— 心理社會完整性 · HARD · MCQ —
一位患有強迫症的病人花數小時洗手。在治療初期，哪種護理策略最有效？
A client with obsessive-compulsive disorder (OCD) spends hours washing hands. Which nursing strategy is most effective during the initial phase of treatment?
- AImmediately prevent the handwashing to break the cycle.立即阻止洗手行為以打破循環。
- BPunish the behavior by restricting access to the sink.透過限制使用水槽來懲罰該行為。
- CAllow the ritual initially and gradually limit the time for it.✓ 正解初期允許該儀式，並逐漸限制其時間。
- DExplain that the handwashing is irrational and unnecessary.解釋洗手行為是非理性且不必要的。
— Explanation · 中文詳解 —
強迫症病人的儀式行為是用來減輕焦慮的。若突然中斷，會導致嚴重焦慮爆發。治療原則是先建立關係，允許儀式執行，再透過「反應抑制」計畫逐步縮短時間。A 做法過於激進；C 做法無效，病人知道行為不合理但無法控制；D 懲罰措施會破壞治療聯盟且增加敵意。
Initially allowing the ritual helps establish trust and reduces severe anxiety that would result from abrupt interruption. The most effective strategy is to gradually limit the time spent on the behavior, helping the client tolerate anxiety while modifying the compulsion.
✦ 台美臨床差異
台美在 OCD 照護一致，皆推崇暴露與反應抑制法（ERP），但在台灣健保體系下，心理諮商時間較受限。