A POWERPOINT
PRESENTATION ON
OBSESSIVE-COMPULSIVE DISORDER (OCD)
OBJECTIVE
Medical/
Nursing
Management
Pathophy
siology
Types
signs and
symptoms
Definition
of OCD
■ OCD is a mental health disorder, characterized by distressing
unpleasant thoughts or images (obsessions ) and by repetitive
unwanted actions (compulsions ). Though obsessions increase
anxiety, they are not simple real-life worries. The consequent
compulsion may serve to decrease or increase the individual’s
anxiety ( Gargano et al.,2023).
WHAT IS
OCD?
Types of obsessive-compulsive
Disorder
1) Contamination- occurs due to
severe fear of contracting diseases
causing the sufferer to wash oneself
and their environment to a harmful
degree excessively.
4)Intrusive thoughts; Sufferers are
affected by disturbing thoughts and can
be concerned with any topic.
5) Ruminations; the individual is
involved in a sustained chain of
thoughts on an unproductive topic.
2)Aggressive and somatic
obsessions with checking compulsion;
common with people riddled with
anxiety
They engaged in checking compulsion
for hours at a time.
3) Hoarding obsession with collecting
compulsion; homes are littered with
unwanted old and countless items
om, 2024).
(Theanxiety.c
SYMPTOMS OF OCD
OBSESSIVE THOUGHTS
Fear of being contaminated by
germs
Excessive worries with tidiness
and symmetry
Excessive concerns about
religious issues, illness, or
morality
Disturbing intrusive thoughts
■
COMPULSIVE BEHAVIORS
■ Obsessive washing and cleaning.
■ Placement of objects in patterns using
rigid rules
■ Extreme double-checking of appliances,
locks, and safety measures.
■ tapping, word repetitions, and counting
■
(Gargano et al.,2023)
PATHOPHYSIOLOGY OF OCD
BIOLOGICAL DIAMENTION
■ Hereditary is associated with OCD
Multipath Model Of OCD ■ Significant risk found in firstdegree relatives
■ OCD can manifest due to poor
development of the fetal brain.
associated with environmentally
based biological factors such as;
smoking in pregnancy.
(Sue et al.,2022).
• Several cortical
and subcortical
regions such as
the orbitofrontal
cortex
Parts of the
brain affected in
OCD
• Dorsolateral
prefrontal cortex
• Amygdala
• Head of the
caudate nucleus
• Thalamus
Serotonin
(neurotransmitter)
(Gargano et al., 2023)
This Photo by Unknown Author is licensed under CC BY-SA
IRREGULARITY IN THE BRAIN AND OCD
■OCD acts on
the cognitive
functions of the
brain linked with
executive
functioning
1) Impaired planning
and decision making
2) difficulty shifting
attention away from
intrusive thoughts/
compulsive behaviors
DYSFUNCTION IN THE PREFRONTAL CORTEX
Orbitofrontal Cortex (OFC): The OFC involves
decision-making, emotional processing, and reward
evaluation. Dysfunction within the OFC may result in
difficulties in assessing the significance of stimuli and
lead to repetitive, compulsive behaviors aimed at
decreasing perceived threats.
Anterior Cingulate Cortex (ACC): The ACC plays a
role in error detection, conflict monitoring, and
emotional regulation. Hyperactivity in the ACC can
amplify feelings of uncertainty and distress, reinforcing
obsessive thought patterns and compulsive rituals.
Impact of Prefrontal Cortex Dysfunction on Cognitive
Processes and Obsession Generation
Decision-Making: Hyperactivity in the prefrontal cortex
can impair decision-making processes, leading
individuals with OCD to interpret neutral stimuli as
threatening and prioritize avoidance behaviors.
Emotional Regulation: Dysregulation within the prefrontal
cortex affects emotional processing, resulting in
heightened anxiety and an inability to effectively regulate
emotional responses to intrusive thoughts.
Abnormalities in Basal Ganglia(caudate nucleus
and putamen)
Dysfunctional Basal ganglia
Normal Basal Ganglia
→Regulate motor function
I.
Difficulty inhibiting unwanted motor
actions/perceived behaviours
Habit formation
II.
Disrupt the balance of
neurotransmitters and neural
Procedural learning
signaling within the basal ganglia
circuits
Stores automatic behaviors like
washing and grooming
III.
contributing to the manifestation of
OCD symptoms.
Disfunction in the Basal Ganglia Contd.
Hyperactivity in the basal ganglia may contribute to the
reinforcement of repetitive actions and rituals characteristic of
OCD.
Additionally, it can disrupt the inhibitory control mechanisms
that normally suppress compulsive behaviors, leading to
their persistence despite efforts to resist them.
