Obsessive Compulsive Disorder: Bipolar Disorder

Mental health problems are associated with excessive stress to a specific situation or event. The most common types of mental disorder are dementia, schizophrenia, bipolar disorder, anxiety disorder and depression. According to Thomsen (2013), the signs and symptoms may include mood fluctuation, personality change and social withdrawal. An anxiety disorder is one of the most significant type of mental health disorder linked with feelings of worry, fear and uneasiness. There are several individuals who do not realize the fact that they have defined and treatable disorder. Thus, such conditions remain under diagnosed. The anxiety disorders also include impairment in the everyday functioning. One of the most common types of anxiety disorder is “Obsessive-Compulsive Disorder (OCD).” This condition is not due to medical and substance use. It is a disorder of the brain which leads to severe anxiety and adversely affects the behavior of the person suffering from this condition. In this report, the aetiology, incidence and predisposing factors that contributes to OCD and the elements of a mental health condition examination related to OCD will be highlighted. Moreover, medication and nursing practice action plan based on this condition will be discussed Goodman et al., 2014).

One of the most severe types of anxiety disorder which affects around 2% of the global population is “Obsessive-Compulsive Disorder.” As stated by Grant (2014), this disorder is characterized by two features. The first one is obsessions such as intrusive and disturbing thoughts, impulses or images. Secondly, compulsions that includes repetitive mental acts and behaviors which neutralize obsessions and reduce the psychological distress. Such conditions causes life impairment and are time consuming.

Evidences reveal the fact that there is no specific cause of OCD (Soomro, 2012). However, the possible causes of OCD has been thought to be a combination of genetic, neurological, cognitive, behavioral or environmental factors that trigger the onset of the disorder. There are several circuits in the brain that regulates the primordial aspects of human behavior like excretion, aggression and sexuality. These circuits are responsible for the transmission of information from orbitofrontal cortex of the brain to the thalamus and striatum area. When such circuits are activated, specific impulses causes an individual to perform a significant behavior. Imbalance in neurotransmitters such as serotonin can cause OCD. Moreover, OCD can be caused by environmental factors and genetic factors such as mutation in the brain cell (Veale & Roberts, 2014).

According to, the incidence of DSM-III-R “Obsessive-compulsive disorder” in terms of adults has been estimated at 0.55 per 1000 individuals. According to ABS 2007, 1.9% of the Australians suffer from OCD every year. Research reflects the fact there is no discrepancy between the genders and both male and female are equally affected. The significant signs and symptoms originate during the childhood and presentation can be identified in the late adolescence or early adulthood Veale & Roberts, 2014).

The factors that increase the incidence or risk of triggering OCD are as follows:

• Family history where an individual in the family is affected by this disorder might elevate the risk of OCD.
• Traumatic events or long-term stressful events can cause OCD.
• Environmental factors such as occupational, relationship or educational changes, and abuse might lead to OCD (Bokor & Anderson, 2014).

The mental state examination is a key part of the clinical assessment process in the mental health practice. It is a defined mode of observing and explaining an individual’s present state of mind in regards to behavior, attitude, thought process, cognition, perception and judgment. Based on the MSE assessment OCD can be discussed related to several elements such as mood, thought process, behavior, psychomotor agitation and speech (Zohar et al.,  2012).

In “Obsessive Compulsive Disorder,” various situations trigger significantly the obsession and compulsion in the individual’s behavior, mood and thought process resulting in mood fluctuations anxiety, depression, distress and unwanted thoughts. Therefore these three elements have been selected in order to describe OCD (Bell, 2015).

There are several medicines that are used in order to cure “Obsessive Compulsive Disorder.” As discussed by Williams et al., (2012), the main aim of the OCD treatment is to effectively manage the signs and symptoms at the lowest possible dosage. Few psychiatric medicines have been designed to treat the obsessions and compulsions associated with OCD. There are certain antidepressants that are regularly used for the treatment of OCD. Two common medicines used for the treatment of OCD are Clomipramine and Fluvoxamine.

