SEMINAR ON OBSESSIVE

COMPULSIVE DISORDER
NAME: SIVIKA CHETRY
ROLL NO:31
BSC nursing 3rd year.
CONTENTS
 INTRODUCTION
 DEFINITION
 EPIDEMIOLOGY
 ETIOLOGY
 CLASSIFICATIONOF OCD
 CLINICAL SYNDROME
 TREATMENT
 NURSING MANAGEMENT
 NURSING DIAGNOSIS
CONTD…
 JOURNAL REVIEW
 CONCLUSION
 SUMMARY
INTRODUCTION
 Obsessive compulsive disorder is a mental
illness in which a person has uncontrollable,
reoccurring thoughts (obsessions) and
behaviours (compulsions) that he or she
feels the urge to repeat over and over.
 The disorder may begin in childhood, but

often begins in adolescence or early

childhood.
CONTD..
 Itis equally common among men and
women. The course is usually chronic.
 Many OCD sufferers also have major

depressive disorder, panic disorder, social

phobia, substance abuse etc.
DEFINITION
 According to ICD9, Obsessive compulsive
disorder is a state in which the
outstanding symptom is a feeling of
subjective compulsion which must be
resisted- to carry out some action, to
dwell on an idea, to recall an experience,
or ruminate on an abstract topic.
EPIDEMIOLOGY
 OCD has a lifetime prevalence of 2-3% in
the United states. Two third of cases
have their onset earlier than age 25 and
only 15% occur after age 35. In India , the
study found lifetime prevalence of 0.6% .
This rate is considerably lower compared
to the 2-3% rate reported in the
European and North American studies.
ETIOLOGY
 GENETIC FACTORS-
 Twin studies have found a significantly

higher concordance rate for monozygotic

twins than dizygotic twins.
 Family studies have shown that 35% of

the first degree relatives of OCD patients

are also affected.
CONTD..
 BIOCHEMICAL INFLUENCES-
Neurotransmitter serotonin( 5-HT) may
be abnormal.
CONTD..
 PSYCHOANALYTIC THEORY/
PSYCHODYNAMIC THEORY:
 1. Isolation of affect
 2. Undoing
 3. Reaction formation
CONTD…
 BEHAVIOURAL THEORY: Obsession as a
conditioned to anxiety( similar to
phobia).
 BIOLOGICAL THEORIES: Occur secondary

to may illnesses such as-

 1. Von Economo’s encephalitis
 2. Basal ganglia lesions
 3. Gilles de la tourette syndrome
CONTD..
 4.Hypothalamic and third ventricle
lesions.
CLASSIFICATION OF OCD AS PER ICD-10
 PREDOMINANTLY OBSESSIONAL
THOUGHTS OR RUMINATIONS:
 Include ideas, thoughts, mental images

or impulses which are very much

distressing to the individual.
 PREDOMINANLY COMPULSIVE

ACTS( COMPULSIVE RITUALS)

CONTD…
 The ritual act is a symbolic attempt to
avert the danger or fear.
 MIXED OBSESSIONAL THOUGHTS AND

ACTS: Majority of OCD individuals will

have both obsessional thoughts and
compulsive thoughts and compulsive
acts.
CLINICAL SYNDROMES
 Four clinical syndromes have been
described in literature:
 WASHERS-
 This is the commonest type.
 The obsessions is of contamination with

dirt, germs, body excretions.

 The compulsion is washing of hands or the

whole body repeatedly many times a day.

CONTD…
 CHECKERS:
 The person has multiple doubts.
 The compulsion of course is checking

repeatedly to remove the doubt.

 PURE OBSESSIONS:
CONTD…
 PURE OBSESSIONS-
 Characterized by repetitive intrusive

thoughts, impulses or images which are

not associated with compulsive acts.
 Here, the person repetitively ruminates

in his mind about pros and cons of

thoughts.
CONTD…
 PRIMARY OBSESSIVE SLOWNESS-
 Characterized by severe obsessive ideas

