OCD

• describe how the DSM-5 categorises OCD


  The DSM recognizes disorders which are related to OCD (e.g. trichotillomania, hoarding disorder, excoriation disorder) as they involve repetitive behaviours underpinned by compulsive thoughts.
• explain the behavioural characteristics of OCD


  Compulsive behaviours are categorized by repetition and ability to reduce anxiety. Usually sufferers feel a need to repeat an action (e.g. hand washing, counting, checking) and these action are intended to ease anxiety.

  Avoidance behaviour are shown by some, depending on the nature of their compulsion. An example might be that someone whose anxiety is triggered by the thought of having germs on their hands avoids using public toilets, emptying their bin, or changing their child’s nappies.
• Explain the emotional characteristics of OCD


  The anxiety caused by OCD can feel overwhelming and frightening. It is often co-morbid with depression (low mood, lack of enjoyment in activities etc.). OCD can often cause feelings of guilt or disgust in the sufferers. E.g. relationship intrusive thoughts, mental contamination, contamination
• Explain the cognitive characteristics of OCD


  Around 90% of sufferers experience obsessive thoughts (a cognitive feature of OCD).

  Some sufferers may adopt cognitive coping strategies (e.g. a religious person feeling obsessive guilt may cope by praying) which can leave them unable to maintain everyday tasks.

  Those sufferers with OCD have insight into their condition, meaning they are aware of their behaviours and thoughts being irrational. Yet are able to justify their anxiety because they often experience such catastrophic ideas but what could happen if they don’t do the behaviour.
• biological approach to OCD genetic explanation research

  OCD is thought to be largely biological in nature ad genes are involved in OCD vulnerability.

  Lewis 1936 found 37% of patients also had parents with OCD; 21% has a sibling with OCD - suggesting a vulnerability to OCD can run in families (as part of the diathesis stress model)

  Nestadt et al. (2010) conducted a review of previous twin studies examining OCD. They found that 68% of identical twins and 31% of non-identical twins’ experience OCD, which suggests a very strong genetic component.
• types of genetic exlanation

  
  

  Candidate genes for OCD have been identified (e.g. gene 5HT1-D beta is involved in the efficiency of transport of serotonin across the synapses).

  Polygenetic- OCD seems to be identified by several genes, rather than a single gene. Taylor (2013) has analysed findings of previous studies and identified 230 genes that may affect OCD (mostly dopamine e and serotonin levels-believed to have roles in mood regulation).

  Aetiologically heterogeneous – OCD is likely to b influenced by different genes in different individuals (as each case is unique).
• Describe neural correlates as a biological explanation of OCD

  Our genes affect our neurotransmitter levels and brain structure. Neural explanation considers both.

  Serotonin – regulates mood. Some cases of OCD are correlated with reduced functioning of the brain ‘s serotonin systems.

  Decision making- specific types of OCD appear to impaired decision making which may be related to abnormal functioning of the lateral frontal lobes. Evidence also suggests the left Para hippocampal gyrus functions abnormally in patients with OCD.
• Research into neural correlates as an explantion of OCD

  Max et al 1994 found that when the basal ganglia is disconnected from frontal cortex during surgery, OCD-like symptoms are reduced, providing support for the role of the basal ganglia in OCD
• Is there research support for biological explanation of OCD?Evaluation

  A strength of the biological explanation of OCD comes from research support seen in family studies. Lewis (1936) examined patients with OCD and found that 37% of the patients with OCD had parents with the disorder and 21% had siblings who suffered.  Research from family studies like this provides support for a genetic explanation for OCD, although it does not rule out other (environmental) factors playing a role.
• Is there good evidence for biological basis of OCD?Evaluation


  Nestadt et al. (2000)  proposes that individuals who have a first‐degree relative with OCD are up to five times more likely to develop the disorder over their lifetime compared to members of the general population without this genetic link. Therefore this is a good evidence for the influence of genes on OCD. Although when twin studies, we must take caution in assuming any similarity in MZ twins is genetic, as they may also have more similarities in their environment (as DZ twins may be boy/girl for example).
• Is environment important at all? to what extent? is this helpful in terms of treatments?Evaluation

  Environment does play a role. Cromer et al 2007 found over 50% of OCD patients had a traumatic event in their past, with most severe cases in those with multiple trauma. This is a strength as environmental factors also affects OCD.
• What issue might comorbidity present?Evaluation


  As OCD is highly comorbid with depression, it is difficult to know whether disruption of serotonin systems is due to depression or OCD.
• What does the biological treatment of OCD use?


