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cmn 552 Unit 31. What are the common symptoms represented in OCD? (Sadock, p. 418) - correct answer intrusive thoughts, rituals, preoccupations, and compulsions 2. Differentiate between an obsession and a compulsion. (Sadock, p. 418) - correct answer Obsession: A recurrent and intrusive ...

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cmn 552 Unit 3
1. What are the common symptoms represented in OCD? (Sadock, p. 418) - correct
answer intrusive thoughts, rituals, preoccupations, and compulsions

2. Differentiate between an obsession and a compulsion. (Sadock, p. 418) - correct
answer Obsession: A recurrent and intrusive thought, feeling, idea, or sensation.
Compulsion: A conscious, standardized, recurrent behavior, such as counting,
checking, or avoiding

3. What is the prevalence of OCD? - correct answer Lifetime prevalence in the
general population estimated at 2 to 3 percent.
Fourth most common psychiatric diagnosis.
Among adults, men and women are equally likely to be affected.

Among adolescents, boys are more commonly affected than girls.
Mean age of onset is about 20 years.

The onset of the disorder can occur in adolescence or childhood, in some cases as
early as 2 years of age.

Single persons are more frequently affected with OCD than are married persons,
although this finding probably reflects the difficulty that persons with the disorder have
maintaining a relationship.

Occurs less often among blacks than among whites,
although access to health care rather than differences in prevalence may explain the
variation.

4. What are the common comorbid psychiatric conditions in patients with OCD? Sadock
p. 418 - correct answer The lifetime prevalence for major depressive disorder with
OCD is 67 percent and social
phobia 25 percent.

Also, alcohol use disorder, generalized anxiety disorder, specific phobia, panic disorder,
eating disorders, and personality disorders. Tourette's disorder 5-7 percent.
Tics 20-30 percent.

What are the risk factors for the development of OCD? Sadock p. 419 - correct answer
There is a significant genetic component.

6. What etiological factors have been attributed to the development of OCD? Sadock p.
419-420 - correct answer There is a positive link between streptococcal infections
and OCD.

,Altered function in neurocircuitry between orbitofrontal cortex, caudate, and thalamus.
Increased activity in the
frontal lobes, basal ganglia and cingulum. Bilaterally smaller caudates.

7. Review the psychosocial factors for the development of OCD. (Sadock, p. 420) -
correct answer 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 of OCD. Only
about 15 to 35 percent of patients with OCD have had premorbid obsessional traits.

Many patients with OCD may refuse to cooperate with effective treatments such as
selective serotonin reuptake inhibitors (SSRis) and behavior therapy.

Patients may become invested in maintaining the symptomatology because of
secondary gains. For example, a male patient, whose mother stays home to take care
of him, may unconsciously wish to hang on to his OCD symptoms because they keep
the attention of his mother.

Research suggests that OCD may be precipitated by a number of environmental
stressors, especially those involving pregnancy, childbirth, or parental care of children.
An understanding of the stressors may assist the clinician in an overall treatment plan
that reduces the stressful events themselves or their meaning to the patient.

8. In OCD patients, what is "magical thinking"? (Sadock, p. 421) - correct answer
Persons believe that merely by thinking about an event in the external world they can
cause the event to occur without intermediate physical actions.

In what ways can the psychiatric nurse practitioner characterize (specify) insight in the
OCD patient? (Sadock, p. 421) - correct answer Patients with good or fair insight
recognize that their OCD beliefs are definitely or probably not true or may or may not be
true.
Patients with poor insight believe their OCD beliefs are probably true.
Patients with absent insight are convinced that their beliefs are true.

What are the diagnostic/clinical features of OCD? Sadock p.421 - correct answer
Patients with OCD often take their complaints to physicians other than psychiatrist.

Most patients with OCD have both obsessions & compulsions - up to 75%. Obsessions
and compulsions are the essential feature of OCD.

Sometimes, patients overvalue obsessions and compulsions, for example they may
insist that compulsive cleanliness is morally correct, even though they have lost their
jobs because of time spent cleaning.

