Practice Questions: The Individual with Functional Psychiatric Disorder
Mental Health Nursing: The Individual with Functional Psychiatric Disorder
Subject: Mental Health Nursing | Chapter: The Individual with Functional Psychiatric Disorder | Total Questions: 45 | Exam Level: Competitive Nursing Examinations
Type 1: Direct Factual Questions
Q1: What is the hallmark feature of conversion disorder?
(a) Loss of memory without organic cause
(b) Physical symptoms without identifiable organic pathology
(c) Persistent preoccupation with having a serious illness
(d) Intentional production of symptoms for external gain
Ans: (b)
Explanation: Conversion disorder is characterized by neurological symptoms (such as paralysis, blindness, or seizures) that cannot be explained by medical evaluation. The condition involves unconscious conversion of psychological conflict into physical symptoms. Option (a) describes dissociative amnesia, option (c) describes illness anxiety disorder, and option (d) describes factitious disorder or malingering.
Q2: Which defense mechanism is primarily involved in somatoform disorders?
(a) Projection
(b) Displacement
(c) Somatization
(d) Rationalization
Ans: (c)
Explanation: Somatization is the unconscious process of converting psychological distress into physical symptoms. This is the primary defense mechanism in somatoform disorders. Projection involves attributing one's feelings to others, displacement redirects emotions to safer targets, and rationalization involves logical justification of behavior.
Q3: According to DSM-5, what is the duration criterion for diagnosing somatic symptom disorder?
(a) At least 2 weeks
(b) At least 1 month
(c) At least 3 months
(d) At least 6 months
Ans: (d)
Explanation: Somatic symptom disorder requires that symptoms be present for at least 6 months with excessive thoughts, feelings, or behaviors related to the somatic symptoms. The condition involves persistent distress and impairment. Shorter durations do not meet the diagnostic criteria for this disorder.
Q4: La belle indifference is characteristically seen in which disorder?
(a) Generalized anxiety disorder
(b) Conversion disorder
(c) Obsessive-compulsive disorder
(d) Panic disorder
Ans: (b)
Explanation: La belle indifference refers to an inappropriate lack of concern about serious symptoms, classically seen in conversion disorder. Patients appear surprisingly unconcerned despite severe neurological symptoms. This feature helps distinguish conversion disorder from anxiety disorders where distress is typically prominent.
Q5: Which neurotransmitter imbalance is associated with obsessive-compulsive disorder?
(a) Dopamine excess
(b) GABA deficiency
(c) Serotonin dysregulation
(d) Acetylcholine excess
Ans: (c)
Explanation: Obsessive-compulsive disorder (OCD) is associated with serotonin dysregulation in the brain, particularly in the orbitofrontal cortex, caudate nucleus, and thalamus. This explains why SSRIs (selective serotonin reuptake inhibitors) are effective in treating OCD. Dopamine is associated with psychotic disorders, GABA with anxiety disorders, and acetylcholine with cognitive function.
Q6: What is the primary characteristic of illness anxiety disorder (formerly hypochondriasis)?
(a) Presence of multiple unexplained physical symptoms
(b) Preoccupation with having a serious illness despite medical reassurance
(c) Intentional falsification of symptoms
(d) Presence of neurological symptoms without organic cause
Ans: (b)
Explanation: Illness anxiety disorder involves preoccupation with having or acquiring a serious illness despite minimal or no somatic symptoms and negative medical evaluations. Patients have high health anxiety and are not reassured by negative tests. Option (a) describes somatic symptom disorder, (c) describes factitious disorder, and (d) describes conversion disorder.
Q7: Which brain circuit is implicated in the pathophysiology of OCD?
(a) Limbic-hypothalamic circuit
(b) Cortico-striato-thalamo-cortical circuit
(c) Mesolimbic pathway
(d) Reticular activating system
Ans: (b)
Explanation: The cortico-striato-thalamo-cortical (CSTC) circuit is implicated in OCD, involving the orbitofrontal cortex, caudate nucleus, and thalamus. Dysfunction in this circuit leads to repetitive thoughts and behaviors. The mesolimbic pathway is associated with schizophrenia, while the limbic system is involved in emotional regulation.
Q8: What percentage of OCD patients have onset before age 25?