  Biological treatments of OCD and other illnesses use drug therapy (sometimes called pharmacotherapy) to correct the abnormal levels of serotonin. Biological explanations of OCD have a lot of support and so it is likely that biological treatments will be effective.
• describe how drug therapy is used to treat OCD


  Medication is given to increase/decrease neurotransmitter levels in the brain to increase/decrease activity. OCD is associated with low serotonin, so drugs are given to patients to increase serotonin levels.
• Describe SSRI 


  SSRI (selective serotonin reuptake inhibitor) are a type of antidepressant which increase the levels of serotonin in the synapse be preventing the re-absorption and breakdown of it by the presynaptic neurone. this seems to help people experiencing OCD. Dosage depends on the SSRI prescribed (for example, a20mg of fluoxetine daily) but can be increased if it is not effective. Patients can take either capsules or liquid medication. Usually, patients will need 3-4 months of daily medication to start to see an impact on symptoms.
• Are drugs used alone to treat OCD?

  Drugs are typically used alongside psychological therapies (CBT being the most common one for OCD). Medications can improve patients’ mood which can help with engagement with therapy.

  Other drugs my be prescribed in some cases where also SSRI ne may not make much differences. Tricyclics and SNRI’S are common alternatives.
• Research into SSRI


  Choy and Schneier (2008), SSRIs (selective serotonin reuptake inhibitors), a type of antidepressant with brand names including Prozac, are the preferred treatment option for OCD. Antidepressants improve mood and reduce the anxiety experienced by patients with OCD.
• How does anti anxiety drugs work like Benzodiazepines?


  Benzodiazepines(BZ) works by enhancing the action of neurotransmitters GABA(gamma-aminobutyric acid)
• How does GABA work?

  GABA tells neurons in the brain to ‘slow down’ and ‘stop firing’ and around 40% of the neurons in the brain respond to GABA. This means that BZs have a general quietening influence on the brain and consequently reduce anxiety, which is experienced as a result of the obsessive thoughts common in OCD.
• Hoes drug therapy treat the cause of disorder or symptom?Evaluation

  Drug treatments are criticised for treating the symptoms of the disorder and not the cause. Although SSRIs work by increasing the levels of serotonin in the brain, which reduces anxiety and alleviates the symptoms of OCD, it does not treat the underlying cause of OCD. Furthermore, once a patient stops taking the drug, they are prone to relapse. Koran et al. (2007) suggest that psychological treatments such as CBT may be a more effective long‐term solution to provide a lasting treatment and a potential cure. 
• Does side effect overpower the effectiveness of drug therapy?

  Evidence suggests that SSRIs are effective in treating OCD, some patients experience mild side effects like indigestion, while other may experience more serious side effects like hallucinations. BZs are renowned for being addictive and can also cause increased aggression and long‐term memory impairments. BZs are recommended for short‐term treatment only of up to four weeks, according to Ashton (1997). Side effects affects the use of drug treatments, as patients will often stop taking it if they experience negative side effects.
• does research say SSRI are effective?


  Soomro et al 2009 reviewed studies comparing SSRIs to placebos in treating OCD and all 17 studies showed SSRIs were better than placebos. they were most effective when combined with therapy (especially CBT).

  Greist et al 1995 conducted a meta-analysis where they reviewed placebo – controlled trails of the effects of 4 drugs on OCD, they found all 4 drugs were significantly more effective than placebo.
• Which treatment is more cost effective?


  Drugs are cheaper than psychological therapies so are better value for public health systems (e.g. NHS). They also do disrupt patients lives in the way therapy might, they can simply stop taking their medication when they feel it’s no longer needed.