CASE PRESENTATION ON

OBSESSIVE COMPULSIVE
DISORDER
[Document subtitle]

SUBMITTED TO –

Madam. Kalyani Saha

Professor SUBMITTED BY –
Apollo College of Nursing, Kolkata
Shubhrima Khan
M.Sc. Nursing 2nd year
Apollo College of Nursing, Kolkata

1
IDENTIFICATION DATA:

Name: Uma Biswas

Age: 53 years
sex: Female
Father/spouse: Tusar Kanti Biswas (Husband)
Hospital Reg. No.: 32318
Address: 118/12, Bandel road, Bamangachi, Solkia, Howrah
Education: Graduate
Occupation: House maker
Income: Rs. 40,000/ month
Religion: Hinduism
Marital status: Married
Name of hospital: Pavlov Mental Hospital
Date of admission: 11.04.2021
Under doctor: Dr. J. Maity
Name of Informant: Tamal Biswas
Relationship with Informant: Son
Reliability of information: Reliable
Diagnosis: F42.2 (Mixed Obsessional taught and acts)

PRESENTING CHIEF COMPLAINT:

According to patient:

Amar khub batik ache  10 years

Khub besi jol ghati, saradin gordor poriskar korte thaki  10 years
saradine motamoti 4 – 5 bar snan kori  10 years
ei jonno barite sami r cheler sathe jhogra jhamela hotei thakto  10 years
tarpor ekdin baritei pore giye amar spine injury hoye gelo  8 years (2014)
tar jonno hospital e vorti hote holo tarpor setar onek treatment holo  8 years (2014)
tarpor to bethar jonno r sekom vabe barir kaj gulou korte parchilam na  8 years (2014)
kaj loker kaj amar pochondo hocchilona bole kajer lok keo chariye dilam 8 years (2014)
tarpor amar sami r chele birokto hoye amake baruipur Antara te niye gelo dekhanor jonno 
2015

2
Tin mas okhane vorti chilam  7 years (2015)
Der bochor dhore okhanei treatment koriyechhilam, serokm kono improve hoini.
2017 sale parar ekjoner kach theke pavlov er sandhan pai, tokhn theke ekhenei dekhachhi  5
years

According to Family member:

Saradin prochur jol ghato  10 years ago (2012)

Dine 5 – 6 snan korto  10 years ago (2012)
Bar bar ghor muchto  10 years ago (2012)
Tarpor ekdin baritei pore giye komore injury hoi  8 years ago (2014)
Hospitalized korte hoi  8 years ago (2014)
Tarpor barite niye asar por complete bed rest e chilo  8 years ago (2014)
Hata chola korte parchilona  8 years ago (2014)
Oi somoy kajer lok rekhechilam barite, tar satheo jhamela bande mayer  8 years ago (2014)
Kaj ppochondo hotona, abar seguloke nije korte jeto  8 years ago (2014)
Tarpor to jhamela kore chariyei dilo  8 years ago (2014)
Spine injury ta kichuta valo howar por maa ke antara te niye gechlam, okhane tin mas vorti
chilo  7 years ago (2015)
Tarpor barite niye asi, ohanei ek der bochor treatment chole  7 years ago (2015)
Tarpor koyekmas valo achi bole maa osudh gulo khawa bondho kore diyechilo
Tokhn abar problem start hoi  5 years ago (2017)
Oi somoy to khub ragaragio korto  5 years ago (2017)
Ektutei birokto hoye jeto  5 years ago (2017)
Khawa dawa kortona thik kore  5 years ago (2017)
Flat er lokjon er satheo choto khato bisoy niye jogra jati korto majhe majhe  5 years ago
(2017)
Antara te onekta khoroch hochhilo bole tarpor ekhane niye elam.
Akhn continue osudh kachhe ebong ager theke onekta valo ache.

HISTORY OF PRESENT ILLNESS:

 Duration: 10 years
 Onset: Gradual
 Course: Continuous

3
 Intensity: Decreasing
 Precipitating factors: Change of house, financial crisis in 2011
 Predisposing factors: loneliness.
 Perpetuating factors: Relapse treatment, lack of knowledge, rejection from family
members.

 Description of present illness: Patient was apparently well 10 years ago when she shifts
to their new house. After few months later her psychological symptoms started like washing
hand frequently, over cleanliness, irritable moods, spend more time in ritualistic behaviour.
That time she did not got any treatment. After few years later in 2014 when she got spinal
injury due to fall, intensity of her compulsive activity becomes increased and she was
treated by psychiatrist in Antara mental hospital. She was treated there for more than 1 year
and there was improvement in her condition. After that she discontinued the treatment and
the symptoms started again with increased intensity. That time she became very irritable,
restless, aggressive, her appetite and sleep were also decreased. Then the patient was taken
to the Pavlov Mental Hospital by her family members and diagnosed with F42.2 (Mixed
Obsessional taught and acts) and since then she is under continuous treatment. Now her
condition is better than previous.

