cmn 552 Unit 3
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1. What are the common symptoms represented in OCD? intrusive thoughts, rituals, preoccupations, and compulsions
(Sadock, p. 418)
2. Differentiate between an obsession and a compulsion. Obsession: A recurrent and intrusive thought, feeling, idea, or sensation.
(Sadock, p. 418) Compulsion: A conscious, standardized, recurrent behavior, such as counting,
checking, or avoiding
3. 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.
4. What are the common comorbid psychiatric conditions The lifetime prevalence for major depressive disorder with OCD is 67 percent and
in patients with OCD? Sadock p. 418 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? There is a significant genetic component.
Sadock p. 419
6. What etiological factors have been attributed to the There is a positive link between streptococcal infections and OCD.
development of OCD? Sadock p. 419-420 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 OCD differs from obsessive-compulsive personality disorder, which is associated
of OCD. (Sadock, p. 420) 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. Persons believe that merely by thinking about an event in the external world they
421) can cause the event to occur without intermediate physical actions.
In what ways can the psychiatric nurse practitioner Patients with good or fair insight recognize that their OCD beliefs are definitely or
characterize (specify) insight in the OCD patient? probably not true or may or may not be true.
(Sadock, p. 421) 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 Patients with OCD often take their complaints to physicians other than psychiatrist.
p.421
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 -Contamination
p421-422 -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 A: The presence of obsessions, compulsions, or both. Obsessions are defined by
patient with OCD? Sadock 422 (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 co
What are the reasons other clinical specialists are likely to Patients with OCD often take their complaints to physicians rather than
be seeing a patient with OCD? 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 Tourette's Disorder
differential diagnosis when evaluating a patient for OCD?
Save
Students also studied
study cards (SHEET METAL LEVEL 1)... Glaziers review test Chapter 17 Glass and Glazing MHA 70
230 terms 124 terms 77 terms 120 term
steve_wong7 Preview Steph3797 Preview noah_schelble Preview cro
1. What are the common symptoms represented in OCD? intrusive thoughts, rituals, preoccupations, and compulsions
(Sadock, p. 418)
2. Differentiate between an obsession and a compulsion. Obsession: A recurrent and intrusive thought, feeling, idea, or sensation.
(Sadock, p. 418) Compulsion: A conscious, standardized, recurrent behavior, such as counting,
checking, or avoiding
3. 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.
4. What are the common comorbid psychiatric conditions The lifetime prevalence for major depressive disorder with OCD is 67 percent and
in patients with OCD? Sadock p. 418 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? There is a significant genetic component.
Sadock p. 419
6. What etiological factors have been attributed to the There is a positive link between streptococcal infections and OCD.
development of OCD? Sadock p. 419-420 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 OCD differs from obsessive-compulsive personality disorder, which is associated
of OCD. (Sadock, p. 420) 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. Persons believe that merely by thinking about an event in the external world they
421) can cause the event to occur without intermediate physical actions.
In what ways can the psychiatric nurse practitioner Patients with good or fair insight recognize that their OCD beliefs are definitely or
characterize (specify) insight in the OCD patient? probably not true or may or may not be true.
(Sadock, p. 421) 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 Patients with OCD often take their complaints to physicians other than psychiatrist.
p.421
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 -Contamination
p421-422 -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 A: The presence of obsessions, compulsions, or both. Obsessions are defined by
patient with OCD? Sadock 422 (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 co
What are the reasons other clinical specialists are likely to Patients with OCD often take their complaints to physicians rather than
be seeing a patient with OCD? 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 Tourette's Disorder
differential diagnosis when evaluating a patient for OCD?
