CMN 552 Unit 3 Questions And Answers Verified
100% Correct
What are the reasons other clinical specialists are likely to be seeing a
patient with OCD? - 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? - ANSWER -Tourette's
Disorder
What is the best way to distinguish between OCD and major
depressive disorder?
Sadock pg 418 - 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. - 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.
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.
Review the psychosocial treatment options for OCD. Sadock, pp.
424426 - ANSWER -Psychodynamic exploration of a patient's
resistance to treatment may improve compliance. Well-controlled
studies have found that pharmacotherapy, behavior therapy, or a
combination of both is effective in significantly reducing the
symptoms of patients with OCD. The decision about which therapy to
use is based on the clinician's judgment and experience and the
patient's acceptance of the various modalities.
Behavior therapy - Behavior therapy is as effective as
pharmacotherapies in OCD, and some data indicate that the beneficial
effects are longer lasting with behavior therapy. Many clinicians,
therefore, consider behavior therapy the treatment of choice for OCD.
Behavior therapy can be conducted in both outpatient and inpatient
settings. The principal behavioral approaches in OCD are exposure
and response prevention.
Desensitization, thought stopping, flooding, implosion therapy, and
aversive conditioning have also been used.
Psychotherapy: Individual analysts have seen striking and lasting
changes for the better in patients with obsessive-compulsive
, personality disorder, especially when they are able to come to terms
with the aggressive impulses underlying their character traits.
Some clinicians have observed marked symptomatic improvement in
patients with OCD in the course of analysis or prolonged insight
psychotherapy.
Supportive psychotherapy undoubtedly has its place, especially for
those patients with OCD who, despite symptoms varying degrees of
severity, are able to work and make social adjustments. With
continuous and regular contact with an interested, sympathetic, and
encouraging professional person, patients may be able to function by
virtue of this help, without which their symptoms would incapacitate
them. Occasionally, when obsessional rituals and anxiety reach an
intolerable intensity, it is ne
What are the treatment options for extreme cases of OCD that are
treatment resistant? Sadock, p. 426 - ANSWER -Eelectroconvulsive
therapy (ECT) and psychosurgery are considerations. ECT should be
tried before surgery.
Cingulotomy: Surgical procedure which may be successful in treating
otherwise severe/treatment-unresponsive patients.
Other surgical procedures (e.g., subcaudate tractotomy, also known
as capsulotomy) have also been used for this purpose.
Deep brain stimulation (DBS): Indwelling electrodes in various basal
ganglia nuclei are under investigation to treat both OCD and
Tourette's disorder. DBS is performed by using MRI-guided electrode
implantation. Complications of DBS include infection, bleeding, or the
development of seizures, which are almost always controlled by
treatment with Dilantin.
100% Correct
What are the reasons other clinical specialists are likely to be seeing a
patient with OCD? - 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? - ANSWER -Tourette's
Disorder
What is the best way to distinguish between OCD and major
depressive disorder?
Sadock pg 418 - 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. - 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.
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.
Review the psychosocial treatment options for OCD. Sadock, pp.
424426 - ANSWER -Psychodynamic exploration of a patient's
resistance to treatment may improve compliance. Well-controlled
studies have found that pharmacotherapy, behavior therapy, or a
combination of both is effective in significantly reducing the
symptoms of patients with OCD. The decision about which therapy to
use is based on the clinician's judgment and experience and the
patient's acceptance of the various modalities.
Behavior therapy - Behavior therapy is as effective as
pharmacotherapies in OCD, and some data indicate that the beneficial
effects are longer lasting with behavior therapy. Many clinicians,
therefore, consider behavior therapy the treatment of choice for OCD.
Behavior therapy can be conducted in both outpatient and inpatient
settings. The principal behavioral approaches in OCD are exposure
and response prevention.
Desensitization, thought stopping, flooding, implosion therapy, and
aversive conditioning have also been used.
Psychotherapy: Individual analysts have seen striking and lasting
changes for the better in patients with obsessive-compulsive
, personality disorder, especially when they are able to come to terms
with the aggressive impulses underlying their character traits.
Some clinicians have observed marked symptomatic improvement in
patients with OCD in the course of analysis or prolonged insight
psychotherapy.
Supportive psychotherapy undoubtedly has its place, especially for
those patients with OCD who, despite symptoms varying degrees of
severity, are able to work and make social adjustments. With
continuous and regular contact with an interested, sympathetic, and
encouraging professional person, patients may be able to function by
virtue of this help, without which their symptoms would incapacitate
them. Occasionally, when obsessional rituals and anxiety reach an
intolerable intensity, it is ne
What are the treatment options for extreme cases of OCD that are
treatment resistant? Sadock, p. 426 - ANSWER -Eelectroconvulsive
therapy (ECT) and psychosurgery are considerations. ECT should be
tried before surgery.
Cingulotomy: Surgical procedure which may be successful in treating
otherwise severe/treatment-unresponsive patients.
Other surgical procedures (e.g., subcaudate tractotomy, also known
as capsulotomy) have also been used for this purpose.
Deep brain stimulation (DBS): Indwelling electrodes in various basal
ganglia nuclei are under investigation to treat both OCD and
Tourette's disorder. DBS is performed by using MRI-guided electrode
implantation. Complications of DBS include infection, bleeding, or the
development of seizures, which are almost always controlled by
treatment with Dilantin.