and or extensive compulsive rituals

therefore manifested anxiety.
 Scales used to elicit symptoms and

severity of OCD- YALE BROWN

OBSESSIVE COMPULSIVE SCALE.
CONTD…
 Y-BOCS classifies the symptoms and signs
of OCD as follows:
 1. Aggressive obsessions.
 2. Contamination obsessions.
 3. Sexual obsessions.
 4. Hoarding/ Saving obsessions.
 5. Religious/ scrupulous obsessions.
CONTD…
 6. Obsessions with need for symmetry or
exactness.
 7. Somatic obsessions.
 8. Miscellaneous obsessions.
 9. Cleaning/ washing compulsions.
 10. Checking compulsions.
 11. Repeating rituals.
CONTD…
 12. Counting compulsion.
 13. Ordering/ Arranging compulsions.
 14. Hoarding/ Collecting compulsions.
 15. Miscellaneous compulsions.
TREATMENT
 PSYCHOTHERAPY:
 1. Psychoanalytic psychotherapy.
 2. Supportive psychotherapy.
CONTD…
 BEHAVIOUR THERAPY AND COGNITIVE
BEHAVIOUR THERAPY:
 Effective mode of therapy.
 80% success rate.
 The techniques used are:
 1. Thought stopping.
 2. Response prevention.
CONTD…
 3.Systematic desensitisation.
 4. Modelling.
DRUG THERAPY
 Benzodiazepines( e.g Alprazolam,
clonazepam)- controlling anxiety.
 Antidepressants: Improve specific

serotonin reuptake inhibitors( SSRIs).

 Clomipramine (75-300mg/ day).
 Fluoxetine ( 20- 80mg/ day).
 Fluvoxamine( 50-200 mg/ day).
CONTD…
 Antipsychotics
 Buspirone
ELECTROCONVULSIVE THERAPY
CONTD…
 PSYCHOSURGERY
 1. Stereotactic limbic leucotomy.
 2. Stereotactic subcaudate tractotomy.
NURSING MANAGEMENT
 ASSESSMENT:
 History taking.
 Physical examinations.
 Compulsive activities.
 Social functioning.

 Mental status examinations.

CONTD…
 Pattern
of utilization, coping abilities or
defense mechanism.
NURSING DIAGNOSIS:
 Exhaustion related to anxiety and
obsessional thoughts.
 Altered physical functioning related to

ritual behaviour.
 Social isolation related to anxiety and

thoughts.
JOURNAL REVIEW
 TOPIC: OBSESSIVE COMPULSIVE DISORDER
DURING COVID-19 PANDEMIC. ( 25 March
2022).
 AUTHOR- Elizabeth S. Linde, tibor V. varga,

Amy Clotworthy.
 BACKGROUND: The covid 19 pandemic and

its associated restrictions may contribute to a

deterioration in mental health , individuals
CONTD…
 Withobsessive compulsive disorder
(OCD) may be particularly affected. This
systematic review aimed to investigate
the effects of the current pandemic on
people diagnosed with OCD and whether
pandemics may affect the development
of OCD symptoms.
CONTD…
 METHOD: A systematic search using NCBI
pubmed, SCOPUS and Google scholar on
February 9th 2021. Research articles
related to OCD and Covid-19 or other
pandemics were attempted to be
identified using pre- defined search
terms.
CONTD…
 Case reports, clinical guidelines, letters and
clinical research articles>,= 100 participants
were included, reviews were excluded.
 The systematic review adheres to PRISMA

guidelines and the Newcastle- Ottaua scale

was used to assess the quality of the
included clinical research article.
RESULT
A total of 79 articles were included in the full
test assessment. Of these, 59 were clinical
research articles, two were clinical
guidelines, six were case reports, and 12
were letters.
 The research articles examined OCD

symptoms in adult patients with diagnosed

OCDS, the general population, pregnant
women, children and adolescents.
CONTD….
 Only one study on OCD in previous pandemics was
identified.
 CONCLUSIONS: This systematic review found that

people with and without diagnosed OCD prior to

the pandemic generally experienced a worsened
landscape of symptoms of OCD during the COVID-
19 pandemic. However, the responses are
heterogenous and many factors other than the
pandemic seemed to affect the development of
OCD symptoms.
CONTD…
 To prevent the impairement of
symptoms and the development of new
cases, close monitoring of patients with
OCD and education of the general public
is essential.
CONCLUSIONS
 Obsessive compulsive disorder (OCD) is a
mental disorder where people feel the
need to check things repeatedly , have
certain thoughts or feel they need to
perform certain routines repeatedly.
 People are unable to control either the

thoughts or the activities.

BIBLIOGRAPHY
 Niraj Ahuja, “ A short textbook of Psychiatry”,
20th edition, 2011, page no: 95-98,published
by Jaypee brothers medical publishers (p) ltd.
 R sreevani, “ A guide mental health &

psychiatric nursing,4th edition,2016, page

no:224-228, published by Jaypee brothers
medical publishers(p) ltd.
 www.frontiersin.org