Understanding the role of basal ganglia abnormalities in
OCD highlights the importance of targeting this brain
region in the development of effective therapeutic
interventions. (Stein et al., 2015)
SEROTONIN THEORY
A range of studies points to the role of the serotonin system in
mediating OCD. Serotonin is a naturally occurring neurotransmitter
that carries signals between nerve cells and around the body. It plays
important roles such as learning, memory, happiness, sleep as well
as mood and emotions. Low serotonin levels in the brain trigger
someone with OCD to become nervous and more alert to stimuli than
normal in their behaviors causing compulsive behaviors such as
extreme hand washing, counting, or organizing.
Serotonin imbalance is a significant factor in the pathophysiology of
Obsessive-Compulsive Disorder (OCD), with disturbances in
serotonin neurotransmission contributing to the development and
maintenance of symptoms.
As with any mental disorder there are
a multitude of treatments that can be
beneficial to the patient
Treatments
of OCD
These treatments are typically divided
into two main areas
Pharmacological
Non-pharmacological
■ The main differences between these
two treatment options are that the
pharmacological treatment model
focuses upon medications as the
primary source of treatment
Treatments
of OCD
■ Whereas there are a variety of
psychotherapies that the patient can
be treated with
■ It should be noted that both methods
of treatment have their merits and
their place in the treatment journey of
an individual suffering from OCD
Pharmacological treatments
Fluvoxamine
maleate
Sertraline
Fluoxetine
Escitalopram
Clozapine
Paroxetine
Clomipramine
hydrochloride
Fluvoxamine
maleate
■ Class – Selective
Serotonin Re-uptake
Inhibitors (SSRI)
■ Dose – 50mg daily
(initially), up to 300mg
daily
Source BNF 2024
Sertraline
■ Class – Selective Serotonin Re-uptake Inhibitors (SSRI)
■ Dose – 50mg daily, up to 200mg daily
Source BNF 2024
Escitalopram
■ Class – Selective Serotonin Reuptake Inhibitors (SSRI)
■ Dose – 5mg daily, up to 10mg daily
Source BNF 2024
Paroxetine
■ Class – Selective Serotonin Re-uptake Inhibitors (SSRI)
■ Dose – 20mg daily (initially), up to 60mg daily
Source BNF 2024
Fluoxetine
■ Class – Selective Serotonin Re-uptake Inhibitors (SSRI)
■ Dose – 20mg daily (initially), up to 60mg daily
Source BNF 2024
Clozapine
■ Class – Antipsychotics (second generation)
■ Dose – 12.5mg daily (initially), up to 300mg daily
Source BNF 2024
Clomipramine hydrochloride
■ Class – Tricyclic antidepressant
■ Dose – 25mg daily (initially), up to 250mg daily
Source BNF 2024
Pharmacological treatments
SSRIs, these medications
inhibit the reuptake of
serotonin
neurotransmitters.
Antipsychotic (Clozapine),
inhibits several
neurotransmitters receptors
dopamine type 4, serotonin
type 2, norepinephrine,
acetylcholine, and
histamine receptors
Tricyclic antidepressant,
this medication inhibits the
reuptake of serotonin and
norepinephrine
neurotransmitters
Non-pharmacological treatments
Cognitive behavioural therapy
Neurosurgical
Deep-brain stimulation
Non-pharmacological treatments
Cognitive behavioural therapy
Due to the proven efficacy of SSRI’s and CBT they are often used
together in clinical settings (Cottraux, et al., 2005)
CBT is the most effective evidenced-based psychotherapy for
OCD at present. It can also be argued as the most effective
treatment for OCD, including pharmacotherapy 36-40.
It can be utilised in group, individual, and online settings
Non-pharmacological treatments
A cognitive reappraisal or restructuring component and behavioural
interventions
CBT has two components
These can be used jointly or independently
Exposure-response prevention is a highly utilised form of CBT for OCD.
Exposure-response prevention is a structured psychotherapy that
exposes the patient to provoking stimuli (Hirschtritt, et al., 2017).
Neurosurgical
In cases where CBT and SSRI treatment has
been unsuccessful in significantly reducing OCD
symptoms neurosurgical options are sometimes
utilised
These include anterior cingulotomy, ventral
capsulotomy, subcaudate tractotomy, and limbic
leucotomy
(Nuttin, et al., 2014)
Nonpharmacologic
al treatments
Non-pharmacological treatments
Anterior cingulotomy, creates small lesions on the anterior
cingulate gyrus (Kim, et al., 2003)
Ventral capsulotomy, creates lesions on the anterior limb of
the internal capsule/ventral striatum (Barrios-Anderson, et
al., 2022)
Subcaudate tractotomy, creates lesions in the substantia
innominata (Doshi, 2009)
Limbic leucotomy, is a combination of ventral capsulotomy
and subcaudate tractotomy (Mashour, et al., 2005)
Non-pharmacological
treatments
■ Deep-brain stimulation
■ This therapy is another neurosurgical procedure but involves
implanting electrodes in specific brain regions to stimulate
these regions.
