ocd

• 1. According to Gava 2007. The most common treatment for OCD is drug therapy. The most commonly used drugs for OCDs, as well as depression, is antidepressants. Low levels of serotonin are associated with OCD, so drugs that increase this are used. These drugs may normalise the worry circuit and reduce the anxiety associated with OCD.
• 2. SSRIs are currently the preferred drug for treating anxiety disorders as they regulate mood and anxiety. They work when serotonin is released into the synapse from a nerve. It targets the receptor sites and then is re-absorbed by the initial neuron sending the message. To increase serotonin levels, the re-uptake is inhibited so the receptor sites get an increased level of serotonin and increase the stimulation to the receiving neuron.
• 3. Another type of antidepressants are tricyclics which is used more for OCD than depression nowadays. Tricyclics block the transporter mechanism that re-absorbs both serotonin and noradrenaline into the pre-synaptic cell after it has fired. Therefore, more of the neurotransmitter are left in the synapse, prolonging the activity. They have the advantage of targeting more than one neurotransmitter but do have greater side effects, so are used in cases where SSRIs are not effective.
• 4. Anti-anxiety drugs such as benzodiazepines can also be used as they slow down the activity of the central nervous system by enhancing the neurotransmitter GABA that has a general quieting effect on the brain. GABA releases chloride ions when reacting with special sites. These make it harder for the neuron to be stimulated by other neurotransmitters making the person feel more relaxed.

   
• There is considerable evidence for the effectiveness of drug therapy for OCD.

  17 studies were reviewed of SSRIs vs placebos. The SSRIs were found to be more effective when compared to the placebo for up to 3 months after the treatment, reducing the symptoms of OCD. However, there is only evidence around 3-4 months after treatment and not any longer.

  Therefore, drug treatments have shown to be successful in the short term, but there is limited evidence on the long-term effect.
• An issue with drug therapies is the side effects.

  For example, headaches and nausea are common side effects of SSRIs. Although they aren’t necessarily severe, they are enough to stop the patient from taking the drug. The tricyclic antidepressants tend to have more side effects, such as hallucinations, so are used when SSRIs aren’t effective. Anti-anxiety can cause issues with increased aggressiveness. Also issues with addiction to this drug so can only be used for a minimum of 4 weeks.

  These side effects and possibility of addiction therefore limits the usefulness of drugs for treatment.
• Another issue with drug therapy is that even though it works in the moment, it is not a lasting cure.

  It was found that patients relapse within a few weeks if medication is stopped. Koran 2007 in a comprehensive review suggested that even though drug therapy may be more commonly used, CBT should be tried first. This suggests that, while drug therapy is cheap and requires little effort, and can be effective in the short term, it doesn’t provide a lasting cure.
• A popular explanation for OCD is that the genes are inherited from family members. One of these genes may be the COMT gene. The COMT gene is associated with the regulation of dopamine. One form of the COMT gene has been found to be oresent in more people with OCD, than those without. This version increases the neurotransmitter dopamine, leading to higher levels in the individual.
• The other gene that could be associated with OCD is the SERT gene. This gene is associated with the transport of serotonin. A version of this can lead to lower levels of serotonin in an individual. A mutation of these gene was found in 2 unrelated families were 6 of the 7 had OCD.
• However, a link between OCD and genes is very complex, a simple gene such as for eye colour will determine this, but this is more likely for complex behaviour such as OCD. Therefore, having these genes doesn’t determine you to develop OCD, it will just give a vulnerability to developing it, as well as other disorders such as depression.
• . The abnormal levels of these neurotransmitters have been proven from studies. High levels of dopamine have been proved to influence OCD due to animal studies. When animals are given high levels of dopamine, they perform behaviour similar to individuals who have OCD. In contrast, low levels of serotonin were proved to be relevant in OCD due to antidepressants, which increase serotonin, decrease OCD symptoms. Antidepressants that don’t increase serotonin, have no effect on reducing OCD symptoms.
• Alternative explanations can be used for development of OCD such as the two-process model.

  Initial learning occurs when a neutral stimulus (eg dirt) is associated with anxiety. The association is maintained because the stimulus is then avoided. Therefore, the obsession is formed and a link learned with compulsive behaviours such as hand washing which reduces the anxiety. This is supported by success of exposure and response prevention that is similar to SD. 

  This suggests that OCD may have psychological causes as well as or even instead of biological causes.
• A strength of this approach in relation to OCD is the application. For example, if one of the parents has the COMT gene, the mothers fertilised eggs can be screened, giving the parents the option to abort those eggs that inherit that gene. Or, gene therapy can be used that may be able to turn the genes ‘off’ so OCD doesn’t develop. However, this does raise some ethical issues and also implies that OCD is fully due to genes so presumes that there is a relatively simple relationship between them. So, applying biological therapies to disorders such as OCD can be complex and controversial. 
• There is research support for genes and the OFC.

  For example, Menzies (2007) used MRI to produce images of brain activity in OCD patients and immediate family members (without OCD) and a group of unrelated healthy people. OCD patients and their close relatives had reduced grey matter in key regions of the brain including the OFC. 

  This supports the view that the differences are inherited and can lead to OCD in some individuals with differences. 

   
• Evidence from the genetic basis of OCD comes from twin studies. 

  A meta-analysis of 14 twin studies of OCD found that, on average, monozygotic twins were more than twice as likely to develop OCD if their twin had the disorder, than was the case for dizygotic twins (Billett 1998). 

  This does show that there is a genetic basis for OCD, however the concordance rates are not 100% which means there may also be environmental factors that play a part too, using the diathesis stress model.