CLASS TEACHING

ON
“Obsessive Compulsive Disorder and its Management”

SUBMITTED TO : SUBMITTED BY :
MR. SANTHOSH KUMAR, M. Sc (N), DURWENDRA NARAYAN JAISWAL,
LECTURER, M.SC NURSING II YEAR,
DEPT. OF MENTAL HEALTH NURSING DEPT. OF MENTAL HEALTH NURSING
Name of the student teacher : Mr.Durwendra Narayan Jaiswal

Name of the subject : Psychiatric Nursing

Name of the topic : Obsessive Compulsive Disorder and its Management

Group : B.Sc. Nursing III year

Size of the class : 58

Date :

Duration: 45 Minute

Venue : B.Sc. Nursing 3rd year class room

Previous knowledge: Students may have some knowledge regarding Obsessive Compulsive Disorder and its Management.

Methods of teaching : Lecture cum discussion

Teaching media : White board, LCD, Chart

 General objectives - After the class the students will be able to acquire knowledge in depth about Obsessive Compulsive Disorder and its Management.

Specific objectives - At the end of the class the students will be able to

- introduce obsessive-compulsive disorder

- define obsessive-compulsive disorder

- classify the obsessive-compulsive disorder

- explain the etiology of obsessive-compulsive disorder

- describe the clinical features of obsessive-compulsive disorder

- illuminate the diagnostic procedures for obsessive-compulsive disorder

- mention the treatment of obsessive-compulsive disorder

- describe the nursing management of obsessive-compulsive disorder

- summarize the topic.

Specific Teaching Learning A.V.

S.No. Time Contents Evaluation
Objective Method Method Aids
1. 2 min. Introduce Introduction Lecture Listening LCD What is OCD?
Obsessive- ‘An Anxiety disorder, characterized by a
Compulsive subject’s obsessive, distressing, intrusive
disorder thoughts and related compulsions (tasks or
rituals) which attempts to neutralize the
obsession’.
2. 2 min. Define Definition Explanation Listening and LCD What is
Obsessive- Recurrent thoughts or ideas (obsessions) understanding Obsession?
Compulsive that an individual is unable to put out of his or
disorder her mind and actions that an individual is
unable to refrain from performing
(compulsions).
3. 4 min. Classify the Classification Explanation Listening Charts What are the
Obsessive-  F42.0 Predominantly obsessive thoughts types of
Compulsive or rumination OCD?
disorder  F42.1 Predominantly compulsive act
 F42.2 Mixed obsessional thoughts and
acts
 F42.8 other obsessive-compulsive
disorder
 F42.9 Obsessive-compulsive disorder,
unspecified
4. 8 min. Explain the Etiology Explanation Discussion White What are the
etiology of 1. Genetic factor – twin studies have board causes of
Obsessive- consistently found a significantly higher OCD?
Compulsive concordance rate for monozygotic twins
disorder than for dizygotic twins. Family studies of
these patients have shown that 35% of first
degree relatives of obsessive compulsive
disorder patients are also affected with the
disorder.
2. Biochemical influences – a number of
studies suggest that the neurotransmitter
serotonin may be abnormal in individuals
with obsessive compulsive disorder.
3. Psychoanalytic theory – the
psychoanalytic concept view patients with
obsessive compulsive disorder as having
regressed to developmentally earlier stage
of the infantile superego, whose harsh
exacting punitive characteristics now
reappear as part of the psychopathology.

Freud also proposed that regression to

the pre-oedipal anal sadistic phase
combined with the use of specific ego
defense mechanisms like isolation, undoing,
 displacement and reaction formation, may
lead to OCD.
4. Behaviour theory – this theory explains
obsession as a conditioned stimulus to
anxiety. Compulsions have been described
as learned behaviour that decreases the
anxiety associated with obsessions. This
decrease in anxiety positively reinforces the
compulsive acts and they become stable
learned behaviour. This story is more useful
for treatment purposes.