HISTORY OF PAST ILLNESS

 Past psychiatric history: the patient got admitted to the Antara hospital for 3 months in
2015 due to psychological problems.
 Past medical and surgical history: She has a previous history of hospitalization due
to spinal injury and diagnosed with osteoporosis in 2014. She has no history of diabetes,
hypertension, tuberculosis or any other major medical or surgical illness.
 Allergies: Nothing significant
 Past history of injury/accident: Nothing significant

TREATMENT HISTORY

 Drugs
Tab. Fluvoxin CR (50 mg) 1–x–x
Tab. Clonil 25 mg x–x–1
Tab. Pregalin NT (75/10 mg) x–x–1
Tab. Shelcal XT x–1–x

4
 Tab. Uprise D3 (60K) Once a week
 ECT: Not given
 Psychotherapy: Given
 Family Therapy: Not given
 Rehabilitation: Not given

FAMILY HISTORY:

 Type of family: Nuclear

 No. of family members: Four
 Name of head of family: Tusar Kanti Biswas (Husband)
 Total monthly income: Rs. 40,000
 Source of income: Business
 History of illness among family members: No psychiatric illness in family, no history of
diabetes or Hypertension in family.
There is a nuclear family in Bamangachi, Howrah. There is total four members in the family.
The patient was married, 53 years old, housemaker. Her husband is a business man, 57 years
old. They have a son who is 29 years old, married and work together with his father and live
together with his family.

FAMILY GENOGRAME

natural death Natural death Natural death

Father Mother-
r Father-
in-law in-law
Died in 2004 Mother, 72 years

60 years Husband, 57 45
51 years
years, years
business

Self-53 years

50 46
years years

Son 29
24
years 20 years
years

5
PERSONAL HISTORY

Perinatal History-
Antenatal Period- Not known
Intranatal period-
Birth- Normal delivery
Birth cry- Not known
Birth defects- Not known
Postnatal complications- Not known

Childhood history
Primary care giver- Mother
Feeding-
Age at weaning- can no be elicited
Developmental Milestones-
Behavior and emotional problems-
Illness during childhood:

Educational History
Age at beginning of formal education: 6 years
Academic performance: Good
Extracurricular achievements, if any: Singing
Relationships with peer and teachers: Good
School phobia: Absent
Look for conduct disorder: No
Reason for termination of study: marriage

Play history
Games played (at what stage and with whom): At childhood with siblings
Relationships with playmates: Good

Emotional Problems during Adolescence: Nothing Significant

Puberty:
Age at appearance of secondary sexual characteristics: 12 years
Anxiety related to puberty changes: Anxious
Age at menarche: 13 years
Reaction to menarche: Anxious, irritable

6
 Regularity of cycles, duration of flow: Regular and 4 days cycle
Abnormalities, if any: Nothing significant

Obstetrical History-
LMP: Not known
Number of children: One
Any abnormalities associated with pregnancy, delivery, puerperium: Nothing
significant
Termination of pregnancy, if any: No
Menopause (including any associated problems): Menopause at 47 years of
age. No associated problem found.

Occupational History-
Age at starting work: Home maker
Jobs held in chronological order: Not applicable
Current job satisfaction: Not applicable
Whether Job is appropriate to patient’s background: Not applicable

Sexual and Marital history-

Type of marriage: Arranged
Duration of marriage: 30 Years
Interpersonal and sexual relations: satisfactory
Extramarital relationship if any: No

Premorbid Personality
Interpersonal relationships: Extrovert
Family and social relationship: Satisfactory
Use of leisure time: Busy in house hold activities
Predominant Mood: Normal
Usual reaction to stressful events: Normal
Attitude to self and others: Good, used to interact well with others.
Attitude to work and responsibility: Responsible
Religious beliefs and moral attitudes: She belief in God
Fantasy Life: Nothing significant
Habits
 Eating patter: Normal, non-vegetarian

7
  Elimination: Regular
 Sleep: Adequate
 Use of drugs, tobacco, alcohol: Nil

MENTAL STATUS EXAMINATION

GENERAL APPEARANCE AND BEHAVIOUR:

 Appearance: Looking one's age

 Facial expression: Anxious
 Level of grooming: Normal
 Level of cleanliness: Adequate
 Level of consciousness: Fully conscious and alert
 Mode of entry: Come willingly
 Cooperativeness: Normal
 Eye-to-eye contact: Maintained eye to eye contact properly, intermittently
 Psychomotor activity: Normal
 Rapport: Spontaneous
 Gesturing: Due to osteoporosis she was unable to walk properly.
 Posturing: Normal
 Other movements: Not present
 Other catatonic phenomena: There is no other catatonic phenomena.
 Conversion and dissociative signs: Not present
 Compulsive acts or rituals: Frequent washing hands and takes frequent bath
 Hallucinatory behaviour: Not present

SPEECH

Nurse: Why you came to this hospital?

Patient: ‘Amar batiker somossa ache. Ami onek purano patient, aaj 5 bochor holo ekhane
chikitsa korachhi, er ageo antara te dekhatam.’
 Initiation : Spontaneous
 Reaction time : React immediately when asked
 Rate : Normal
 Productivity : Elaborate replies

8
  Tone : Normal variation
 Relevance : Relevant
 Stream : Normal
 Coherence : Fully Coherent
 Others : Nil

MOOD AND AFFECT

Nurse: How are you feeling today?

Patient: “valo achi.”
 Predominant mood state: Labile
Inference: Affect is congruent to mood and appropriate to situation

THOUGHT

Nurse: How many children do you have?

Patient: ‘Amar ektai chele, ei 6 mas age cheler biye dilam
Form: Thought formation is normal.
Stream: Thought progression is normal.
Content
 Delusion:
Nurse: Do you think that anybody wants to harm you?
Patient: ‘Naa’
Nurse: Have you ever felt that some people are gossiping about you?
Patient: ‘Naa’
Nurse: Have you felt that you are being controlled by someone?
Patient: ‘Naa’

 Ideas:
Nurse: Do you ever feel that your life is worthless?
Patient: “Age mone hoto, amar ei batik er jonno jokhn amar barir lokjon birokto hoto
tokhn mone hoto”
Nurse: Do you ever thought to take your own life?
Patient: ‘Na na serokm kokhno mone hoini’

9
 Thought Alienation Phenomena:
Nurse: Do you think that someone is inserting though in you or withdrawing your
thought?
Patient: “Naa”
 Obsessive Phenomena:
Nurse: Do you have any thought that comes to your mine repeatedly?
Patient: “Ha”
 Phobia:
Nurse: Do you have any fearful feeling about some object or anything else?
Patient: “Naa.”
Inference: He has worthleeness ideas and obsessional taught, phobia is not found.

PERCEPTION

Illusion: Nothing significant

Hallucination:
Nurse: Have you seen anything which has not seen by others?
Patient: “Naa.”
Nurse: Have you smelt anything which has not smelled by others?
Patient: “Naa.”
Nurse: Have you heard anything which has not heard by others?
Patient: “Naa.”
Nurse: Have you feel anything moving on your skin?
Patient: “Naa.”
Inference: No such illusion or hallucinatory behavior is found.

COGNITIVE FUNCTION

 Consciousness : Fully conscious

 Orientation :
Time:
Nurse: What time of the day it is?
Patient: ‘Akhn sokal’
Place
Nurse: Where are you now?
Patient: ‘Antara Mental Hospital’.

10
 Person
Nurse: who am I?
Patient: ‘student’
Inference: She is oriented to time place and person.

 Attention
Nurse: I will tell you few numbers, you have to repeat them after me. Say 1, 3
Patient – ‘1, 3’
Nurse: Now say 1,3, 5
Patient: ‘1, 3, 5’
Nurse: say again 1,3,5,7
Patient: ‘1, 3 ,5, 7’
Inference: Attention is aroused normally

 Concentration
Nurse - subtract 3 from 40 and repeat 5 times?
Patient – ’37, 34, 31, 28, 25’
Inference: Concentration is normally sustained.

 Memory
Immediate memory: -
Nurse: I will tell you 5 words, you have to repeat them after 5 minutes: Tree, leaf,
flower, fruit, bird
Patient: ‘Gaach, pata, ful, fol, pakhi’
Recent memory: -
Nurse- what did you take in dinner last night?
Patient- ‘Ruti and Tarka’
Remote memory: -
Nurse: Do you remember your son’s birthday?
Patient: 22nd April, 1992
Inference- Immediate, Recent and Remote memory is intact.

 Intelligence
Nurse -Who is the health minister of West Bengal?
Patient – ‘Mamata Banerjee’
Nurse: Tell me the answer of 11 × 2 + 78?

11
 Patient – ‘100’
Inference – her Intelligence level was good

 Abstraction

Nurse: Explain the phrase, “Grapes are sour”

Patient: “nije kono jinis na pele, sei jinis kei dos deoa”
Nurse: Do you able to say one similarity between an orange and an apple?
Patient: ‘Dutoi fol’.
Nurse: What is the dissimilarity between an orange and a ball?
Patient: Lebu khawa hoi r ball diye khela kora hoi’.
Inference: Her abstract thinking ability was intact.

 Judgement

Personal:
Nurse: what you think about your future?
Patient – ‘jotodin banchbo jeno sustha thaki, amar jonno jate onno karor odubidha na
hoi setai chai’

Social judgement:
Nurse: What you will do if some guest will come to your house?
Patient: ‘taderke bosabo, otithi appayon korbo’

Test judgement:
Nurse – What you will do seeing fire in a place?
Patient – ‘Pasapasi aro lokjon ke dakbo tarpor Fire brigade e khobor dewar chesta
korbo.’
Inference: Her personal, social and test judgement is intact.

INSIGHT

Nurse - Why are you come to this hospital?

Patient – ‘Amar batik er problem ache onek bochor dhore, onek bochor holo ekhanei treatment
korachhi, tari follow up e esechi.
Inference – She has grade 6 insight about her illness. She is aware about the symptoms
that bring changes in her behaviour or personality.

12
DISEASE WITH ICD CODE:

According to patient and informant the patient was apparently alright 10 years ago when they
sold their land and change their house. After few months of shifting to the new house her
psychological symptoms were aroused like frequent hand washing, over cleanliness, irritable
moods, spending more time in household activities, taking too many baths in a day. In that
time, she was not treated by any psychiatrist. In 2014 once she falls down in her home and got
injury in her spine and became hospitalized. After this event intensity of her psychological
symptoms increased more like aggressiveness, excessive irritable mood, quarrel with maid and
neighbors. After getting recovery from her spinal injury, she was taken to the Antara Hospital
in 2015 and there she got admitted for 3 months. After getting discharge from the hospital, she
was treated in outdoor basis at the same hospital and there was an improvement in her
condition. More than 1 year she was treated there. When she feeing batter, she discontinued
the medicine for 2 months and again her ritualistic compulsive behaviour started. Then she
taken to the Pavlov Mental Hospital by her family members in 2017 and since then she was
under continuous treatment and diagnosed with F42.2 (Mixed Obsessional taught and acts).
History revealed that there were no such abnormalities found in her childhood and adolescent
period. She was good in studies and studied up to graduation level. She possessed an extrovert
premorbid personality and had good relationship with her family members. She was
responsible towards self and others. Regarding her marital history she had a satisfactory
relationship with her spouse. As her husband and son remain always busy in their work, she
sometimes feels loneliness at home, sometimes family conflict occurs due to her compulsive
behaviour. Her mental status examination revealed that she had hopelessness, worthlessness
ideas, she did not have any impairment in attention, concentration, memory, judgement and
she had true insight about her illness.

13
 PHYSICAL EXAMINATION

Central nervous system 13.09.21 14.09.21 15.09.21

Level of consciousness (alert/conscious/drowsy Conscious Conscious Conscious

/comatose)
Orientation
Time – Oriented Oriented Oriented
Place –
Person –
Speech (aphasia, slurred, relevant, irrelevant) Relevant Relevant Relevant
Paralysis (hemiplegia, paraplegia, hemiparesis, Absent Absent Absent
quadriplegia, others)
Respiratory system
Chest shape-Normal/ Barrel Chest Normal Normal Normal
Chest movement-Bilateral/ Lt. Lateral/ Rt. Lateral Bilateral Bilateral Bilateral
Respiratory pattern- Normal/ Tachypnea/ Normal Normal Normal
Bradypnea/ Dyspnea
Respiratory rate- 22 breath/ min 21 breath/ min 18 breath/ min
Respiratory sound- Stridor/ Wheezing/ Granting Normal Normal Normal
Chest drain- Present/Absent Absent Absent Absent
Cardiovascular system
Blood pressure 110/70 mmhg 120/80 mmhg 110/60 mmhg
Heart rate 68 beats/min 76 beats/min 80 beats/min
Heart sound – S1 And S2 S1 And S2 S1 And S2
S1 Audible Audible Audible
S2
S3
S4
Pulse –
Carotid
Temporal
Brachial Present Present Present
Radial

14
Femoral
Dorsalis pedis
Popliteal
Posterior tibial
Clubbing- yes/ no No No No
Cyanosis- yes/ no No No No
Pallor- yes/ no No No No
Neck vein distention- yes/ no No No No
CRT < 3sec < 3sec < 3sec
Chest pain No No No
E. N. T
Eye- clean/ discharge Clean Clean Clean
Sclera Whitish Whitish Whitish
Conjunctiva Pink Pink Pink
Periorbital edema- yes/ no No No No
Ear- clean/ wax/ blood / cerumen/ others Clean Clean Clean
Nose- clean/ epistaxis/ others Clean Clean Clean
G.I system
Lip- moist/ crack/ dry moist moist moist
Teeth- clean/ plague/ decay/ others Clean Clean Clean
Mouth- clean/dirty/others Clean Clean Clean
Halitosis- yes/no No No No
Tongue- clean/coated/ dry/moist/others clean clean clean
Nutritional route Oral Oral Oral
Nausea No No No
Vomiting No No No
Constipation No No No
Diarrhea No No No
Melaena No No No
Genitourinary system
Voids- freely/ catheter freely freely freely
Urine –

15
Colour Straw Straw Straw
Appearance Clear Clear Clear
Sedimentation No No No
Hematuria No No No
Retention / incontinence No No No
Integumentary system
Skin- intact/ break down/ rash/ blister Intact Intact Intact
Wound- incisional / injury Absent Absent Absent
Site NA NA NA
Condition-redness/discharge/apposition/ NA NA NA
edema/healthy/others
Invasive line- central/ peripheral Absent Absent Absent
Site-
Patency- NA NA NA
Pain-
Musculoskeletal system
Joint- mobile/ contracture/ painful/ stiff Painful Painful Painful
Bed sore
Site- Absent Absent Absent
Condition-
Degree-

16
 DESCRIPTION OF THE DISEASE

INTRODUCTION

Neurotic disorder is a less severe form of psychiatric disorder where, patients show either
excessive or prolonged emotional reaction to any given stress. These disorders are not caused
by organic disease of the brain and however severe, do not involve hallucinations and
delusions.

Obsessive Compulsive Disorder (OCD) is a severe anxiety-related disorder. A person suffering

from this mental disorder, experiences frequent disturbing and undesirable obsessive views,
frequently followed by repetitive compulsions, impulses. OCD presents itself in many
appearances, and people are often surprised to learn that it goes far beyond the common
perception of excessive. Hand washing or repetitive checking of light switches are examples
of this disorder.

EPIDEMIOLOGY

 Obsessive–compulsive disorder occurs worldwide.

 OCD affects about 2.3% of people at some point in their lives, while rates during any given
year are about 1.2%.
 The disorder may begin in childhood, but more often begins in adolescence or early
adulthood.
 It is unusual for symptoms to begin after the age of 35, and half of people develop problems
before 20.
 Males and females are affected about equally.

DEFINITION

Obsessive Compulsive Disorder (OCD) is a mental disorder where the affected person can
experience unreasonable thoughts which could lead to compulsive abnormal behaviour. It is
normally characterized by excessive compulsion for perfectionism, orderliness, cleanliness,
etc.

Obsessions are unwanted thoughts and urges which are beyond one’s control which give rise
to depressions and anxiety.

17
 Compulsions are repetitive activities that a person suffering from obsession does to get rid of
their uncontrollable thoughts. These compulsive activities tend to repeat over and over again.

CLASSIFICATION:

According to book In my patient

F42: Obsessive-compulsive disorder F42.2: Mixed obsessional thoughts and

 F42.0: Predominantly obsessive thoughts or acts
ruminations
 F42.1: Predominantly compulsive acts
 F42.2: Mixed obsessional thoughts and acts
 F42.8: Other obsessive-compulsive disorders
 F42.9: obsessive-compulsive disorder, unspecified.

ETIOLOGY

According to book In my patient

 Genetic factors: Twin studies have consistently found a significantly higher

Not known
concordance rate for monozygotic twins than for dizygotic twins. Family
studies of these patients have shown that 35% of the first-degree relatives of
obsessive-compulsive disorder patients are also affected with the disorder.
 Biochemical influences: A number of studies suggest that the
Nothing significant
neurotransmitter serotonin (5-HT) may be abnormal in individuals with
obsessive-compulsive disorder.
 Psychoanalytic theory: The psychoanalytic concept (Freud) views patients
with obsessive-compulsive disorder (OCD) as having regressed to
No significant
developmentally earlier stages of the infantile superego, whose harsh
childhood trauma
exacting punitive characteristics now reappear as part of the
events
psychopathology.
Freud also proposed that regression to the pre-oedipal anal sadistic phase
combined with the use of specific ego defence mechanisms like isolation,
undoing, displacement and reaction formation, may lead to OCD.
 Behaviour theory: This theory explains obsessions as a conditioned
stimulus to anxiety. Compulsions have been described as learned behaviour

18
 that decreases the anxiety associated with obsessions. This decrease in Triggered by
anxiety positively reinforces the compulsive acts and they become stable stressful stimulus,
learned behaviour. This theory is more useful for treatment purposes. relapse treatment

CLINICAL FEATURES

According to book In my patient

 Obsessional rituals
 Obsessional thoughts: These are words, ideas and beliefs that intrude
forcibly into the patient's mind. They are usually unpleasant and  Washing hand

shocking to the patient and may be obscene or blasphemous. frequently

 Obsessional images: These are vividly imagined scenes, often of a  Spending too many

violent or disgusting kind involving abnormal sexual practices. hours in household

 Obsessional ruminations: These involve internal debates in which activities.

arguments for and against even the simplest everyday actions are  Takes too many

reviewed endlessly. baths in a day.

 Obsessional doubts: These may concern actions that may not have  Anxious and

been completed adequately. The obsession often implies some danger irritable mood

such as forgetting to turn off the stove or not locking a 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. Sometimes
these may take the form of doubting the very fundamentals of beliefs,
such as, doubting the existence of God and so on.
 Obsessional impulses: These are urges to perform acts usually of a
violent or embarrassing kind, such as injuring a child, shouting in
church, etc.
 Obsessional rituals: These may include both mental activities such as
counting repeatedly in a special way or repeating a certain form of
words, and repeated but senseless behaviours such as washing hands 20
or more times a day. Sometimes such compulsive acts may be preceded
by obsessional thoughts; for example, repeated handwashing may be
preceded by thoughts of contamination. These patients usually believe
that the contamination is spread from object to object or person to

19
 person even by slight contact and may literally rub the skin off their
hands by excessive hand washing.
 Obsessive slowness: Severe obsessive ideas or extensive compulsive
rituals characterize obsessional slowness in the relative absence of
manifested anxiety. This leads to marked slowness in daily activities.

INVESTIGATIONS AND DIAGNOSES

According to book In my patient

 Medical history and Physical  Psychiatric history: family conflict, migration, lack of
examination proper knowledge, stressful situation, loneliness
 Psychiatric history & and  Physical examination
examination to rule out the ritualistic  Mental Status Examination (obsessional thoughts,
behaviour that is irrational and worthlessness and hopeless ideas.)
excessive Total Blood Count:
 Blood test to rule out the alteration in  Hb: 11.4 gm
neurotransmitters  TLC: 4650
 MRI and CT shows enlarged basal  Platelet: 213000
ganglia in some patients.  DC: N – 59, L – 35, E – 02, B – 01, M – 03
 Positron-emission tomography  ESR: 18
scanning shows increased glucose Blood Glucose:
metabolism in part of the basal  FBS: 103
ganglia  PPBS: 92
 Based on ICDIO criteria. Kidney function Test
 Bl. Urea: 15.44 mg/dl
 S. Creatinine: 0.41 mg/dl
Liver function test
 Total bilirubin: 0.6
 SGOT: 25
 SGPT: 17
 ALP: 92
 GGT: 21

20
 Electrolyte Estimation
 Serum Na+: 137 mmol/L
 Serum K+: 4.5 mmol/L
HbsAg: Non-reactive
RTPCR: Negetive
Urine R/E, M/E: NAD
 CT brain
 ECG – normal sinus rhythm, ventricular rate: 61bpm

TREATMENT:

According to book In my patient

Pharmacotherapy: Drugs:
 Antidepressants: Selective serotonin reuptake inhibitors are the class Tab. Fluvoxin CR (100)
of antidepressants that works very effectively on the serotonin 1–x–x
neurotransmitter system. The medicines that belong to the class of Tab. Clonil 25 mg
SSRIs to treat OCD are – citalopram (Celexa), escitalopram x–x–1
(Cipralex/Lexapro), paroxetine (Paxil), sertraline (Zoloft), fluoxetine Tab. Pregalin NT (75/10
(Prozac), fluvoxamine (Luvox). mg) x–x–1
 Anxiolytics: benzodiazepines Tab. Shelcal XT
x–1–x
Congnitive Behavior therapy:
Tab. Uprise D3 (60K)
 Exposure and response prevention: This is vivo exposure procedure
x–1–x
combined with response prevention techniques. For example,
compulsive handwashers are encouraged to touch contaminated
Behaviour therapy
objects and then refrain from washing in order to break the negative
reinforcement chain.  Activity scheduling

 Thought stoppage: thought stopping is a technique to help an is done

individual to learn to stop thinking unwanted thoughts. Following are  Relaxation

the steps in thought stopping: techniques (deep

 Sit in a comfortable chair, bring to mind the unwanted thought breathing exercise,

concentrating on only one thought per procedure progressive muscle

relaxation,
meditation)

21
  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.
 Relaxation technique: It includes deep breathing exercise, progressive
muscle relaxation, meditation, imagery and music.

Other therapies:

 Supportive psychotherapy
 ECT—for patients' refractory to other forms of treatment.

22
 Assessment Nursing Goal Planning Intervention Evaluation
diagnosis
Subjective data: Anxiety related STG:  Level of anxiety should be assessed  Level of anxiety is assessed Anxiety and
Getting angary to Situational To help the associated
when someone crisis; stress as  Causes of anxiety should be identified  Causes of anxiety are identified symptoms are
patient to
interfere in her evidenced by reduce anxiety  reduced.
activities. being At the beginning of treatment plenty of  At the beginning of treatment plenty
Restless aggressive time should be allowed for rituals. of time are allowed for rituals.
LTG
Agitated when unable to
complete To reduce  Client’s efforts should be supported to  Client’s efforts are supported to
participation in explore the meaning and purpose of explore the meaning and purpose of
Objective data: compulsions.
ritualistic the behavior the behavior.
Anxious look,
irritable mood behavior
 structured schedule of activities  structured schedule of activities is
To prevent her should be provided for the client, provided for the client, including
from including adequate time for adequate time for completion of
exhaustion completion of rituals. rituals.

 Gradually time should be limit for  Gradually time is limited for

ritualistic activities. ritualistic activities.

 positive reinforcement should be  Positive reinforcement is given for

given for no ritualistic behaviors. no ritualistic behaviors.

 If needed anxiolytic medications

should be administered.

23
 Assessment Nursing diagnosis Goal Planning Intervention Evaluation

Subjective data: Ineffective individual STG:  Allow client to take as much  client is allowed to take as Patient achieve
Spending more coping related to To increase the responsibility as possible for own much responsibility as possible the ways to
time in ritualistic unmet needs, lack of ability of the self-care practices. for own self-care practices. bring control
behaviour and positive feedback, client to bring over activities
obsessional rejection from family control over the  Encourage the client to identify and  client is encouraged to identify
thoughts. members as evidence activities. recognize her limitations. and recognize her limitations.
by engaged in
Objective data: ritualistic behaviour. LTG:  The client should be helped to set  The client is helped to set
realistic goals. realistic goals.
Verbal To develop
expressions of adaptive
 The client should be helped to  The client is helped to identify
having no coping
identify the areas or activities need the areas or activities need to be
control over the strategies.
to be controlled. controlled.
activities.

 Client should be helped to identify  Client is helped to identify the

the alternative ways alternative ways

 Positive reinforcement should be  Positive reinforcement is given

given for performance of each for performance of each
positive activities. positive activities.

24
 Assessment Nursing Goal Planning Intervention Evaluation
diagnosis
Subjective data: Altered family STG:  Role of the patient within the family  Role of the patient within the Family process
Quarrels and conflict process related to To improve should be assessed. family is assessed. is improved.
with family overconcern about family process
members ritualistic
activities as LTG:  Role of the others family members  Role of the others family
Objective data: evidenced by should be identified members is identified
To provide the
rejection by
Verbal expressions patient with a
family members,
of loneliness, healthy family  Patient should be encouraged to
family conflict, discuss her feelings and conflict to  Patient is encouraged to discuss
unwillingness to stay environment
loneliness the family members. her feelings and conflict to the
at home.
family members.

 Patient should be encouraged to

explore the available options for  Patient is encouraged to
changes her behaviour and practice. explore the available options
for changes her behaviour and
practice.
 positive reinforcement should be
given for ability to resume role
responsibilities.  positive reinforcement is given
for ability to resume role
responsibilities.

25
 Assessment Nursing Goal Planning Intervention Evaluation
diagnosis
Subjective data: Imbalanced STG:  Nutritional status should be  Nutritional status of the patient Patient starts
Loss of appetite nutrition, less than To help the assessed. is assessed. eating and
body patient to  shows
Poor intake of food requirements, Food should be served in patient’s  Food is served in patient’s own
improve her improvement in
and fluid own utensils. utensils.
related to intake of diet weight.
inadequate food  Patient should be helped to wash  Patient is helped to wash hands.
Objective data:
and fluid intake LTG: hands.
 She is encouraged to use fork
Weight loss secondary to
Weakness To improve  She should be encouraged to use and spoon if she feels her hands
spending fork and spoon if she feels her hands will get dirty.
nutritional
excessive time in will get dirty.
status  Patient’s like and dislike
ritualistic
behaviour as  Patient’s like and dislike regarding regarding food is identified.
evidenced by food should be identified.
 High-protein, high caloric,
weight loss,  High-protein, high caloric, nutritious diet is provided.
weakness, nutritious diet should be provided.
anorexia  Patient is encouraged to take
 Patient is to be encouraged to take meals timely.
meals timely.
 Sit with patient while she eats.
 Sit with patient while she eats.
 Body weight is checked
 Body weight should be checked regularly
regularly

26
 Assessment Nursing diagnosis Goal Planning Intervention Evaluation

Subjective data: Altered sleep rest STG:  Plan daytime activities according to  Daytime activities are Patient feels
Decreased sleep at pattern related to To provide the patient's interests, do not allow performed by the patient. comfortable at
night, Early anxiety, adequate rest him to sit idle. night and sleep
morning awakening hospitalization as hours to the is improved
Objective data: evidenced by patient  Patient should be encouraged to do  Patient is encouraged to do
Drowsiness difficulty in falling LTG: thorough washing before going to thorough washing before
asleep, early To help the bed. going to bed.
morning patient to get
awakening and adequate sleep  Ensure a quiet and peaceful  A quiet and peaceful
drowsiness at night environment when the patient is environment is ensured when
preparing for sleep. the patient is preparing for
sleep.
 Provide comfort measures.
 Comfort measures are given.
 Environmental stimulus should be
kept minimum.  Environmental stimulus is
kept minimum.
 Patient should be encouraged to
repeat the act only in the morning  Patient is encouraged to repeat
after getting up. the act only in the morning
after getting up.
 Mild anxiolytic should be
administered if necessary.

27
 Assessment Nursing Goal Planning Intervention Evaluation
diagnosis
Subjective data: Knowledge To improve  At first the knowledge level  At first the knowledge level is Knowledge level is
Discontinuation of deficit related to knowledge level should be assessed assessed improved
medicine. mental illness, of the client and
treatment protocol family  Proper information regarding the  Adequate information regarding
Frequent asking of
and outcome of course of treatment, expected the course of treatment,
question regarding
treatment as outcome should be given to the expected outcome are given to
the illness and
evidenced by patient. the patient.
treatment outcome.
frequent asking of
Objective data: question,  Patient should be encouraged to  Patient is encouraged to perform
Noncompliance to perform the healthy practices and the healthy practices and to
Relapse treatment
drug to maintain healthy habits at maintain healthy habits at home.
Noncompliance to
home.
drug
 All the questions ask by the  All the questions ask by the
patient should be answered with patient are answered with proper
proper explanation explanation

 Patient should also teach about  Patient is taught about the drug
the drug compliance, prognosis compliance, prognosis and
and complications of the illness. complications of the illness.

28
PSYCHOEDUCATION

Psychoeducation was given regarding the following points:

 For people with anxiety disorders, the goal is effective management of stress and anxiety,
not the total elimination of anxiety. Learning anxiety management techniques and effective
methods of coping with life and its stresses is essential for overall improvement in life
quality.
 The stress related techniques such as relaxation, guided imagery and meditation, should be
taught to the patient to encourage him to practice regularly.
 The patient is taught about medications and lifestyle changes like, exercise regularly, eat
well-balanced meals, get enough rest and sleep.
 The patient should be educated about the physiology of anxiety, early symptoms of anxiety
so as to prevent it from escalating (for example, sweaty palms, racing heart, difficulty
concentrating or attending).
 Educate the patient and family about medications (therapeutic dose, frequency of
administration, side effects, untoward effects) and the importance of compliance.
 Patient is taught to identify stressors and situations that promote or exacerbate anxiety and
to avoid them as much as possible.
 Teach the patient and family how to access community resources and support groups,
reliable educational sources on the internet.
 Informed the client and the family about the importance of taking the medicines regularly
and not to discontinue the drug until the doctor tells. And also, the side effects and sign of
toxicity of antipsychotic drugs and the need to seek medical attention immediately.
 Patient is advised to come for follow up. Follow-up interventions are helpful especially for
anxiety disorder patients. During follow-up meet the patient and family members to discuss
realistic expectations for the patient.

CONCLUSION

OCD is a tough disorder to live with. We all may think that OCD can have an easy fix, and that
it really isn't that hard to live with. But the reality is that it is not, as it affects almost every
aspect of the person’s life, whether it be interactions with family or friends, or simple everyday
tasks that we all take for granted.

29
BIBLIOGRAPHY

 Neeraja KP. Essentials of mental health & psychiatric nursing. 1st ed. Vol. 1. 2008; New
Delhi: Jaypee Brothers Medical Publishers (P) Ltd; p. 280-84
 Sreevani R. A guide to mental health and psychiatric nursing; 4 th ed. 2016; New Delhi:
Jaypee Publishers. p.225 - 27
 Townsend CM. Psychiatric mental health nursing. 9th ed. New Delhi: Jaypee brothers’
medical publishers (P) LTD; p. 568-78

30