■ In relation to OCD the brain region typically targeted is the
anterior limb of the internal nucleus accumbens or the
thalamus/subthalamic nucleus (Alonso, et al., 2015)
Approaches to SelfManaging OCD
■
Taking medication regularly
as prescribed
■
Self-regulating the
symptoms
■
Engaging in peer support
groups
■
Self-help resources
How Does medication Allow People SelfManage OCD and Support Their Mental
Wellbeing
■ About 7 out of 10 people with OCD will benefit from
medication. For the people who benefit from
medication, they usually see their OCD symptoms
reduced by 40-60%. For medications to work, they
must be taken regularly and as directed by their
doctor (Sabetnejad et al., 2016)
■ Some people with OCD that regularly take SSRIs
to manage their symptoms can feel less tense and
anxious resulting in a positive effect on their lives.
Others may not experience symptom relief from
taking their medication however despite it not
improving symptoms it can prevent them from
becoming more severe
■ Medication can also play a crucial role in allowing
people that suffer from OCD to have a professional
career as if OCD is left untreated severe symptoms
can affect work, study and social relationships
(Soomro et al., 2008)
The Benefits of Self Regulating
the Symptoms of OCD
■
Learning and becoming knowledgeable about anxiety has been
found to reduce levels of anxiety in people with OCD however, if the
information is negative or confusing it can cause increased levels of
anxiety
■
Becoming aware of the symptoms of OCD can allow for some
people to self-regulate as some people may experience lower levels
of stress and anxiety when symptoms occur if they know why they
are experiencing these feelings
■
Designing a strategy that will help deal with obsessions will allow
people to have a higher probability of self-managing their OCD and
increasing their overall mental wellbeing
■
Strategies for OCD typically aim to reduce stress through engaging
in a healthy lifestyle. This can include eating a healthy diet, getting
enough exercise and improving sleep (Adams et al., 2018)
(Charpentier et al., 2022)
How Does Engaging in Peer
Support Groups Help People
Manage the Symptoms of OCD?
■
Peer support groups can improve the mental wellbeing of people
suffering from OCD as meeting others with the same experiences can
make people feel less lonely and isolated as well as understood
■
Common struggles that people that suffer from OCD have can
become normalised making people feel included and providing
reassurance that they are not suffering on their own. If a support
group is run effectively, it can provide those involved with a sense of
community
■
A peer support group can be a non-judgemental which can make it
easier for people to open up about their struggles living with OCD
■
Success stories from others can help inspire and motivate people with
severe symptoms of OCD and can provide reassurance
■
It has been found that most people do not find success in managing
their OCD on their own and peer support groups have been shown to
allow people to manage their symptoms better than self-help
resources
How Does Self Help Resources Have a
Positive Effect on the Mental Wellbeing of
People Suffering From OCD?
■
Some healthcare professionals such as general practitioners can
recommend self-help books to their patients that they can get for
free from local libraries
■
Knowledge really is power when it comes to tackling OCD and selfhelp books can provide people with education on OCD which
increases their chances of improving their mental wellbeing
■
These resources can also allow people with OCD to build and
develop coping strategies when symptoms such as anxiety are
present
■
Even if self-help resources do not improve the mental wellbeing of
people suffering from OCD, they can definitely provide the
foundation and knowledge before trying other approaches
■
Self-help resources can never replace or be as powerful as
seeking help through a health care professional however, having
general knowledge of OCD before going to therapy can speed up
the recovery process
THE ROLE OF THE NURSE
➢Mental health nurses have an important
role whilst supporting an individual with
Obsessive Compulsive Disorder (OCD), by
providing psychoeducation, psychotherapy
and medications, whilst adapting a holistic
approach.
➢By doing so, nurses can tailor each
individual patients treatment plan,
ensuring all factors such as; spiritual
and cultural aspects are considered.
➢This creates the best person-centred
care plan for each patient with OCD.
➢By implementing the biopsychosocial
model to their practice, nurses can reduce
morbidity and mortality, as well as
improving the patients cognitive functioning
(Gellatly & Molloy, 2014).
(Agorastos et al., 2014)
THE ROLE OF
THE NURSE
Assessment
■
A clinical assessment should be carried out by the nurse
that includes
•
History of present illness
•
Symptoms
•
Past psychiatric history & family psychiatric history
•
Social and developmental history
•
Medical and substance history
•
Mental status examination.
■
Followed by a risk assessment of self-harm and harm to
others.
(Pampaloni et al., 2022)
THE ROLE OF THE NURSE
Supporting Children and
Adolescents
■
Previously considered to be rare among children and adolescents, OCD
is a more common psychiatric issue within this population, with
prevalence rates ranging from 1%-4%.
