Psychopathology

• What is the biological treatment for OCD


  drug therapy which aims to increase/decrease levels of neurotransmitters in the brain or to increase/decrease their activity
• SSRIS as a form of drug therapy for OCD:

  • Prevent the reabsorption of serotonin so that it isn't broken down in the brain and instead continues to stimulate the postsynaptic neuron. By blocking the receptors, serotonin stays in the synapse for longer and therefore has more chance of latching onto the pre synaptic nerve
• Tricyclics as a form of drug therapy for OCD:

  • Has the same effect as SSRIs in the serotonin system whilst also acting in other various systems 
  • Has more side effects so is generally only used for people who dont respond to SSRIs
• SNRIs as a form of drug therapy for OCD:

  • A different class of anti depressant drugs and are a second line of defence for people who don't respond to SSRIs
  • Increases levels of serotonin as well as nonadrenaline
• Combination of SSRIs with other treatments:

  • Often used with CBT 
  • The drug acts on patients emotional symptoms so that they can engage more effectively in psychological/behavioural treatments 
• Genetic explanations of OCD, candidate genes:

   genes which appear to make some people more vulnerable to this disorder. Often genes that interact, not just single ones (polygenic)
• Genetic explanations of OCD, COMT genes:

   involved in the production of Catechol-O-Methyltransferase. 

  • Tukel found that lower levels of activity of the COMT gene led to higher levels of the neurotransmitter dopamine. 
  • Higher levels of dopamine are associated with stereotyped movements which may manifest themselves as compulsions of OCD 
• Genetic explanations of OCD, SERT gene:

   Another candidate gene type, also called 5-HTT.

  •  Involved in the transport of serotonin  
  • Low levels of serotonin are also implicated in OCD
  • Ozaki found evidence of two unrelated families with mutations of this gene where 6/7 family members had OCD
• Neural explanations of OCD, worry circuit:

  There's evidence from PET scans that people with OCD have areas of abnormality within their brains. 

  The orbitofrontal cortex sends signals to the thalamus about potential worries, usually these minor worries are suppressed by the candidate nucleus

  However, if the candidate nucleus is damaged, the worry isn't suppressed and the thalamus is alerted and confirms the worry to the orbitofrontal cortex. This creates a “worry circuit” which leads to obsessive thoughts 
• Neural explanations of OCD, dopamine and serotonin:

  serotonin and dopamine are linked to these regions of the frontal lobe and are implicated in the malfunction of the caudate nucleus 

  Sukel found the main neurotransmitter of the basal ganglia is dopamine and high levels of dopamine lead to over activity in this area of the brain.
• OCD:

   An experience of obsession which takes the form of persistent and uncontrollable thoughts, images, impulses and worries. People with OCD believe the only way to get rid of these irrational thoughts is to perform compulsive behaviours, often to prevent perceived harm happening to themselves or other people
• Compulsions:

  repetitive physical behaviours and actions or mental thought rituals that are performed over and over again in an attempt to relieve the anxiety caused by the obsessive thoughts
• 4 Main categories of OCD:

  • Intrusive thoughts 
  • Checking 
  • Contamination 
  • Hoarding
• Cognitive characteristics of OCD:

  • The obsession. The constant thoughts which take the form of persistent and uncontrollable thoughts and images
• Emotional characteristics of OCD:

  The concern and upset caused by knowledge that their obsessions are irrational and abnormal
• Behavioural characteristics of OCD:

  • The compulsive behaviours which they are unable to control
• CBT as a treatment of depression:

  aims to change the way a client thinks, by challenging negative irrational and maladaptive thought processes, leading to a change in behaviour. It focuses on the here and now problems and difficulties, looking for ways to improve the state of mind now
• CBT ABC model:

  A - affect (how they feel)

  B - behaviour (How they act)

  C - cognition (How they think)
• Steps of becks cognitive therapy:

  1. Client assessed to discover severity of condition 
  2. Therapist will establish a baseline prior to treatment 
  3. Therapist and client work together to identify negative irrational thoughts about the world, the self and future
  4. Thoughts are then challenged directly through reality testing
  5. Then set tasks for the client (homework) to test reality of the thoughts themselves. This is known as the ‘patient as scientist” approach as the client is investigating their own assumptions 
• What is REBT:

  REBT is based on an extension of Ellis’ ABC model, it emphasises changing irrational thoughts to rational ones. 

