Biological approach for OCD

• what does biological mean ?

  refers to process of 'knowing' including thinking , reasoning ,remembering and believing
• what is OCD?

  a condition characterised by obsessions and/or compulsive behaviour
• what are obsessions?

  internal components such as intrusive thoughts , impulses + images (cognitive aspect) that individuals struggle to resist alongside increased anxiety (emotional aspect)
• what are compulsions?

  external behaviours which are irresistible , repetitive mental or physical actions (behavioural aspect of OCD) which are carried out in an attempt to relieve the anxiety which occur with obsessions
• what are the behavioural characteristics of OCD?

  1. Compulsions are repetitive
  2. Compulsions reduce anxiety
  3. Avoidance - avoiding situations that trigger anxiety which can prevent them from functioning adequately (leaving the house) e.g people avoid germs to prevent compulsive hand washing
• what percentage of people with OCD show just compulsive behaviour and not obsessions?

  10% , just a sense of irrational anxiety

  vast majority - compulsions are performed in attempt to manage anxiety which comes occur with obsessions
• what is the OCD cycle?

  Obsessive thought = anxiety = compulsive behaviour = temporary relief
• what are the emotional characteristics of OCD?

  1. Anxiety + distress - unpleasant emotional experience of anxiety which are accompanied with compulsions and obsessions
  2. Accompanying depression - anxiety = low mood etc
  3. Guilt + disgust - negative emotions directed against something external e.g dirt ,self
• what are the cognitive characteristics of OCD?

  1. Obsessive thoughts
  2. Cognitive coping strategies - to deal with obessions e.g praying managing guilt + anxiety but may be seen as abnormal
  3. Insight into excessive anxiety - aware that their obsessions + compulsions are not rational (concerning + diff disorder if they werent)
• what is a contradiction to having insight into excessive anxiety?

  people with OCD tend to experience catastrophic thoughts about worst case scenarios that might result if their anxieties were justified alongside tend to be hypervigilant
• what is an alternative relaxation technique ?

  drugs such as valium
• what does genetic explanations mean?

  genes make up chromosomes which consists of DNA which codes for physical and psychological features of an organism and are transmitted from parents to offspring
• what did Aubrey Lewis observe from his OCD patients?

  37% had parents with OCD

  21% had siblings with OCD suggesting that OCD runs in families
• what is passed on one generation to another instead of the certainty of OCD (results of Lewis study)?

  genetic vulnerability
• what is genetic vulnerability?

  the possibility that OCD is passed on from one gen to another
• what is the diathesis - stress model?

  certain genes leave people more likely to develop a mental disorder than other but NOT certain as some environmental stress is necessary to trigger the condition
• what are candidate genes?

  identified genes which create vulnerability for OCD as some are involved in the regulation of the serotonin system
• what does the gene 5HT1-D beta do?

  it is implicated in the transport of serotonin across synapses
• why does OCD seem to be polygenic?

  OCD is not caused by one single gene but by a combo of genetic variations that together increase vulnerability to OCD
• what did Steven Taylor find about OCD?

  up to 230 diff genes may be involved in OCD which can consist of dopamine + serotonin which are both neurotransmitters that are believed in regulating mood
• what term is used to describe when origins of OCD vary from one person to another ?

  aetiologically heterogenous

  the diff types may be the result of particular genetic variations e.g hoarding + religious
• what are neural explanations?

  the genes associated with OCD likely to affect the levels of key neurotransmitters as well as structures of the brain
• how does abnormal levels of neurotransmitters explain OCD?

  neurotransmitters are responsible for relaying info from one neuron to another so if the levels are not regulated mood-relevant info not relayed correctly or balanced
• what is the root of OCD?

  high levels of dopamine (reward , motivation system, pleasure + motor skills) and low levels serotonin (mood ,memory processing , sleep + cognition)
• Strength : Genetic explanation for OCD

  P - strong evidence base

  E - twin study (68% MZ twins shared OCD ; 31% DZ twins shared OCD , family studies ( family mem with OCD 4x likely to develop it as someone without)

  E - suggests some people are vulnerable to OCD as a result of their genetic makeup

  L -research studies suggest there must be some genetic influence on development of OCD
• Limitation : Genetic explanation for OCD

  P - environmental risks factors

  E - Cromer et al found over half of OCD clients in their sample has experienced a traumatic past = OCD more severe

  E - suggesting that , although there is strong evidence GV makes a person more or less vulnerable to OCD, environmental risk factors can also trigger / increase risk of developing OCD

  L - genetic vulnerability only provides partial expla to OCD
• Strength:Neural explanations for OCD

  P - existence of some supporting evidence

  E - OCD symp form part of conditions that are known to be biological in origin e.g Parkinson's disease (tremors + muscle paralysis)

  E - if biological disorders produce OCD symp , we may assume the biological processes underlie OCD

  L - bio factors may be responsible for OCD
• Limitation : Neural explanations in OCD

  P - serotonin-OCD link may not be unique to OCD

  E - e.g some people have co-morbidity as they have OCD alongside experiencing clinical depression

  E - depression can possibly cause a disruption to the serotonin system so the cause of OCD may not be due to the disruption of serotonin activities as there are other underlying issues aswell

  L - serotonin may not be relevant to OCD symptoms
• what does drug therapy do for mental disorders?

  aims to increase or decrease levels of neurotransmitters in brain to in/de their activity
• what is the standard medical treatment used to tackle symptoms of OCD?

  a type of antidepressants called SSRIs
• what does SSRIs increase in the brain?

  serotonin as it prevents the re-absorption and breakdown of serotonin back in the pre-synaptic neuron
• what does preventing the reabsorption of serotnin do?

  increase the levels in the synapse and continue to stimulate the post-synaptic neuron which compensates for the lack of it caused by OCD
• what is a typical dose of fluoexetine?

  20mg but can vary depending on person
• how long does it for SSRI to have an impact?

  3 to 4 months of daily use
• whats one other treatment SSRIs can be combined with to treat OCD ?

  CBT as the drugs reduce the persons emotions of feeling anxious + depressed which helps the client engage more effectively with the CBT
• what is an alternative if SSRIs do not work after 3 to 4 months?

  the dose can be increased or it can be combined with other drugs
• what are tricyclics?

  older type of antidepressants e.g clomipramine which acts on various systems including serotonin system (has same effect as SSRIs)
• why are tricyclics generally kept in reserve for people who do not respond to SSRIs?

  more severe side-effects than SSRIs
• what are SNRIs?

  more recently been introduced as a treatment for OCD (2nd line of defence if SSRIs dont work) which increases levels of serotonin and a diff neurotransmitter (noradrenaline)
• Strength: drug treatments for OCD

  P - good evidence for its effectiveness

  E - cs reviewed 17 studies that compared SSRIs to placebos , all 17 had signif better outcomes , typically symptoms reduce for 70% ,remaining 30% can be helped by either alternatives or combi of drugs + psychological therapies

  E - clear evidence SSRIs reduce symptom severity + improve QOL for people w OCD

  L - drugs appear to be helpful for most people w OCD