(a) 25%
(b) 50%
(c) 75%
(d) 90%
Ans: (c)
Explanation: Approximately 75% of OCD cases have onset before age 25 years, with many cases beginning in childhood or adolescence. The disorder has a bimodal distribution with peaks in childhood (ages 10-12) and early adulthood (ages 20-22). Early onset is associated with more severe symptoms and comorbidity.
Type 2: Clinical Scenario / Case-Based Questions
Q9: A 28-year-old woman presents with sudden onset of bilateral leg paralysis. Neurological examination and imaging studies are normal. She appears unconcerned about her paralysis. What is the most likely diagnosis?
(a) Multiple sclerosis
(b) Conversion disorder
(c) Malingering
(d) Guillain-Barré syndrome
Ans: (b)
Explanation: The presentation of neurological symptoms without organic pathology combined with la belle indifference (inappropriate lack of concern) is characteristic of conversion disorder. The symptoms often follow psychological stress and are unconscious. Malingering involves intentional symptom production, while MS and Guillain-Barré syndrome would show organic findings.
Q10: A 35-year-old man washes his hands 40-50 times daily, causing skin excoriation. He reports intrusive thoughts about contamination. What is the priority nursing intervention?
(a) Prevent all hand washing immediately
(b) Allow sufficient time for rituals while gradually setting limits
(c) Confront the patient about irrational behavior
(d) Isolate the patient to prevent spreading anxiety
Ans: (b)
Explanation: For OCD, the nurse should initially allow time for rituals to prevent overwhelming anxiety, then gradually set limits as part of treatment. Abrupt interruption (option a) can cause severe anxiety and aggression. Confrontation is non-therapeutic, and isolation increases anxiety. The approach should be gradual and supportive.
Q11: A 42-year-old woman has visited 8 different doctors in 6 months for chest pain. All investigations are normal, but she insists she has heart disease. Which disorder is most likely?
(a) Somatic symptom disorder
(b) Factitious disorder
(c) Illness anxiety disorder
(d) Malingering
Ans: (c)
Explanation: Illness anxiety disorder is characterized by preoccupation with having a serious disease despite negative medical evaluations and reassurance. Patients engage in doctor shopping and excessive health-related behaviors. Somatic symptom disorder involves more prominent physical symptoms, factitious disorder involves intentional symptom production for sick role, and malingering has external incentives.
Q12: A patient with conversion disorder develops sudden blindness. On examination, the pupillary reflex is normal. What does this suggest?
(a) Organic pathology is present
(b) The symptom is functional in nature
(c) The patient is malingering
(d) Immediate ophthalmology referral is needed
Ans: (b)
Explanation: In conversion disorder, pupillary reflexes remain intact despite reported blindness, indicating functional (non-organic) symptoms. In true organic blindness, pupillary responses would be affected. The preservation of reflexes supports the diagnosis of conversion disorder, though thorough evaluation is still necessary to rule out organic causes before confirming the diagnosis.
Q13: A 30-year-old woman constantly checks if doors are locked, spending 3 hours daily on this ritual. She is late for work daily. What is the most appropriate initial nursing action?
(a) Tell her the checking is unnecessary
(b) Acknowledge the anxiety and discuss impact on daily life
(c) Forcibly prevent the checking behavior
(d) Recommend immediate hospitalization
Ans: (b)
Explanation: The therapeutic approach for OCD involves acknowledging the patient's anxiety and helping them understand the impact on functioning. This builds therapeutic alliance necessary for treatment. Dismissing concerns (option a) or forcibly preventing rituals (option c) increases anxiety. Hospitalization is not immediately necessary unless the patient is unable to function or at risk of harm.
Q14: A patient with somatic symptom disorder reports new severe abdominal pain. What is the nurse's priority action?
(a) Dismiss it as another somatic complaint
(b) Perform proper assessment and document findings
(c) Refer to psychiatry immediately
(d) Administer PRN anxiolytic medication
Ans: (b)
Explanation: Despite the psychiatric diagnosis, the nurse must perform thorough assessment of all new symptoms because patients with somatic symptom disorder can develop genuine medical conditions. Dismissing symptoms (option a) can lead to missed diagnoses and medical complications. Assessment should be professional, thorough, but time-limited to avoid reinforcing illness behavior.
