recurrent or persistent thoughts,
impulses,or images that are experienced as
intrusive inappropriate,are not simply excess
worries about real life problems that can cause
anxiety or distress.
 People feel these thoughts are
senseless,irrational or excessive,but they are
unable to control.Obsessions include fear of
germs,fear of harming loved ones, or constant
doubts.

OBSESSIONS:

7.  Fear of getting dirty,contaminated or infected by people or
things in the environment.
 Fear of developing a serious life-threatening illness like
AIDS,cancer etc.
 Extreme concern to keep in order,symmetry or exactness.
 Fear of committing a crime,such as a theft or harming others.
 Recurrent thoughts or images of sexual nature.
 Doubts that a task or assignment has been done poorly or
incorrectly.
 Fear of loosing some important things that will be needed
later.
 Fear that some disaster will occur.
Common Obsessions:

8.  Obsessional doubts:This form of obsession is most common.
 Obsessional thoughts:These are usually unpleasant and
repetitively intrude into consciousness (words,phrase) interfering
with the normal train of thought.
 Obsessional images:Vividly imagined scenes,often of a
violent,sexual or disgusting nature that repeatedly come to mind.
 Obsessional convictions:Notions that are often based on the
magical formula of thoughts-equals-act (Thinking ill of my son will
cause him to die).
 Obsessional rumination:The subject is often religion or
metaphysics-why and where; of questions which are as
unanswerable as they are endlessly ponderable.(eg.who created
world? what is the purpose of life?)
 Obsessional impulses:Typically related to self injury.
TYPES OF OBSESSION:

10.  Compulsions are repetitive acts that the person
is driven to carryout in spite of knowing that
they are meaningless,unnecessary or
excessive.These compulsions are meant to
reduce their anxiety.
COMPULSIONS:

12.  Repeatedly cleaning and grooming behaviours such
as washing hands,taking bath,brushing teeth in
particular ways.
 Repeatedly cleaning the things in the house.
 Counting over and over to a particular number of
time.
 Repeatedly checking,locks electrical outlets,gas
knobs,light switches etc.
 Some people with OCD about 25% will have only
obsessions or compulsions.Most of the patient 80%
will have both obsession and compulsion.
Common Compulsions are:

14.  : Compulsions are of two types:
 -Yielding compulsion.
 -Controlling compulsion
TYPES OF COMPULSIONS

15.  Psychoanalytic theory:Psychoanalytic theorists
suggest that OCD develops when defence
mechanism fail to contain the obsessional
character’s anxiety.Defence mechanism like
Isolation,Undoing,Reaction formation are used.
 Learning theory:Two stage learning theory of
obsessivecompulsive disorder is important.In
stage I,the person engages in compulsive rituals
in order to decrease anxiety.If successful in
reducing anxiety,the compulsive behaviour is
more likely to occur in future.
ETIOLOGY:

17.  Organic Factors:Obsessional symptoms are frequent
in patients following head injury,encephalitis.
 Biochemical Theories:Serotonin has been implicated
in mediating impulsivity,suicidality,aggression,anxiety,
social dominance and learning.
 Genetic:About 80-90% of monozygotic twins are
concordant for obsessional illness versus a
concordance rate in dizygotic twins of no more than
50 percent.


18.  Recurrent,persistent ideas
(doubts),thoughts,images, pictures or impulses.
 These obsessions are viewed by the patient as
senseless or repugnant that invade his thinking.
 Patient makes attempts to ignore or suppress the
obsessions.
 Obsessions may be followed by repetitive,
seemingly,purposeless behaviors.
 Patient views obsessions and compulsions as
abnormal, tries to control them and seeks treatment.

CLINICAL MANIFESTATIONS

19.  The common complications include-
depression,Dryness of skin,Suicidal
attempt,anxiety.
COMPLICATIONS:

20.  Behaviour Therapy:
 Exposure Techniques:
 Exposure procedures that aim to decrease the anxiety
associated with obsessions.
 Response prevention techniques that aim to decrease
the frequency of rituals.
 Exposure to anxiogenic stimuli requires
that the patients perform rituals to decrease their
anxiety and discomfort.If the patients can hold
themselves back from performing the rituals,which will
reduce their discomfort, anxiety gradually diminishes.
MANAGEMENT:

21.  Blocking and Punishing Techniques:
 Aversive training is the procedure
whereby pairing of the obsessive-compulsive
phenomena is done with an aversive
stimulus.Thought stopping is also used for
obsessions.The procedure was described as
involving the production of a strong
stimulus,that has the strength to interfere with
the ongoing thought process;such as shouting,
“stop” or a loud bang.
CONT…

22.  The most promising antidepressant
clomipramine is mainly antiobsessional
irrespective of depressive
symptoms.SSRIs(Serotonin Reuptake Inhibitors)
are given. These drugs increase the amount of
serotonin available for nerve cells in the brain.The
Anti-obsessional drugs mostly given are:
 Drug - Oral Dose(mg)
 Clomipramine - 50-300
 Fluoxetine - 20-100
Pharmacotherapy:

23.  Sertraline - 100-200
 Fluvoxamine - 50-150
 Paroxetine - 10-40
 Citalopram - 10-40
 Escitalopram - 5-20
CONT…

24.  Psychotherapy:
 Supportive psychotherapy is helpful in
acute cases and is dealing with obsessive
character traits of perfection
doubting,procrastination and indecisiveness
CONT…

25.  Is the last choice. It may head to striking reduction in
tension and distress cinglectomy may be thought off
when symptoms are very problematic.
 Nursing problems identified in these patients
are:
 Increasing anxiety
 Decreased coping ability with compulsion
 Decreased communication
 Ritualistic acts
 Lower self-esteem
 Disturbed sleep
 Need for behaviour modification
Psychosurgery:

26.  PRIMARY PREVENTION:
 Early treatment brings good results.So early
identification is very essential.Parentsand
teachers should be educated to identify OCD in
early stages.The OCD symptoms in children will
be:
 Poor academic performance
NURSES ROLE:

27.  No concentration
 No happiness
 Depression
 Public should be made aware that OCD is a
mental disorder which needs treatment.

CONT…

28.  SECONDARY PREVENTION:
 Importance of medication to control the
symptoms to be stressed.
 Family to be encouraged to altered educational
and support groups.
 Encourage patient to engage in behaviour
therapy.
 Normal activity to be approved.
 Unnecessary anxiety should be avoided.
 Teach relaxation technique
CONT…

29.  TERTIARY PREVENTION:
 Strict follow up.
 Stress management.
CONT…

30.  Favourable Factors:
 A normal good premorbid personality.
 Mild or atypical symptoms including
predominance of phobic symptoms,ruminative
ideas and absence of compulsion.

 Short duration of symptoms.
 A phase course.
 Satisfactory resolution of precipitating
disturbance
PROGNOSTIC FACTORS IN OCD:

31.  Anxiety or depression prominent features.

 Poor Prognostic Factors:
 Obsessional premorbid personality
 Early age of onset and
 A clinical picture showing severe symptoms
CONT…

32. NURSING INTERVENTION

33. CELEBRITIES WITH OCD

38.  Obsessive compulsive disorder is a chronic and
distressing disorder that can lead to severe
impairment in social academic and family
functioning.Parents and teachers should be
educated to identify OCD in early stages.Public
should be made aware that OCD is a mental
disorder which needs treatment.
CONCLUSION: