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I Monika
Panwar, Student
of M.Sc.
Nursing
Previous Year.
Today I present
my practice
teaching on
topic from
subject mental
health nursing.

Announcement
of topic.

INTRODUCTION –

Obsessive Compulsive Disorder (OCD) is a severe anxiety related disorder. Student teacher PPT
A person suffering from this mental disorder, experiences frequent introduce the
disturbing and undesirable obsessive views, frequently followed by topic & student
repetitive compulsions, impulses. listens
Hand washing or repetitive checking of light switches are examples of this attentively.
disorder.
Statistical Manual of Mental Disorders" (DSM-5) provides a broad definition
of obsessive-compulsive disorder that includes the presence of obsessions and/or
compulsions that cause major distress or disruption to daily living. 
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1.
 OBSESSION –
5 Define the -Obsessions are thoughts, images, or urges, they can feel repetitive, Student teacher PPT Define
min. obsession. discusses obsession ?
distressing and intrusive. When a person is preoccupied with these thoughts
obsession &
and is unable to control, they usually get rid of them, or ignore them as they student listens
might be obsessions. carefully.
- Obsessions cause depression and is usually in the form of anxiety.

 COMPULSIONS –
2. -Compulsions are an action or behaviours of a person, who does to relieve
5 Describe the Student teacher PPT Describe the
min. compulsions. the distress they feel because of the obsessions. It could be observable or describes meaning of
hidden. compulsion & compulsion ?
-Usually, people with OCD identify the compulsion being senseless. student nodding
However, he or she feels helpless to stop doing it and may need to repeat their head.
the compulsion over and over again. Sometimes this is described as a ritual.
-Common compulsions include excessive washing and checking, and
mental rituals such as counting, repeating certain words, or praying.

- However, engaging in the compulsions brings no pleasure and may offer

only a temporary relief from anxiety.
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3. 1 Explain sign Student teacher PPT What are the

min. & symptoms  SIGNS AND SYMPTOMS OF OCD - explains sign & sign &
of obsession Person with the obsessive compulsive disorder present with a wide variety symptoms of symptom of
compulsion
of symptom including, obsession OCD ?
disorder.
compulsion
 Persistent, unwanted thoughts, impulses or images (obsessions).
disorder &
 They performs irritating, often seemingly purposeful, ritualized
student note
behaviours (compulsions) in order to neutralize or to reduce the
down.
thought.
 Repetitive and unpleasant, with at least one obsession or
compulsion recognized as excessive or unreasonable. The
persisting symptoms lasts for at least 50 to 60 minutes a day or
considerably interfering with normal functioning.
\
The common obsessive thoughts and compulsive behaviors include:

1. Obsessive cleaning, washing hands, household works to reduce an

exaggerated fear of contamination is common.
2. Obsessive fears about harm occurring to themselves or others which
can result in compulsive behaviours.
3. Repeatedly counting items or objects, such as bottles, clothes or
pavement blocks while walking, junk mail and old newspapers.

Obsessive-compulsive disorder usually includes both obsessions and

compulsions. But it's also possible to have only obsession symptoms or
only compulsion symptoms.
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 OBSESSION SYMPTOMS :

 Fear of being contaminated by touching objects others have touched

 Doubts that you've locked the door or turned off the stove

 Intense stress when objects aren't orderly or facing a certain way

 Images of hurting yourself or someone else that are unwanted and

make you uncomfortable

 Thoughts about shouting obscenities or acting inappropriately that

are unwanted and make you uncomfortable.

 COMPULSION SYMPTOMS :

 Hand-washing until your skin becomes raw

 Checking doors repeatedly to make sure they're locked

 Checking the stove repeatedly to make sure it's off

 Counting in certain patterns

 Silently repeating a prayer, word or phrase

 Arranging your canned goods to face the same way

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5. 5 Enumerate Student teacher PPT List down the

min. the causes of enumerates the causes of
OCD.  CAUSES - The cause of obsessive-compulsive disorder isn't fully causes of OCD OCD ?
understood. Main theories include: & student note
down key point.
 BIOLOGY - OCD may be a result of changes in your body's own
natural chemistry or brain functions. researchers believe that
activity in several portions of the brain is responsible. More
specifically, these areas of the brain may not respond normally to
serotonin, a chemical that some nerve cells use to communicate
with each other.