According to Pauls et al., (2014), Clomipramine is a non-selective serotonin reuptake inhibitor has proved the fact that deficit of serotonin can lead to the development OCD. Serotonin is thus considered as a key element in the pathophysiology of this disorder.  This drug blocks the serotonin reuptake pathway by the help of the pre-synaptic neuron. In turn the serotonin availability elevates in the post-synaptic receptors. Although it is not evident the type of patient that would respond to this particular drug, studies show that about 40% to 60% patients have responded to Clomipramine. In the initial administration phase the doses are divided along with meals to reduce the gastrointestinal side effects. Gradually over the next few weeks the doses should be increased up to maximum of 250 mg every day.

As a nurse it is important to monitor for sedation and vertigo, at the initial stage of the medication application so that any side effect of the drug can be detected and stopped if required. Secondly, physicians should be informed if fever and other issues are detected such as sore throat since these changes can reflect the hematological complications (Figee et al., 2013).

Fluvoxamine is a selective serotonin reuptake inhibitor which restores the balance of serotonin and ultimately aids in decrease obsessive and compulsive behavior. As discussed by Milad & Rauch (2012), Fluvoxamine is a potent selective serotonin reuptake inhibitor with around 100-fold affinity for the serotonin transporter over the norepinephrine transporter. In adults 50 mg of Fluvoxamine should be administered as a single dose. The dose should be increased every 4 to 7 days per the tolerance level of the patient. The doses should be divided into two parts and the larger part should be given at the bedtime, in case the doses are not equally divided.

Fluvoxamine can increase or decrease the level of certain enzyme. Therefore, as a nurse assessment of the AST, ALT and bilirubin level should be monitored. Secondly, while administering the medicine side effects such as nausea, vomiting, pulse rate and seizures should be monitored (Figee et al., 2013).

A recovery focused practice based on the nursing practice is embodied in the practice and attitudes and it is also essential in promoting the hope, sense and wellbeing for self determination of individual with any mental disorder. The application of the “Cognitive Behavioral therapy” can be an effective method of treating OCD patients. In this practice patients are counseled related to several sessions which mainly focuses on the reduction in the negative thoughts by the application therapeutic treatment (Hofmann et al., 2012).  

This therapy has achieved success in several studies. This therapy has been found to be the most effective for dealing with the OCD patients and for their recovery. The goal of this therapeutic approach is to make the to be his or her own therapist, while providing the hope of their recovery and ensuring that they will not have any risks or side effects associated with it. This is the reason, why it is the right therapy of choice (Andersson et al., 2012). The recovery of the patient’s situation is promoted by encouraging patient’s positive thought and breaking the negative thought process.

In CBT process, two evidence-based processes are used. One is cognitive therapy, which focuses on “how people think” and the behavior therapy, which focuses upon “how this affects upon the way the individual behave”. The Exposure and response prevention therapy (ERP) is used as the part of behavioral approach for helping the exploration of alternative ways to respond to the obsessional thoughts or doubts. The therapy teaches the individual with OCD that their thoughts are not the key problems to them, rather the problem is what the person is making of those thoughts and in which way they are responding to those thoughts. It is the key way of the recovery process from OCD (Arch et al., 2012). Therefore, it can be said that, this therapy is a recovery-focused therapy, where the self-determination of the patient is being prioritized.

The key nursing skills and competencies that are required for the implementing CBT, for ensuring recovery of an OCD patient includes excellent communication skills and critical thinking skills. Communication is very important for establishing a good therapeutic relationship with the patient, as therapeutic relationship is the core of this therapy. After establishing a goo therapeutic relationship, the patient would be encouraged to value the perspective of the caregiver (Rogers, 2012). Therefore, if the caregiver or nurse do not consist good communication skill, the success of the recovery process would be hampered.

In most of the cases, this treatment is highly effective, but in some cases, the change in thought process can enhance anxiety in the patient, which can significantly hamper the progress of recovery process. In these cases, the treatment process might not reach a successful conclusion (Arch et al., 2012). Therefore, to achieve successful outcome of the process, caregivers have to ensure that the patient is not subjected to increased anxiety during the therapeutic process. These kinds of issues can be avoided by keeping a calm environment surrounding the patient. 