Q15: A 25-year-old patient develops sudden mutism after witnessing a traumatic accident. Physical examination is unremarkable. What is the most likely diagnosis?
(a) Stroke
(b) Conversion disorder
(c) Laryngeal pathology
(d) Schizophrenia
Ans: (b)
Explanation: Conversion disorder commonly presents with neurological symptoms following psychological stressors, such as trauma. Mutism (inability to speak) without organic findings is a classic presentation. The temporal relationship to trauma and absence of physical findings support this diagnosis. Stroke and laryngeal pathology would show organic findings, and schizophrenia presents differently.
Q16: A patient with OCD is started on exposure and response prevention therapy. What should the nurse explain about this treatment?
(a) It involves exposing to feared situations while preventing compulsive responses
(b) It uses medications to eliminate all obsessive thoughts
(c) It requires immediate cessation of all rituals
(d) It focuses only on relaxation techniques
Ans: (a)
Explanation: Exposure and Response Prevention (ERP) is the gold standard psychological treatment for OCD. It involves gradual exposure to anxiety-provoking stimuli while preventing the compulsive response. This helps the patient learn that anxiety decreases naturally without rituals. The process is gradual, not immediate, and is more effective than medication or relaxation alone.
Type 3: Drug / Pharmacology Questions
Q17: Which class of medications is considered first-line pharmacotherapy for OCD?
(a) Benzodiazepines
(b) Typical antipsychotics
(c) Selective serotonin reuptake inhibitors (SSRIs)
(d) Mood stabilizers
Ans: (c)
Explanation: SSRIs are the first-line pharmacological treatment for OCD, as the disorder is associated with serotonin dysregulation. Effective SSRIs include fluoxetine, fluvoxamine, sertraline, and paroxetine. Higher doses and longer trial periods (10-12 weeks) are often needed compared to depression. Benzodiazepines are not effective for OCD, and antipsychotics are used only as augmentation.
Q18: What is the therapeutic dose range of fluoxetine typically required for treating OCD?
(a) 10-20 mg/day
(b) 20-40 mg/day
(c) 40-80 mg/day
(d) 100-120 mg/day
Ans: (c)
Explanation: OCD typically requires higher doses of SSRIs compared to depression. Fluoxetine for OCD is usually prescribed at 40-80 mg/day, which is higher than the 20-40 mg/day used for depression. The response may take 10-12 weeks at adequate doses. Lower doses are often ineffective for OCD symptoms.
Q19: A patient with OCD has not responded to two different SSRIs. What is the appropriate next step in pharmacotherapy?
(a) Switch to benzodiazepines
(b) Add clomipramine or switch to it
(c) Discontinue all medications
(d) Start typical antipsychotic monotherapy
Ans: (b)
Explanation: Clomipramine, a tricyclic antidepressant with potent serotonin reuptake inhibition, is effective for treatment-resistant OCD. It can be used when SSRIs fail. Alternatively, augmentation with low-dose atypical antipsychotics (like risperidone or aripiprazole) can be considered. Benzodiazepines are not effective for OCD, and discontinuing all treatment or using typical antipsychotics alone is inappropriate.
Q20: What is an important teaching point for patients starting SSRIs for OCD?
(a) Symptom improvement occurs within 3-5 days
(b) Full therapeutic effect may take 10-12 weeks
(c) Medication can be stopped once symptoms improve
(d) Drowsiness is the most common side effect
Ans: (b)
Explanation: Patients must understand that SSRIs for OCD require 10-12 weeks at therapeutic doses for full effect, which is longer than for depression (4-6 weeks). This prevents premature discontinuation. SSRIs should not be abruptly stopped due to discontinuation syndrome. Common side effects include nausea, sexual dysfunction, and activation, not primarily drowsiness.
Q21: Which medication can be used for augmentation in treatment-resistant OCD?
(a) Diazepam
(b) Aripiprazole
(c) Lithium
(d) Propranolol
Ans: (b)
Explanation: Atypical antipsychotics such as aripiprazole, risperidone, or quetiapine are used for augmentation in treatment-resistant OCD when SSRIs alone are insufficient. They are added at low doses to the SSRI. Benzodiazepines (diazepam) are not effective for OCD, lithium has limited evidence, and propranolol (beta-blocker) is used for anxiety, not OCD.
