A nurse is caring for a client with OCD who is taking a selective serotonin reuptake inhibitor (SSRI) The client reports that they are having difficulty sleeping. Which of the following interventions should the nurse recommend?

Choice C rationale:

Risperidone is an atypical antipsychotic medication that is sometimes used as an augmentation strategy in treating OCD, particularly in cases where there are prominent obsessive-compulsive symptoms that are not well-controlled by other interventions. However, it's important to note that risperidone's use in OCD is off-label, meaning it's not approved by regulatory agencies specifically for OCD treatment.

Choice D rationale:

Selective serotonin reuptake inhibitors (SSRIs) are a cornerstone of pharmacological treatment for OCD. These medications, such as fluoxetine, sertraline, and fluvoxamine, increase the availability of serotonin in the brain and help alleviate obsessive-compulsive symptoms. They have been extensively studied and are considered first-line treatment options.

Choice A rationale:

Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) commonly used to treat depression and anxiety disorders. While it may have some benefit for anxiety symptoms, including those related to OCD, it is not considered a first-line treatment for OCD. SSRIs have shown greater efficacy for OCD management.

Choice B rationale:

Tricyclic antidepressants (TCAs) were among the first medications used to treat OCD. However, their side effect profiles and the availability of more effective and better-tolerated options, such as SSRIs, have led to TCAs being used less frequently for OCD treatment.

Choice E rationale:

Dopamine agonists are not commonly used for OCD treatment. In fact, they can potentially exacerbate symptoms, as imbalances in dopamine transmission are implicated in the pathophysiology of OCD. Using dopamine agonists without a clear rationale could worsen the condition.

Choice A rationale:

Exposure and response prevention is a cornerstone of cognitive-behavioral therapy (CBT) for OCD. It involves exposing the individual to anxiety-provoking situations (exposure) and then preventing the usual compulsive response that reduces anxiety (response prevention) This helps the individual learn that their feared outcomes are unlikely to occur and that their anxiety will diminish over time without engaging in rituals.

Choice B rationale:

Systematic desensitization is a technique used to treat phobias and anxiety disorders by gradually exposing the individual to their feared stimuli while teaching relaxation techniques. While it may have some applicability in OCD treatment, it is not as directly aligned with the core features of OCD as exposure and response prevention.

Choice C rationale:

Flooding is a therapeutic technique that involves exposing the individual to an extreme level of their fear in order to diminish the anxiety response over time. While this approach might be used in certain anxiety disorders, it is not typically the first-line intervention for OCD. Exposure and response prevention is a more gradual and controlled technique that is better suited for OCD treatment.

Choice D rationale:

Thought stopping involves interrupting obsessive thoughts by using cues or distractions. This technique is not as effective in treating OCD as exposure and response prevention, which directly addresses the connection between obsessions and compulsions. Thought stopping may not provide the individual with a comprehensive strategy for managing their OCD symptoms.