The above problem can also be solved by implementing a combined therapy for the OCD patient. Pharmacotherapy can be added with the cognitive behavioral therapy. It has been shown significant improvement of the recovery process in some OCD patients, who are suffering from anxiety related issues during the CBT process. Some psychotic medications for reducing the anxiety symptoms are administered to the patient, to keep the patient calm. It helps to stimulate the positive thoughts in the patient and reduce agitation during positive thought process. In these ways, the barrier of implementing CBT for an OCD patient can be overwhelmed (Rogers, 2012).

“Obsessive-Compulsive Disorder (OCD)” is a type of anxiety disorder that involves compulsions and obsessions such as repetitive ideas, fear of contamination, aggression, constant sexual thoughts, images of hurting a close one and thoughts of getting harmed. The signs and symptoms may include mood fluctuation, personality change and social withdrawal. An anxiety disorder is one of the most significant types of mental health disorder linked with feelings of worry, fear and uneasiness. The factors that contribute to OCD biological, hereditary and environmental factors. There are certain antidepressants that are regularly used for the treatment of OCD. Two common medicines used for the treatment of OCD are Clomipramine and Fluvoxamine. Nursing interventions such as recovery focused practice based on the nursing practice can be implemented in order to cure OCD. Thus, it can be concluded that although the cause of OCD is not correctly identified, yet evidences have proved that certain medications and nursing interventions have got success in this field.

Andersson, E., Enander, J., Andrén, P., Hedman, E., Ljótsson, B., Hursti, T., … & Rück, C. (2012). Internet-based cognitive behaviour therapy for obsessive–compulsive disorder: a randomized controlled trial. Psychological medicine, 42(10), 2193-2203.

Arch, J. J., Eifert, G. H., Davies, C., Vilardaga, J. C. P., Rose, R. D., & Craske, M. G. (2012). Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders. Journal of consulting and clinical psychology, 80(5), 750.

Bell, J. (2015). Obsessive Compulsive Disorder.

Bokor, G., & Anderson, P. D. (2014). Obsessive–compulsive disorder.Journal of pharmacy practice, 0897190014521996.

Figee, M., Luigjes, J., Smolders, R., Valencia-Alfonso, C. E., van Wingen, G., de Kwaasteniet, B., … & Levar, N. (2013). Deep brain stimulation restores frontostriatal network activity in obsessive-compulsive disorder.Nature neuroscience, 16(4), 386-387.

Goodman, W. K., Grice, D. E., Lapidus, K. A., & Coffey, B. J. (2014). Obsessive-compulsive disorder. Psychiatric Clinics of North America, 37(3), 257-267.

Grant, J. E. (2014). Obsessive–compulsive disorder. New England Journal of Medicine, 371(7), 646-653.

Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: a review of meta-analyses.Cognitive therapy and research, 36(5), 427-440.

Milad, M. R., & Rauch, S. L. (2012). Obsessive-compulsive disorder: beyond segregated cortico-striatal pathways. Trends in cognitive sciences, 16(1), 43-51.

Pauls, D. L., Abramovitch, A., Rauch, S. L., & Geller, D. A. (2014). Obsessive-compulsive disorder: an integrative genetic and neurobiological perspective. Nature Reviews Neuroscience, 15(6), 410-424.

Rogers, C. (2012). On becoming a person: A therapist’s view of psychotherapy. Houghton Mifflin Harcourt.

Soomro, G. M. (2012). Obsessive compulsive disorder. BMJ clinical evidence, 2012.

Thomsen, P. H. (2013). Obsessive–compulsive disorders. European child & adolescent psychiatry, 22(1), 23-28.

Veale, D., & Roberts, A. (2014). Obsessive-compulsive disorder. BMJ, 348, g2183.

Williams, M., Powers, M. B., & Foa, E. B. (2012). Obsessive‐Compulsive Disorder. Handbook of evidence-based practice in clinical psychology.

Zohar, J., Greenberg, B., & Denys, D. (2012). Obsessive-compulsive disorder. Handbook of clinical neurology. Elsevier BV, 106, 375-90.