Q22: What is the mechanism of action of clomipramine in treating OCD?
(a) Dopamine receptor blockade
(b) GABA enhancement
(c) Serotonin and norepinephrine reuptake inhibition
(d) Monoamine oxidase inhibition
Ans: (c)
Explanation: Clomipramine is a tricyclic antidepressant that works by inhibiting serotonin and norepinephrine reuptake, with particularly potent effects on serotonin. This makes it effective for OCD. It has more anticholinergic side effects than SSRIs and requires monitoring for cardiac effects. It is not an MAOI or dopamine blocker.
Type 4: Procedure-Based Questions
Q23: When performing exposure and response prevention therapy for OCD, what is the correct sequence?
(a) Immediate exposure to most feared stimulus → prevention of all rituals
(b) Gradual exposure starting from least anxiety-provoking → response prevention
(c) Complete ritual prevention → then exposure therapy
(d) Relaxation training → medication → exposure
Ans: (b)
Explanation: ERP follows a hierarchical approach starting with least anxiety-provoking stimuli and progressing gradually to more difficult exposures while preventing compulsive responses. This systematic desensitization prevents overwhelming anxiety. Immediate exposure to most feared stimuli (flooding) can be too traumatic. The process is gradual, collaborative, and structured.
Q24: What is the appropriate nursing approach when a patient with conversion disorder requests multiple diagnostic tests?
(a) Arrange all requested tests immediately
(b) Refuse all tests and explain the diagnosis
(c) Conduct necessary initial evaluation, then limit further testing
(d) Refer to psychiatry without any medical evaluation
Ans: (c)
Explanation: The nurse should ensure appropriate initial medical evaluation to rule out organic pathology, then limit repetitive testing that reinforces illness behavior. Excessive testing validates the symptom pattern and may cause iatrogenic harm. However, dismissing without evaluation risks missing genuine pathology. A balanced, time-limited approach is therapeutic.
Q25: In cognitive-behavioral therapy for somatic symptom disorder, what is the primary therapeutic focus?
(a) Proving symptoms are not real
(b) Exploring unconscious conflicts
(c) Modifying illness beliefs and behaviors
(d) Prescribing maximum medications
Ans: (c)
Explanation: CBT for somatic symptom disorder focuses on identifying and modifying maladaptive illness beliefs and reducing illness behaviors (such as excessive checking, doctor shopping). The goal is to improve functioning, not to prove symptoms are "not real." Psychodynamic therapy explores unconscious conflicts, but CBT is the evidence-based approach for this disorder.
Q26: What is the therapeutic communication technique when interacting with a patient with illness anxiety disorder?
(a) Provide extensive reassurance repeatedly
(b) Acknowledge concerns with brief, scheduled appointments
(c) Argue that their fears are irrational
(d) Ignore all health-related discussions
Ans: (b)
Explanation: The therapeutic approach involves acknowledging the patient's distress while providing brief, scheduled appointments rather than extensive, repeated reassurance (which reinforces anxiety). Time-limited interactions prevent reinforcement of health anxiety. Arguing or ignoring breaks therapeutic rapport, while excessive reassurance paradoxically increases anxiety.
Type 5: Priority Questions
Q27: A patient with OCD is experiencing severe anxiety due to prevented hand-washing ritual. What is the nurse's priority action?
(a) Force continued prevention to break the cycle
(b) Allow the ritual this time and gradually set limits later
(c) Administer PRN antipsychotic medication
(d) Place the patient in seclusion
Ans: (b)
Explanation: When anxiety becomes severe or overwhelming, the priority is safety and reducing extreme distress. The nurse should allow the ritual temporarily while planning gradual limit-setting as part of structured treatment. Forcing prevention during severe anxiety can lead to aggression or harm. Antipsychotics are not first-line for anxiety, and seclusion increases anxiety in OCD.
Q28: A patient with conversion disorder suddenly develops respiratory distress. What is the priority nursing action?
(a) Assume it is conversion symptom and provide reassurance
(b) Assess airway, breathing, circulation immediately
(c) Call psychiatry consultation
(d) Document as psychogenic symptom
Ans: (b)
Explanation: ABC (Airway, Breathing, Circulation) always takes priority, regardless of psychiatric diagnosis. Patients with conversion disorder can develop genuine medical emergencies. Immediate assessment ensures safety. Only after ruling out organic causes should psychogenic origin be considered. Assumption without assessment can lead to serious medical complications or death.