 GENETICS - OCD may have a genetic component, but specific

genes have yet to be identified. If you, your parent or a sibling, have
an obsessive-compulsive disorder, there's close to a 25% chance
that another immediate family member will have it.

 ENVIRONMENT - Some environmental factors such as infections

are suggested as a trigger for OCD, but more research is needed.

 STRESSFUL LIFE EVENTS -Traumatic or stressful event, may

increases the risk of OCD. This reaction may, for some reason,
trigger the intrusive thoughts, rituals and emotional distress
characteristic of OCD.

 OTHER MENTAL HEALTH DISORDERS-  OCD may be

related to other mental health disorders, such as anxiety disorders,
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6. 1 Enlist the depression, substance abuse or tic disorders.

min. complication
of OCD.
Student teacher What are the
PPT
 COMPLICATIONS enlists the complication
complication of of OCD ?
Problems resulting from OCD may include, among others: OCD & student
listens carefully
 Health issues, such as contact dermatitis from frequent hand- & note down.
washing
 Inability to attend work, school or social activities
 Troubled relationships
 Overall poor quality of life

7.  Suicidal thoughts and behaviour Student teacher How can be

1 Clarify about clarifies the PPT OCD
min. prevention
 PREVENTION prevention & prevented ?
from OCD.
student raise
question.
Getting treatment as soon as possible may help prevent OCD from
worsening and disrupting activities and daily routine.

 SEVERITY VARIES

OCD usually begins in the teen or young adult years. Symptoms usually
begin gradually and tend to vary in severity throughout life. Symptoms
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generally worsen when you experience greater stress. OCD, usually
8. 1 Discuss the
min. diagnosis of considered a lifelong disorder, can have mild to moderate symptoms or be Student teacher How can be
OCD. so severe and time-consuming that it becomes disabling. PPT
discusses the OCD diagnose
diagnosis of ?
 DIAGNOSIS OCD & student
listens carefully.
A doctor or mental health care professional will make a diagnosis of OCD.
A general physical with blood tests is recommended to make sure the
symptoms are not caused by illegal drugs, medications, another mental
illness, or by a general medical condition. To be diagnosed with OCD, a
person must have must have:

 Obsessions, compulsions or both

9.  Obsessions or compulsions that are upsetting and cause difficulty
10 Describe the with work, relationships, other parts of life and typically last for at
min. medical least an hour each day Student teacher Which
management PPT
describes the psychotherapy
of OCD.
management of can be used in
 MANAGEMENT OF OCD OCD & student the
listens management
Currently, there is no cure for this disorder. However, with effective
treatment, people can learn to manage their symptoms and restore normal attentively & of OCD list
functioning. A typical treatment plan will often include both psychotherapy note down key down any
and medications, and combined treatment is usually optimal. point. two?
A. PSYCHOLOGICAL TREATMENT

PSYCHOTHERAPY is also helpful in relieving obsessions and

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compulsions. These include : In particular,

 COGNITIVE BEHAVIOR THERAPY (CBT)

Cognitive therapy (CT) is designed to help patients identify these automatic

unrealistic thoughts and change their interpretations of the meaning of the
thoughts, resulting in decreased anxiety and decreased compulsions.
In the stage of CT includes :
 Maintain thought record by patient.
 Gentle  reasoning and Socratic questioning, the therapist will
verbally challenge an unrealistic belief. This helps the patient to
identify the cognitive distortion.
 When patient identifies their obsession & compulsion as symptoms
of OCD,therapist will initiate a few behavioral experiments to
disprove errors in thinking about cause and effect. 

 EXPOSURE AND RESPONSE THERAPY (ERT)

Exposure response prevention therapy helps a person tolerate the

anxiety associated with obsessive thoughts while not acting out a
compulsion to reduce that anxiety. Over time, this leads to less
anxiety and more self-mastery.

