Posted: September 28th, 2023
Obsessive Compulsive Disorder
Obsessive Compulsive Disorder PPT
Please refer to the Grading Rubric (find it attached) for details on how this activity will be graded. Please remember that you and your partner must each submit the assignment, even if it is the same file, so that you both receive feedback and credit.
You and your partner will create a 15-slide PowerPoint presentation on the following topic: obsessive compulsive disorder. INCLUDE AT LEAST 150 WORDS PER SLIDE AS SPEAKER NOTES
Completing this presentation will prepare you to:
· Remember the diagnostic criteria of your chosen topic.
· Create an evidence-based treatment plan for a patient with the chosen condition, including pharmacologic and non-pharmacologic treatment options.
· Summarize factors that may lead to positive and negative outcomes for patients served and how the role of the PMHNP can improve outcomes.
Create your PowerPoint presentation with the objective of teaching your peers about your chosen topic.
The assignment must include the following:
1. Three learning objectives for the activity
2. DSM-5 criteria
3. Screening tools with validity and reliability
4. Pharmacologic and non-pharmacologic treatment options
5. Differences in symptoms and treatments across the lifespan, if applicable
6. Ethical and legal considerations
7. Potential barriers to treatment related to cultural and/or socioeconomic factors and how these impact outcomes of populations served
8. An analysis of how the PMHNP role can serve to improve outcomes for individuals with your chosen diagnosis.
Title: Obsessive Compulsive Disorder
Define obsessive compulsive disorder based on DSM-5 diagnostic criteria (American Psychiatric Association, 2013).
Describe evidence-based pharmacologic and psychotherapeutic treatment options for OCD.
Analyze how the advanced practice psychiatric nurse can improve outcomes for individuals with OCD.
DSM-5 Diagnostic Criteria for OCD (American Psychiatric Association, 2013)
Presents obsessions, compulsions, or both
Obsessions defined as recurrent and persistent thoughts, urges, or images
Compulsions defined as repetitive behaviors or mental acts in response to an obsession or rules that must be applied rigidly.
Screening Tools for OCD
Yale-Brown Obsessive Compulsive Scale (Y-BOCS; Goodman et al., 1989) is considered the gold standard for measuring OCD symptom severity. It has demonstrated high internal consistency, inter-rater reliability, and validity (Goodman et al., 1989).
Obsessive-Compulsive Inventory-Revised (OCI-R; Foa et al., 2002) is a brief self-report measure of OCD symptom dimensions with high internal consistency and test-retest reliability (Foa et al., 2002).
Pharmacologic Treatment Options for OCD
Selective serotonin reuptake inhibitors (SSRIs) such as sertraline and fluoxetine are first-line treatment for OCD (Bystritsky et al., 2012). Augmentation with cognitive-behavioral therapy (CBT) such as exposure and ritual prevention (ERP) is recommended for optimal outcomes (Olatunji et al., 2013).
Non-pharmacologic Treatment Options for OCD
Exposure and ritual prevention (ERP) is the gold standard psychotherapy for OCD with large effect sizes (Olatunji et al., 2013). ERP involves exposing clients to feared triggers while resisting compulsions and safety behaviors (Olatunji et al., 2013).
Differences in OCD Across the Lifespan
Early-onset OCD often presents before age 18 and is associated with tic disorders (Storch et al., 2010). Late-onset OCD after age 35 may be associated with structural brain changes (Kwon et al., 2003). Treatment should be adapted based on developmental needs.
Ethical and Legal Considerations in Treating OCD
Duty to warn in cases of harm to self or others from obsessions (e.g., harm, contamination obsessions)
Right to refuse treatment even if clinically indicated
Importance of informed consent regarding risks/benefits of pharmacotherapy and psychotherapy
Barriers to Treatment Related to Cultural Factors
Cultural beliefs can impact willingness to engage in ERP involving rituals related to religious/spiritual practices (Weisskirch, 2013). Culturally-adapted CBT incorporating client values may improve outcomes (Hinton & Lewis-Fernández, 2011). Overcoming stigma in some cultures also poses a barrier (Weisskirch, 2013).
Barriers to Treatment Related to Socioeconomic Factors
Lack of health insurance coverage and inability to pay out-of-pocket costs limit access to empirically supported psychotherapy and medication management (Katz et al., 2013). The PMHNP role in expanding access to care through community clinics can help address this barrier.
The Role of the PMHNP in Improving Outcomes
Coordinate multidisciplinary care with psychiatrists, therapists, PCPs
Provide medication management and psychotherapy (e.g., ERP)
Conduct psychoeducation to promote treatment adherence
Screen for and treat comorbid disorders that impact prognosis
Advocate for patients to address social determinants of mental health
Case examples of patients with OCD at different stages of life (child, adolescent, adult) including treatment plans involving pharmacotherapy and psychotherapy.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Bystritsky, A. et al. (2012). Clinical utility of complementary and alternative medicine interventions for anxiety disorders. Focus, 10(2), 224–242. https://doi.org/10.1176/appi.focus.10.2.224
Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., & Salkovskis, P. M. (2002). The Obsessive-Compulsive Inventory: Development and validation of a short version. Psychological assessment, 14(4), 485–496. https://doi.org/10.1037/1040-3522.214.171.1245
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., Heninger, G. R., & Charney, D. S. (1989). The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of general psychiatry, 46(11), 1006–1011. https://doi.org/10.1001/archpsyc.1989.01810110048007
Hinton, D. E., & Lewis-Fernández, R. (2011). The cross-cultural validity of posttraumatic stress disorder: implications for DSM-5. Depression and anxiety, 28(9), 783–801. https://doi.org/10.1002/da.20753
Katz, C. L., Jetton, A. M., & Pennant, M. E. (2013). Defining the role of the mental health nurse practitioner in behavioral health primary care. Issues in mental health nursing, 34(5), 336–341. https://doi.org/10.3109/01612840.2012.751593
Kwon, J. S., Kim, J. J., Lee, D. H., Lee, J. M., Lyoo, I. K., Nomura, S., & Seo, J. S. (2003). Gray matter abnormalities in obsessive-compulsive disorder: statistical parametric mapping of segmented magnetic resonance images. The American journal of psychiatry, 160(12), 2130–2132. https://doi.org/10.1176/appi.ajp.160.12.2130
Olatunji, B. O., Davis, M. L., Powers, M. B., & Smits, J. A. (2013). Cognitive-behavioral therapy for obsessive-compulsive disorder: a meta-analysis of treatment outcome and moderators. Journal of psychiatric research, 47(1), 33–41. https://doi.org/10.1016/j.jpsychires.2012.08.020
Storch, E. A., Geffken, G. R., Merlo, L. J., Jacob, M. L., Murphy, T. K., Goodman, W. K., … Grabill, K. (2007). Family accommodation in pediatric obsessive-compulsive disorder. Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 36(2), 207–216. https://doi.org/10.1080/15374410701274955
Weisskirch, R. S. (2013). A cultural context for obsessive-compulsive disorder. Mental Health, Religion & Culture, 16(4), 387-400.