Q29: When caring for multiple patients, which patient with functional psychiatric disorder requires immediate attention?
(a) Patient with OCD who has been checking locks for 30 minutes
(b) Patient with somatic symptom disorder requesting pain medication
(c) Patient with conversion disorder reporting sudden chest pain and dyspnea
(d) Patient with illness anxiety disorder wanting to discuss test results
Ans: (c)
Explanation: Chest pain and dyspnea are potentially life-threatening symptoms requiring immediate assessment regardless of psychiatric diagnosis. ABC and physiological needs (Maslow's hierarchy) take priority. The patient with OCD (option a) can wait safely, pain medication (option b) can be addressed after emergency assessment, and discussion of results (option d) is not urgent.
Q30: A patient with somatic symptom disorder is demanding immediate CT scan for headache. What is the priority nursing intervention?
(a) Arrange CT scan immediately to reduce anxiety
(b) Assess vital signs and neurological status first
(c) Refuse and explain the diagnosis
(d) Administer anxiolytic medication
Ans: (b)
Explanation: Following the nursing process (Assessment first), the nurse must perform proper assessment including vital signs and neurological examination to determine if the headache has concerning features requiring investigation. Automatic testing reinforces illness behavior, but dismissing without assessment is dangerous. Clinical judgment guides appropriate intervention.
Type 6: Community Health & Public Health Questions
Q31: What is the estimated prevalence of OCD in the general population?
(a) 0.5-1%
(b) 2-3%
(c) 5-7%
(d) 10-12%
Ans: (b)
Explanation: The lifetime prevalence of OCD is approximately 2-3% in the general population, making it more common than previously thought. It affects males and females equally, though males tend to have earlier onset. OCD is a chronic condition that significantly impacts quality of life and often goes unrecognized in community settings.
Q32: Which National Mental Health Programme component addresses functional psychiatric disorders?
(a) Community-based treatment and rehabilitation
(b) Only tertiary care in medical colleges
(c) Separate asylums for each disorder
(d) No specific provision exists
Ans: (a)
Explanation: The National Mental Health Programme (NMHP) emphasizes community-based treatment for all mental disorders including functional psychiatric disorders. The District Mental Health Programme (DMHP) provides services at primary and secondary levels. The focus is on integration with general health services, early detection, and rehabilitation, moving away from institutional care.
Q33: At what level of healthcare should initial management of somatic symptom disorders primarily occur?
(a) Tertiary care hospitals only
(b) Primary health centers with training
(c) Specialized psychiatric institutions
(d) Private practice exclusively
Ans: (b)
Explanation: Most somatic symptom disorders present first to primary care settings. With appropriate training and mental health integration, primary health centers can provide initial assessment, education, and basic management. This aligns with the NMHP goal of integrating mental health into general healthcare and reducing burden on tertiary centers.
Q34: What is the disability burden of OCD according to WHO?
(a) Not included in significant disabilities
(b) Among top 20 causes of disability worldwide
(c) Affects only occupational functioning
(d) Causes minimal impairment
Ans: (b)
Explanation: WHO lists OCD among the top 20 causes of disability worldwide for individuals aged 15-44 years. OCD causes significant impairment in occupational, social, and personal functioning. The chronic nature and time-consuming rituals lead to substantial disability-adjusted life years (DALYs). Recognition and treatment are essential public health priorities.
Type 7: Concept-Based / Application Questions
Q35: According to psychoanalytic theory, what unconscious process underlies conversion disorder?
(a) Primary gain through symptom expression
(b) Secondary gain from external rewards
(c) Conscious fabrication of symptoms
(d) Neurological degeneration
Ans: (a)
Explanation: Primary gain refers to the unconscious psychological benefit of converting intrapsychic conflict into physical symptoms, which reduces anxiety. This is the psychoanalytic explanation for conversion disorder. Secondary gain involves external benefits (like attention or avoiding responsibilities) but is not the primary mechanism. The process is unconscious, not conscious fabrication.
Q36: Which theoretical model best explains the maintenance of OCD symptoms?