■
Early detection of OCD is of paramount importance to access effective
treatment for children and adolescents.
■
OCD, when left untreated typically persists and it can have a profound
negative impact on a young person’s social, educational, and emotional
development (Krebs & Heyman, 2013)
■
When the nurse is assessing a child or adolescent with suspected OCD,
it is recommended that they meet with both the child/teen and the
caregiver. As they can minimize the impact of OCD on their lives due to
guilt or shame.
■
OCD symptoms can be hidden from family members, particularly those
related to ‘bad thoughts.
■
Younger children tend to have their parents in the room to help with
providing a history, while adolescents usually prefer to be seen alone.
■
Therefore, it is important for the nurse to also obtain a separate parent
history to provide multiple perspectives (Ramos-Marcuse & Kverno,
2023).
THE ROLE OF THE NURSE
Supporting Adults
■
The nurse will help patients identify the
onset of their OCD symptoms
understand the connection between
their thoughts, feelings, and ritualistic
behaviours, and help them understand
how stress and anxiety play into their
obsessions
■
Educate patients on the meaning and
purpose of their compulsions (such as
rituals or routines) (Rapp et al., 2016)
■
Never attempt to interrupt a ritual as this
can lead to a rise in anxiety. Instead,
patients will be helped to reduce these
behaviours, such as repetitive hand
washing/checking.
■
This can be done by setting a time limit
for routines, slowing decreasing
allocated time.
■
Teaching patients how to effectively
cope with stressful situations without
resorting to obsessive thoughts and /or
compulsive behaviours
■
Providing a safe supportive
environment.
■
Encouraging compliance with
THE ROLE OF THE
NURSE
Supporting the family
■
The nurse will ;develop a trusting professional
relationship with the patient and the family.
■
Listen to the families concerns, whilst educating
them on how to best support their loved one.
■
Inform the family on how to recognise when the
loved ones mental state would decline.
■
Providing emotional support and reassurance.
■
Educate family in regards to patients medication
if being administered (Belschner et al., 2020)
References;
■
Agorastos, A., Huber, C.G. and Demiralay, C. (2014) ‘Influence of religious aspects and personal beliefs on psychological behavior: Focus on Anxiety
Disorders’, Psychology Research and Behavior Management, p. 93. doi:10.2147/prbm.s43666.
■
Belschner, L. et al. (2020) ‘Mindfulness-based Skills Training Group for parents of obsessive-compulsive disorder-affected children: A caregiver-focused
intervention’, Complementary Therapies in Clinical Practice, 39, p. 101098. doi:10.1016/j.ctcp.2020.101098.
■
Gellatly, J. and Molloy, C. (2014) ‘Psychological interventions in obsessive compulsive disorder’, Nursing Standard, 28(51), pp. 51–59.
doi:10.7748/ns.28.51.51.e8909.
■
Krebs, G. and Heyman, I. (2013) ‘Treatment‐resistant obsessive‐compulsive disorder in young people: Assessment and treatment strategies’, Child and
Adolescent Mental Health, 15(1), pp. 2–11. doi:10.1111/j.1475-3588.2009.00548.x.
■
Pampaloni, I. et al. (2022) ‘The global assessment of OCD’, Comprehensive Psychiatry, 118, p. 152342. doi:10.1016/j.comppsych.2022.152342.
■
Ramos-Marcuse, F. and Kverno, K. (2023) ‘Treatment in children and adolescents with obsessive-compulsive disorder: Review for Practitioners’, Journal
of Psychosocial Nursing and Mental Health Services, 61(8), pp. 11–15. doi:10.3928/02793695-20230705-02.
■
Rapp, A.M. et al. (2016) ‘Evidence-based assessment of obsessive–compulsive disorder’, Journal of Central Nervous System Disease, 8.
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■
Young, A. (2019) ‘Assessing and treating obsessive compulsive disorder in practice’, Practice Nursing, 30(4), pp. 178–181.
doi:10.12968/pnur.2019.30.4.178.
References
■
Barrios-Anderson, A., McLaughlin, N.C., Patrick, M.T., Marsland, R., Noren, G., Asaad, W.F., Greenberg, B.D. and
Rasmussen, S., 2022. The Patient Lived-Experience of Ventral Capsulotomy for Obsessive-Compulsive Disorder:
An Interpretive Phenomenological Analysis of Neuroablative Psychiatric Neurosurgery. Frontiers in Integrative
Neuroscience, 16, p.8.
■
Alonso, P., Cuadras, D., Gabriëls, L., Denys, D., Goodman, W., Greenberg, B.D., Jimenez-Ponce, F., Kuhn, J.,
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■
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■
Doshi, P.K., 2009. Surgical treatment of obsessive compulsive disorders: Current status. Indian journal of
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References
■
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■
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■
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