CMN 552 Unit 3 Questions and Correct Answers
Graded A+ 2024
1. What is the DSM 5 diagnostic criteria for diagnosing a patient with OCD? Sadock 422
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
2.What are the reasons other clinical specialists are likely to be seeing a patient with OCD?
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
,3.What would the psychiatric nurse practitioner consider as differential diagnosis when evaluating a
patient for OCD?
Tourette's Disorder
4.What is the best way to distinguish between OCD and major depressive disorder?
Sadock pg 418
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.
5.Review the pharmacotherapy treatment options for OCD. Sadock, pp. 424-425.
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.
Its dosing must be titrated upward over 2 to 3 weeks to avoid gastrointestinal adverse effects and
orthostatic hypotension, and as with other tricyclic drugs, it causes significant sedation and
anticholinergic effects, including dry mouth and constipation. As with SSRIs, the best outcomes result
from a combination of drug and behavioral therapy.
Other drugs: Augment the first drug by the addition of valproate, lithium, or carbamazepine. Other
drugs that can be tried in the treatment of OCD are venlafaxine, pindolol, and the monoamine oxidase
,inhibitors, especially phenelzine (Nardil). Other pharmacological agents for the treatment of
unresponsive patients include Buspar, 5-hydroxytryptamine (5-HT), L-tryptophan, and clonazepam.
Adding an atypical antipsychotic such as risperidone has helped in some cases.
6. What are the common symptoms represented in OCD? (Sadock, p. 418)
intrusive thoughts, rituals, preoccupations, and compulsions
7. Differentiate between an obsession and a compulsion. (Sadock, p. 418)
Obsession: A recurrent and intrusive thought, feeling, idea, or sensation.
Compulsion: A conscious, standardized, recurrent behavior, such as counting, checking, or avoiding
8. What is the prevalence of OCD?
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.
9. What are the common comorbid psychiatric conditions in patients with OCD? Sadock p. 418
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.
10.What are the risk factors for the development of OCD? Sadock p. 419
There is a significant genetic component.
11. What etiological factors have been attributed to the development of OCD? Sadock p. 419-420
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.
12. Review the psychosocial factors for the development of OCD. (Sadock, p. 420)
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.
13. In OCD patients, what is "magical thinking"? (Sadock, p. 421)
Persons believe that merely by thinking about an event in the external world they can cause the event
to occur without intermediate physical actions.
14.In what ways can the psychiatric nurse practitioner characterize (specify) insight in the OCD patient?
(Sadock, p. 421)
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.
15.What are the diagnostic/clinical features of OCD? Sadock p.421
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.