5. 8 min. Describe the Clinical features Discussion Asking LCD What are the
clinical features 1. Obsessional thoughts – these are words, question and symptoms of
of Obsessive- ideas and beliefs that intrude forcibility into understanding OCD?
Compulsive the patient’s mind. They are usually
disorder unpleasant and shocking to the patient and
may be obscene or blasphemous.
2. Obsessional images – these are vividly
imagined scenes, often of a violent or
disgusting kind involving abnormal sexual
practice.
3. Obsessional rumination – these involve
internal debates in which argument for and
 against even the simplest everyday actions
are relieved endlessly.
4. Obsessional doubts – these may concern
actions that may not have been completed
adequately. The obsession often implies
some danger such as forgetting to turn off
the stove or not locking the door. It may be
followed by a compulsive act such as the
person making multiple trips back into the
house to check if the stove has been turned
off. Some time these may take the form of
doubting the very fundamentals of beliefs,
such as, doubting the existence of God and
so on.
5. Obsessional impulses – these are urge to
perform acts usually of a violent or
embarrassing kind, such s injuring a child,
shouting in church etc.
6. Obsessional rituals – these may include
both mental activities such as counting
repeatedly in a special way or repeated but
senseless behaviors such as washing hand 20
or more times a day. Sometime such
 compulsive acts may be preceded by
obsessional thoughts; for example, repeated
hand washing may be preceded by thoughts
of contamination. These patients usually
believe that the contamination is spread from
object to object or person to person even by
slight contact and may literally rub the skin
off their hands by excessive hand washing.
6. 5 min Illuminate the Diagnosis Lecture Listening Chart What are the
diagnostic 1. Suggested by demonstration of ritualistic diagnostic
procedures for behaviour that is irrational or excessive. procedures for
Obsessive- 2. MRI and CT scan shows enlarged basal OCD?
Compulsive ganglia in some patients.
disorder 3. PET scanning shows increased glucose
metabolism in part of the basal ganglia.
7. 7 min. Mention the Treatment Explanation Listening LCD What are the
treatment of (A) Pharmacotherapy therapies used
Obsessive- 1. Antidepressant (fluvoxamine, sertraline for the
Compulsive etc.) treatment of
disorder 2. Anxiolytic (benzodiazepines) OCD?
(B)Behaviour therapy
1. Exposure and response prevention- this
is Vivo exposure procedure combine with
response prevention techniques. E.g.
 Compulsive hand washers are encouraged
to touch contaminated objects and then
refrain from washing in order to break
the negative reinforcement chain.
2. Thought stoppage – thought stopping is
a technique to help an individual learn to
stop thinking unwanted thoughts.
Following are the steps in thought
stopping:
 Sit in a comfortable chair, bring to
mind the unwanted thought
concentrating on only one thought per
procedure.
 As soon as the thought forms, give
the command ‘STOP’ follow this with
calm and deliberate relaxation of
muscles and diversion of thought to
something pleasant.
 Repeat the procedure to bring the
unwanted thought under control.
3. Relaxation technique – it includes deep
breathing exercise, progressive muscle
relaxation, meditation, imagery and
 music.
4. Other therapies
 supportive psychotherapy
 ECT.
8. 5 min. Describe the Nursing Management Lecture cum Discussion Chart What are the
nursing  Guidance and counseling plays a Discussion nursing
management of significant role. Explain the situation and management
Obsessive- encourage the client to substitute for OCD?
Compulsive maladaptive behaviour and energies into
disorder adaptive or coping strategies to overcome
the problem.
 Individual psychotherapy also plays vital
role. Teach how their behavior has to be
modified.
 Encourage them to constantly observe
their behaviour and teach them to utilize
’self control’ technique to overcome
ritualistic behaviour and ask them to
divert their mind and energies into useful
activities.
9. 4 min. Summarize the Summary Lecture
topic. Obsessive Compulsive disorder is defined
as recurrent thoughts or ideas that an individual
is unable to put out of his or her mind and
 actions that an individual is unable to refrain
from performing. The etiologies of OCD are
genetic factor, Biochemical influences,
Psychoanalytic theory, and behaviour theory.
The clinical feature includes Obsessional
thoughts, Obsessional images, Obsessional
rumination, Obsessional doubts, Obsessional
impulses and Obsessional rituals. The
diagnostic procedures used in OCDs are MRI
and CT scan and PET scanning. Treatment of
OCD is done by the help of Pharmacotherapy,
Behaviour therapy, supportive psychotherapy
and ECT

BIBLIOGRAPHY
1. Anand N.K. & Goel Shikha (2011). Essentials of mrntal Health and Psychiatric Nursing. AITBS publishers, India.

2. Gupta Ram Kumar (2010). A Textbook of Mental Health Nursing. S. Vikas & company (Medical Publishers) India. (pp- 327-332).

3. Neeraja K.P. (2009). Essential of Mental Health and Psychiatric Nursing. Volume 2. Jaypee Brothers Medical Publishers (P) LTD. (pp. 456-
457).

4. Sreevani, R. (2010). A guide to mental health & psychiatric Nursing. 3rd edition. Jaypee Brothers Medical Publishers (P) LTD. (pp. 179-183).

5. Townsend Mary, C. (2012). Psychiatric Mental Health Nursing, concept of care in evidence-based practice. 7th edition. Jaypee Brothers
Medical Publishers (P) LTD.