 EYE MOVEMENT DESENSITIZATION AND

REPROCESSING

EMDR is a therapy in which a structured approach is used to

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address past, present, and future aspects of disturbing memories.

EMDR processing phases were administered using the specialized
EMDR protocol in the following sequence:
 Starting with the current triggers (OCD compulsions and
obsessions),
 Followed by the future template (imagining successful
future action),
 And then by past-related disturbing memories (if any).
 Following desensitization of all targets, the positive
cognition is developed and installed.

 Habit Reversal Training 

This intervention includes awareness training, introduction of a competing
response, social support, positive reinforcement, and often relaxation
techniques. Awareness training may be practicing the habit or tic in front of
a mirror, focusing on the sensations of the body and specific muscles
before and while engaging in the behavior, and identifying & recording
when the habit or tic occurs. These techniques increase awareness of how
and when the urges develop, making it more likely that an individual will
be able to intervene and make a change.

B. MEDICATIONS IN THE TREATMENT OF OCD

Especially a type of antidepressant called a selective serotonin reuptake
inhibitor (SSRI), is helpful for many people to reduce the obsessions and
compulsions.
Selective Serotonin Reuptake Inhibitors: SSRIs this is a large class of
antidepressants that work very specifically on the serotonin
neurotransmitter system. These include the following:
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1. Fluoxetine (Prozac)
4. 5 Elaborate the 2. Fluvoxamine (Luvox) Student teacher PPT Which type of
min. types of 3. Sertraline (Zoloft) explains the OCD
OCD.
4. Paroxetine (Paxil) types of OCD & associated
5. Citalopram (Celexa) student note with
6. Escitalopram (Cipralex/Lexapro) down key collection
points. rituals ?
 TYPES OF OCD –

Clinicians and researchers suggest that OCD can be divided into different
types based on the nature of the symptoms experienced.

1. Contamination obsessions with washing/cleaning compulsions: 

Person have feelings of discomfort associated with contamination and wash

or clean excessively to reduce these feelings of distress. 

2. Harm obsessions with checking compulsions: 

Often have intense thoughts related to possible harm to ownself or others
and use checking rituals to relieve distress. For example,
Thinking about a disastrous event, you are increasing the likelihood of such
an event actually happening.
3. Obsessions without visible compulsions: 
This symptom subtype often relates to unwanted obsessions surrounding
sexual, religious, or aggressive themes. Often use mental rituals such as
reciting particular words, counting in head or praying to relieve the anxiety
experiences because of these involuntary thoughts. 
4. Symmetry obsessions with ordering, arranging, & counting
When experiencing this subtype, patient feel a strong need to arrange and
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rearrange objects until they are "just right." This symptom subtype can also
10. 5 Discuss the involve thinking or saying sentences or words over and over again until the Student teacher PPT What are the
min. nursing task is accomplished perfectly.  discusses the key point of
management 5. Hoarding: 
nursing nursing
of patient Hoarding involves the collection of items that are judged to be of limited
with OCD. value by others such as old magazines, clothes, receipts, junk mail, notes, management of management?
or containers. Hoarding is often accompanied by obsessional fears of losing OCD patient &
items or possessions that may be needed one day and excessive emotional student listens
attachment to objects.  attentively

 NURSING MANAGEMENT OF OCD PATIENT –

1. ASSESSMENT
- Assess the patient and patient’s environment.
- Closely observe the patient’s activity.
- Note the time spending on ritual activity.
- Assess the severity of disease condition.

2. PLANNING

3. INTERVENTION
- Using therapeutic communication.
- Offering support and encouragement to the client is important to
help him or her manage anxiety responses.
- The nurse can validate the overwhelming feelings the client
experiences.
- The nurse encourages the client to talk about the feelings and to
describe them in as much detail as the client can tolerate.
- Use diversion techniques to distracting the patient from rituals.
- Help the patient in regain a sense of control.
- Assist the client in pharmacological and psychological treatment.
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4. EVALUATION
- Evaluate the patient’s condition and behaviour for effectiveness of
pharmacological and psychological treatment of patient.
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