(a) Learned behavior reinforced by anxiety reduction
(b) Purely genetic determination
(c) Conscious choice to perform rituals
(d) Supernatural influence
Ans: (a)
Explanation: The behavioral model explains that compulsions are negatively reinforced because they temporarily reduce anxiety from obsessions. This reinforcement cycle maintains the disorder. While genetics play a role, the maintenance is explained by learning principles. OCD is not voluntary, and symptoms cause significant distress, distinguishing it from conscious choice.
Q37: What is the primary difference between somatic symptom disorder and factitious disorder?
(a) Severity of symptoms
(b) Conscious vs. unconscious production of symptoms
(c) Presence of laboratory abnormalities
(d) Response to treatment
Ans: (b)
Explanation: In somatic symptom disorder, symptoms are produced unconsciously without intent; the patient genuinely experiences distress. In factitious disorder, symptoms are consciously fabricated or induced to assume the sick role (no external incentive like malingering). This conscious vs. unconscious distinction is the primary difference, though both lack organic pathology.
Q38: According to the stress-vulnerability model, what triggers functional psychiatric disorders?
(a) Genetic factors alone
(b) Environmental stressors alone
(c) Interaction between biological vulnerability and psychosocial stressors
(d) Supernatural causes
Ans: (c)
Explanation: The stress-vulnerability (diathesis-stress) model proposes that functional psychiatric disorders result from interaction between biological/genetic vulnerability and environmental/psychosocial stressors. Neither alone is sufficient; the disorder manifests when stress exceeds the individual's threshold. This biopsychosocial model guides comprehensive treatment addressing multiple factors.
Q39: Which nursing theory is most applicable when caring for patients with functional psychiatric disorders?
(a) Nightingale's environmental theory
(b) Peplau's interpersonal relations theory
(c) Orem's self-care deficit theory
(d) Neuman's systems model
Ans: (b)
Explanation: Peplau's interpersonal relations theory emphasizes the therapeutic nurse-patient relationship as the foundation for psychiatric nursing. For functional psychiatric disorders, the therapeutic relationship facilitates trust, enables assessment, and supports behavioral change. While all theories have merit, Peplau's focus on communication and relationship is most directly applicable to psychiatric nursing.
Type 8: Infection Control & Nursing Management Questions
Q40: A patient with OCD related to contamination fears is in a multi-bed ward. What is the appropriate nursing management?
(a) Provide single room to prevent any exposure
(b) Maintain standard infection control while supporting gradual exposure
(c) Allow unlimited cleaning rituals
(d) Refuse admission due to infection risk
Ans: (b)
Explanation: The nurse should maintain standard infection control practices appropriate for all patients while supporting therapeutic exposure as part of OCD treatment. Excessive accommodation (single room, unlimited rituals) reinforces symptoms. The goal is balanced care that ensures safety while promoting recovery. Patients with OCD do not pose infection risk to others.
Q41: How should the nurse document symptoms in a patient with somatic symptom disorder?
(a) Ignore all complaints as psychogenic
(b) Document objectively with patient's description and assessment findings
(c) Write "patient is faking symptoms"
(d) Avoid documentation to discourage symptom reporting
Ans: (b)
Explanation: Objective, professional documentation is essential, recording both patient's subjective report and objective assessment findings. This provides legal protection and continuity of care. Judgmental language is unprofessional and potentially litigious. Proper documentation helps identify patterns while ensuring genuine medical issues are not missed. Documentation should be factual, not interpretive.
Q42: What is the appropriate nursing approach to limit-setting for a patient with excessive health anxiety?
(a) No limits; accommodate all requests
(b) Schedule regular brief appointments with clear time boundaries
(c) Refuse all interaction
(d) Respond only to emergency situations
Ans: (b)
Explanation: Structured, time-limited appointments provide appropriate attention while setting therapeutic boundaries. This approach prevents reinforcement of excessive health-seeking behaviors while maintaining therapeutic alliance. Regular scheduled contact reduces anxiety better than PRN availability. Complete accommodation or rejection both worsen symptoms and damage the therapeutic relationship.
Q43: When managing a patient with conversion disorder in the hospital, what is the therapeutic nursing approach?