   D= disputing irrational thoughts and beliefs, therapist challenges irrational thoughts to rational ones. 

  E= effects of the new beliefs and attitudes that emerge
• Steps of Becks rational emotional behavioural therapy:

  • Activating even or adversity
  • Belief about event or adversity 
  • The environmental consequences
  • Disputations to challenge irrational beliefs 
  • Effective new beliefs replace irrational ones 
• Becks negative triad explanation:

  His approach is based on the concept of schemata. It suggests that depression is the result of holding negative schemata about the world, the self and the future. 

  This pessimistic view becomes a self fulfilling prophecy and leads to cognitive bias. 

  Depressed people tend to focus on negative aspects of their lives and ignore the positive ones, causing them to be trapped in a vicious cycle of depression 
• Ellis' ABC model:

  A = activating event e.g. death of family member

  B = Belief e.g. rational(lost my job because they were overstaffed) and irrational (they always had it in for me)

  C = consequence e.g. rational (healthy emotional response)  and irrational (unhealthy response such as depression)
• DEPPRESSION:


  a mood or affective disorder which involves prolonged and fundamental disruption of mood and emotion. 1/20 adults suffer
• In order to be suffering from clinical depression, a person should have experienced at least 5 of these symptoms and a persistent low mood over at least 2 weeks:

  • Poor appetite. Weight loss/gain
  • Sleep difficulty 
  • Loss of energy 
  • Loss of interest or pleasure in usual activities 
  • Feelings of inappropriate guilt 
  • Inability to concentrate
  • Recurrent thoughts of death
• Emotional characreristics of depression:

  • Sadness
  • Anger
  • Loss of pleasure in usual hobbies
• Cognitive characteristics of depression:

  • Negative or irrational thoughts
  • Loss of interest in life
• Behavioural characteristics of depression:

  • Shift in activity level 
  • Sleep changes
  • Appetite changes
• Systematic desensitisation

  takes clients through steps to learn a new response to their feared stimulus 
• Steps of systematic desensitisation:

  1. Clients are taught relaxation techniques 
  2. With a therapist, they create a fear hierarchy. A list of feared objects/situations are ranked from the least to most feared
  3. Patient is exposed to phobic stimulus whilst practising the relaxation stimulus as feelings of anxiety arise.When this has been achieved, the patient continues this process by moving up the hierarchy 
  4. If it works, the patient has been counter conditioned as theyve learnt a new response to a stimulus
• Flooding:


   directly exposing an individual to their phobia
• Steps of flooding:

  • Overwhelming the individuals senses with the item or situation that causes anxiety so the person realises no harm will occur 
  • Exposed repeatedly with no relaxation technique with thoughts, images and experiences of phobia 
• Classical conditioning of phobias:

   Learning through association 

  • Unconditioned stimulus (noise) → unconditioned response (fear)
  • Unconditioned stimulus (noise) + conditioned stimulus (rat) → unconditioned response (fear)
  • Conditioned stimulus (rat) → conditioned response (fear)
• Explanation of phobias:


  Phobias are learnt behaviours, either through operant/classical conditioning or social learning.
• Operant conditioning of phobias:

  avoidance of object or situation due to reduction of anxiety it brings 

  • Avoidance maintains the fear and preserves the phobia 
  • Frequent contact with a phobic object may reveal its harmless which would lead to an extinction of the phobia 
• Phobia:

  anxiety disorder which is an irrational fear of an object or situation. A fear only becomes a phobia when it negatively impacts a person's everyday life. 
• behavioural characteristics of phobias:

  • Avoidance behaviours 
  • Fight or flight responses when confronted with a situation 
• emotional characteristics of phobias:

  • Intense fear and emotional upset 
  • Person becomes distressed at sight or thought of phobia 
• cognitive characteristics of phobias:

  • Occur even though the sufferer realises their fear is irrational.
  • Unable to control their obsessive thoughts
• DEVIATION FROM SOCIAL NORMS:

  Every society or culture has standards of acceptable behaviours/norms 

  • Abnormality: behaviour that deviates from these norms 
  • Norm: a standard that society believes is acceptable
  • E.g. its normal to laugh at a family gathering but not at a funeral