,What are the 4 major symptom patterns in OCD? Sadock p421-422 - correct answer -
Contamination
-Pathological Doubt
-Intrusive Thoughts
-Symmetry
-Other: religious obsessions and compulsions, hair pulling, nail biting, masturbation

12. What is the DSM 5 diagnostic criteria for diagnosing a patient with OCD? Sadock
422 - correct answer A: The presence of obsessions, compulsions, or both.
Obsessions are defined by (1) and (2) as follows:
1. Recurrent and persistent thoughts, urges, or images that are experienced, at some
time during the disturbance, as intrusive and unwanted, and cause marked anxiety and
distress
2. The person attempts to suppress or ignore such thoughts, impulses, or images or to
neutralize them with some other thought or action (i.e. performing a compulsion
Compulsions are defined by (1) and (2):
1. Repetitive behaviors (eg, hand washing, ordering, checking) or mental acts (eg,
praying, counting, repeating words silently) in response to an obsession or according to
rules that must be applied rigidly
2. The behaviors or mental acts are aimed at preventing or reducing distress or
preventing some dreaded event or situation; however, these behaviors or mental acts
either are not connected in a way that could realistically neutralize or prevent whatever
they are meant to address, or they are clearly excessive
NOTE: young children may not be able to articulate the aims of these behaviors or
mental acts.
B: The obsessions or compulsions are time consuming (e.g. take more than 1 hour per
day) or cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning
C: The obsessive-compulsive symptoms are not attributable to the physiological effects
of a substance(e.g., a drug of abuse, a medication) or another medical condition.
D: the disturbance is not better explained by the symptoms of another mental disorder
Specify if:
-with good or fair insight: the individual recognizes that OCD beliefs are definitely or
probably not true or that they may not be true
-with poor insight: the individual thinks OCD beliefs are probably true
-with absent insight/delusional beliefs: the individual is completely convinced that OCD
beliefs are true
Specify if:
Tic-related: the individual has a current or past history of a tic disorder

What are the reasons other clinical specialists are likely to be seeing a patient with
OCD? - correct answer Patients with OCD often take their complaints to physicians
rather than psychiatrists (Table 10.1-2). Most patients with OCD have both obsessions
and compulsions—up to 75 percent in some surveys. Some researchers and clinicians
believe that the number may be much closer to 100 percent if patients are carefully

, assessed for the presence of mental compulsions in addition to behavioral compulsions.
For example, an obsession about hurting a child may be followed by a mental
compulsion to repeat a specific prayer a specific number of times. Other researchers
and clinicians, however, believe that some patients do have only obsessive thoughts
without compulsions. Such patients are likely to have repetitious thoughts of a sexual or
aggressive act that is reprehensible to them. Sadock pg 421. See Table 10.1-1

What would the psychiatric nurse practitioner consider as differential diagnosis when
evaluating a patient for OCD? - correct answer Tourette's Disorder

What is the best way to distinguish between OCD and major depressive disorder?
Sadock pg 418 - correct answer Obsessive compulsive disorder ( OCD) is
represented by a diverse group of symptoms that include intrusive thoughts, rituals,
preoccupations,and compulsions. These recurrent obsessions or compulsion 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 obsessive, a
compulsion, or both.

Sadock pg 347.
A major depressive disorder occurs without a history of a manic,mixed ,or hypomanic
episode. A major depressive episode must last at least 2 weeks , and typically a person
with a diagnosis of a major depressive episode also experiences at least four symptoms
from a list that includes changes in appetite and weight , changes in sleep and
activity ,lack of energy , feelings of guilt , problems thinking and making decisions, and
recurring thoughts of suicide.

Review the pharmacotherapy treatment options for OCD. Sadock, pp. 424-425. - correct
answer The standard approach is to start treatment with an SSRI or clomipramine and
then to move to other pharmacological strategies if the serotonin-specific drugs are not
effective. The serotonergic drugs have increased the percentage of patients with OCD
who are likely to respond to treatment to the range of 50 to 70 percent.

Each of the SSRIs available in the United States has been approved by the FDA for the
treatment of OCD.

Higher dosages have often been necessary for a beneficial effect, such as 80 mg a day
of fluoxetine.

SSRI side effects are generally less troubling than the adverse effects associated with
tricyclic drugs such as clomipramine.

Clomipramine: The most selective for serotonin reuptake versus norepinephrine
reuptake and is exceeded in this respect only by the SSRIs. The potency of serotonin
reuptake of clomipramine is exceeded only by sertraline and paroxetine.

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