(a) Confront about psychological nature of symptoms
(b) Provide matter-of-fact care while focusing on rehabilitation
(c) Give extensive attention to physical symptoms
(d) Isolate from other patients
Ans: (b)
Explanation: The therapeutic approach involves matter-of-fact care without excessive focus on symptoms, while emphasizing rehabilitation and return to function. Confrontation increases resistance and damages rapport. Excessive attention reinforces symptoms through secondary gain. The focus should be on strengths, abilities, and gradual functional improvement rather than symptoms or limitations.
Q44: What is the role of the nurse in managing skin breakdown in a patient with OCD and excessive hand washing?
(a) Bandage hands to prevent washing
(b) Assess skin, provide treatment, and collaborate on gradual ritual reduction
(c) Ignore skin condition to avoid reinforcing behavior
(d) Recommend immediate psychiatric hospitalization
Ans: (b)
Explanation: The nurse must address medical complications (skin breakdown) through assessment and treatment while collaborating with mental health team for gradual reduction of harmful rituals. Physical restraint (bandaging to prevent washing) increases anxiety and is inappropriate. Ignoring medical complications violates duty of care. An integrated approach addresses both physical and psychiatric needs.
Q45: What education should the nurse provide to family members of a patient with OCD?
(a) Participate in all rituals to reduce patient anxiety
(b) Forcibly stop all compulsive behaviors
(c) Understand the disorder, avoid accommodation, and support treatment
(d) Isolate the patient from family activities
Ans: (c)
Explanation: Family education should emphasize understanding OCD as a neurobiological disorder, avoiding accommodation of rituals (which reinforces symptoms), and supporting evidence-based treatment. Participation in rituals worsens the disorder, while forcible prevention causes severe distress without therapeutic structure. Supportive, non-accommodating involvement facilitates recovery while maintaining family relationships.
Quick Revision Summary
- Conversion Disorder: Physical symptoms without organic pathology, often with la belle indifference (inappropriate lack of concern)
- Somatic Symptom Disorder: Excessive thoughts, feelings, or behaviors related to somatic symptoms lasting ≥6 months
- Illness Anxiety Disorder: Preoccupation with having serious illness despite medical reassurance and minimal symptoms
- OCD Neurotransmitter: Serotonin dysregulation in cortico-striato-thalamo-cortical (CSTC) circuit
- OCD Onset: 75% of cases begin before age 25; bimodal distribution (ages 10-12 and 20-22)
- First-line OCD Treatment: SSRIs (fluoxetine 40-80 mg/day, sertraline, fluvoxamine, paroxetine) + Exposure and Response Prevention (ERP)
- OCD Treatment Duration: 10-12 weeks at therapeutic doses for full effect
- Treatment-Resistant OCD: Clomipramine or augmentation with atypical antipsychotics (aripiprazole, risperidone)
- ERP Therapy: Gradual exposure to anxiety-provoking stimuli while preventing compulsive responses
- Primary Gain: Unconscious psychological benefit from converting conflict to physical symptoms
- Secondary Gain: External benefits (attention, avoiding responsibilities) from illness role
- La Belle Indifference: Inappropriate lack of concern about serious symptoms in conversion disorder
- Priority in Functional Disorders: Always assess ABC first; patients can develop genuine medical emergencies
- Nursing Approach to OCD Rituals: Allow time initially, then gradually set limits; never force abrupt cessation
- Documentation: Objective, professional recording of both subjective reports and assessment findings
- Therapeutic Communication: Brief, scheduled appointments with time boundaries for somatic/illness anxiety disorders
- Family Role: Understand disorder, avoid accommodation of symptoms, support evidence-based treatment
- Conversion Disorder Management: Matter-of-fact care focusing on rehabilitation and functional improvement
- OCD Prevalence: 2-3% lifetime prevalence; among top 20 causes of disability worldwide (WHO)
- NMHP Approach: Community-based treatment and integration with general health services
- Stress-Vulnerability Model: Disorders result from interaction between biological vulnerability and psychosocial stressors
- Mnemonic for OCD Treatment: "SSRI + ERP" - Selective Serotonin Reuptake Inhibitors + Exposure and Response Prevention
- Conversion vs. Factitious: Unconscious symptom production vs. conscious fabrication for sick role
- Assessment Priority: Rule out organic pathology first, then time-limited evaluation to avoid reinforcing illness behavior
