Obsession-Compulsive Disorder in Adults - Coursework Example

Obsessive-Compulsive Disorder Institution: Name: Introduction Obsessive-Compulsive Disorder (OCD) is a chronic, disabling, heterogeneous disorder that is classified under anxiety disorders. DSM-V definition dictates that the critical features of the disorder include repetitive obsessions and compulsions or both. The symptoms are severe and prolonged (EMEA, 2005). This paper defines the OCD in adults based on DSM-V diagnostic criteria. It further explores the treatments and outcomes while arguing that Cognitive behavioural therapy (CBT) offers the most effective treatment (Phillips, 2009). Ethical issues regarding its definition, research and treatment are also examined. Definition and Diagnosis Obsessive–compulsive disorder (OCD) is defined by repeated obsessions and compulsions that sub Obsessive–compulsive disorder (OCD) radically impair the functioning. These irrational or intrusive thoughts recurrently form or appear in an individual’s mind. The severity for OCD symptoms is assessed using a self-report and clinical interview measures (Lewis-Ferna´ndez et al., 2009). The structured clinical interviews can be employed in determining whether an individual meets Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria for OCD. According to DSM-V, to be diagnosed with OCD, an individual must have compulsions, obsessions or both. DSM-V specifies that several conditions that embody clinically significant compulsions and obsession must exist (Phillips, 2009; Lewis-Ferna´ndez et al., 2009). Obsession comprises intrusive impulses, images or thoughts that trigger considerable distress. They include concerns about endangering oneself or fixation with contamination (Reaven & Hepburn, 2003). These thoughts, according to DSM-V, are of degrees that lie outside the ordinary range of worries on common problems. For instance, while an individual will try to suppress, neutralise or disregard the obsessions with different actions or thoughts, the obsessions would be recognised as irrational (Lewis-Ferna´ndez et al., 2009). On the other hand, compulsions can be physical or mental repetitive rituals or behaviours that individuals have a difficulty in resisting. Examples of compulsions include tending to seek reassurance, wash hands or continually repeating tasks with the view that they have not been performed correctly. The DSM-V criteria do not need the occurrence of compulsions and obsessions (Lewis-Ferna´ndez et al., 2009). Compulsions are regarded to be clinically-significant when an individual performs them as a response to a response or rules that have to be executed firmly. In which case, while many individuals who do not experience OCD may not perform the acts that are associated with OCD, the peculiarity with the “clinically significant” OCD is found in the idea that those with the condition must perform the actions, lest they will undergo considerable psychological distress (Abramowitz et al., 2002). Such tendencies reduce or prevent the distress by preventing the feared situation or event, despite the fact that they may not be rationally linked to the issues. According to DSM-V, the compulsions and obsessions should also be time-consuming, by taking an average of more than one hour each day. In addition, they should also cause scholastic functioning, occupational and social functioning (Lewis-Ferna´ndez et al., 2009). Recommended treatments and treatment outcomes Empirical evidences, compiled over the last 40 years, indicate that the two kinds of effective OCD treatment include Cognitive behavioural therapy (CBT) through exposure and response prevention and use of serotonin reuptake inhibitor medication (SRIs) pharmacotherapy (Moore & Luenzmann, 2002). Behavioural therapy consists of using “exposure and ritual prevention”, where patients are taken through gradual learning to assist them to tolerate the anxiety linked to restraining from performing ritual behaviour. The efficacy of this treatment intervention bears a formidable evidence base. Cognitive behavioural therapy (CBT) Foa (2010) surveyed published research that spanned over 40 years and concluded that cognitive behavioural therapy (CBT) can effectively treat OCD far more significantly. In his review, the researcher indicated that while exposure and ritual prevention (EX/RP) was strongly supported by most research literature he surveyed, 20 percent of the patients had been shown to drop out. EX/RP is a type of cognitive behavioural therapy that consists of elongated exposure to distressing situations or objects integrated with stringent prevention of rituals (abstinence of ritualising what is believed to cause disaster or obsession). Additionally, despite the fact that 80 percent of the patients showed positive response to EX/RP, 20 percent did not. Given the convincing support Foa (2010) has for OCD, it can be reasoned that determining the usefulness of psychological interventions is difficult, given the lacking control studies. Foa (2010) however failed to offer other alternative treatments other than CBT. Exposure and response prevention Veale (2007) suggested a form of CBT treatment called exposure and response prevention, which is based on the learning theory. The basis of the treatment is that obsessions become associated with anxiety through conditioning processes. Hence, compulsions and avoidance behaviours facilitate the subsistence of anxiety. According to this kind of treatment, a patient is exposed to stimuli that aggravate their obsession, which afterwards help in preventing it from reacting with the compulsions and escapes. Repeating these stages contributes to the disappearance of the response to the fears. Veale (2007) concluded that this kind of treatment is effective in his study after he found that some 75 percent of the patients he was studying responded positively to the study, while 25 percent either refused the treatment or dropped out. Combining CBT with SRI pharmacotherapy Franklin, et al. (2002) investigated CBT with or without SRI pharmacotherapy in treatment of OCD. The research followed after concerns that practicing psychologists who treated OCD were not able to assert affirmatively that CBT, would be more effective with associated SRI pharmacotherapy. Franklin, et al. (2002) investigated the issue with a clinical sample of 56 outpatients who had been administered free-for-service CBT. The researchers found that 55 percent of the patients received CBT alone while 45 percent received CBT and SRI pharmacotherapy. The studies found that both groups made significant post-treatment outcomes. This suggested that CBT is effective with or without associated pharmacotherapy (Franklin, et al., 2002). However, the question of whether the CBT treatment with or without pharmacotherapy cannot be generalised, given the small study sample of 56 patients. Indeed, the small sample size constrained the power to discover statistical differences in the study, since both groups studied received intensive EX/RP. Additionally, it would be wrong to argue that it is valid, since the researchers could not determine the choices of the patients on whether to use the two methods or not. A major implication of the study is that CBT appears to be significantly helpful, whether it is integrated with pharmacotherapy or not. Hence, it could be argued that patients who are already on medication before CBT is initiated do not necessarily need the two treatments to be combined in order to benefit substantially. Despite the strong evidence base that CBT boasts of, a study by Albert et al. (2013) brought doubts on the efficiency, by criticising the quality of many researches. For instance, Albert et al. (2013) carried out document analysis of published researches conducted over the last 30 years to establish the effectiveness of SRI and OCD and concluded that unsatisfactory treatment with these interventions was common, as some patients may fail to respond to the treatments. According to the researchers, most studies that have examined and appropriated efficacy to both interventions have had significant challenges, such as small sample sizes and short study duration. Traditional psychotherapy OCD was at the outset regarded as intractable. According to Foa (2010), psychodynamic and psychoanalytic theories of subconscious wishes and drives contributed to varied conceptualization of PCS, although it never bore positive treatment results in reducing the OCD symptoms. Results of document analysis research conducted by Foa (2010) show that although psychodynamic psychotherapy bore little fruition or limited clinical benefits, it continued to be used on OCD patients. After a review of literature, Foa (2010) concluded that the traditional approaches used in OCD treatment need radical revision, since they have failed to contribute to the comprehensive resolution for the disorders. Foa (2010) proposed that OCD treatments should focused on the present experiences of the patient, rather than focus on using psychodynamic interpretations of the past experiences. Foa (2010) further lamented that psychology made insignificant contribution to treatment of OCD. Ethical concerns that might arise during assessment, diagnosis and treatment Several ethical concerns may arise during assessment, diagnosis and treatment, since several situations that pose ethical challenge to the clinician-patient relationships are likely to be faced. The challenges should however be approached in an informed manner, using six cardinal principles of medical ethics, so as to help overcome the ethical dilemmas. These include respect for others, nonmaleficence, confidentiality, autonomy, veracity, beneficence (Aboujaoude, 2011). Nonmaleficence refers to a duty to avoid causing harm to others. This ethical concern is specifically relevant during the treatment of the patient. For instance, working with OCD patients would require patience, in order to realise the positive outcomes. While some patients may be obstinate and determined to quit the treatment, this would present an ethical dilemma to the medical professional. In which case, a decision by the psychiatrist to terminate the treatment would amount to patient abandonment, as the obstinate patient would be vulnerable and unlikely to find engage in another treatment. Besides, the patient is likely to experience a relapse in OCD symptoms. Under such situations, the APS (2007) code of ethics specifies that a psychiatrist has a duty to nonmaleficence defines the dilemmatic situations, where he has to tolerate the patient and work to see positive outcomes, in order to deter greater harm to the patient. On the other hand, ‘respect for others’ refers to the virtual of attributing a patient intrinsic value. It is specifically applicable during assessment, diagnosis and treatment (Aboujaoude, 2011). APS code of ethics specifies that a psychiatrist must ensure the safety and wellbeing of a patient without prejudgements and with consideration for the patient’s dignity, despite the irritations the OCD patient may cause. Beneficence defines an obligation to work to the benefit of the patient and to secure their good will. It is applicable during the assessment, diagnosis and treatment. APS (2007) code of ethics outlines that a physician has to act beneficently. For instance, in treatment of OCD, the psychiatrist should aim for the patients’ good, through competent prescription of psychopharmacological treatment to individuals who are not likely to show improvement from exclusive sustenance of psychotherapy. Autonomy defines the capacity to make thought-out independent decisions for oneself, as well to undertake actions based on that particular decision (Aboujaoude, 2011). It specifically applies during treatment. For instance, a psychiatrist can determine that an OCD patient has a decisional capacity to accept or refuse treatment even when there are grounds to believe that the patient is being offered the best possible chance for improvement. Veracity refers to the duty to be truthful and to refrain from misimpressions or misrepresentations. Veracity applies during assessment, diagnosis and treatment (Aboujaoude, 2011). For instance, during diagnosis, the psychiatrist must truthfully note down the symptoms, as well as, honestly describe and justify the interventions that are undertaken as truthfully reflecting the OCD symptoms. To allay chances of misimpressions that often cause anxiety, the psychiatrist may have to discuss with the patients in details of the issues of concern and what is expected from the intervention. Conclusion Obsessive–compulsive disorder (OCD) is characterised by repeated obsessions and compulsions that disable normal functioning. The intrusive thoughts recurrently form in an individual’s mind. Most empirical researches have concluded that CBT provides the most effective treatment intervention, whether it is integrated with pharmacotherapy or not. However, most these studies that have examined and appropriated efficacy to both interventions have had significant challenges, such as small sample sizes and short study duration. Overall, several ethical concerns may arise during assessment, diagnosis and treatment. The challenges should however be approached in an informed manner, using six cardinal principles. These include respect for others, nonmaleficence, confidentiality, autonomy, veracity, beneficence References Aboujaoude, E. (2011). Ethics Commentary: Ethical Challenges in the Treatment of Anxiety. Focus 9(3), 289-291. Abramowitz. J. (2006). The Psychological Treatment of Obsessive-Compulsive Disorder. The Canadian Journal of Psychiatry 51(7), 407-415 Abramowitz, J., Schwartz, S. Moore, K. & Luenzmann, R. 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