OCD (Obsessive Compulsive Disorders) (TREATING OCD- DRUG THERAPY…
OCD (Obsessive Compulsive Disorders)
TREATING OCD- DRUG THERAPY
Effective at tackling symptoms
- Clear evidence for reduction of symptoms and improvement in quality of life. Soomro et al (2009) compared SSRI's to placebos, and results for SSRI's were significantly better. Symptoms decline for about 70% of patients, and combinations can help the left % too.
Some cases follow trauma
- Believed to be biological in origin. However drugs cannot necessarily treat traumatic events that have caused the OCD.
Cost effective and non-disruptive
- Cheaper than psychological treatments. Good value and don't disrupt patients lives.
- Some believe research is biased as it is often done by drug companies. (Goldacre 2013)
- Suffer indigestion, blurred vision, loss of sex drive. temporary. For tricyclics, side effects are even worse. Suffer erection problems, tremors and weight gains (1 in 10). Reduce effectiveness.
Drugs work in various ways to increase serotonin levels.
SSRI'S- Selective serotonin reuptake inhibitors. They prevent the reabsorption and breakdown of serotonin in the postsynaptic neuron, increasing serotonin levels. Daily dosage of Fluoxetine is 20mg, but can be increased. Takes 3-4 months.
Combining with other treatments
- Often used alongside CBT. Due to reduction in stress and anxiety, patients can focus more for CBT.
- SSRI's can be combined with other drugs.
Tricyclics- EX- Clomipramine. Much more severe side effects, so only used if patients don't respond to SSRI's.
SNRI's- serotonin-noradrenaline reuptake inhibitors. Also a second line of defence like tricyclics. Increase serotonin and noradrenaline levels.
- Evidence does suggest that structures of brain do function abnormally. However cannot justify that abnormal functioning causes OCD, as they could be as a result of rather than a cause.
Unclear whats involved
- Cavedini et al (2002) have shown these neural systems to be involved in decision making. However, research has identified other ways, in which may be involved sometimes. No full understanding.
Some supporting evidence
- Antidepressants work on serotonin system, increasing its levels. This can reduce OCD symptoms. Also OCD form part of a number of conditions that are biological in origin, example Parkinsons disease (Nestadt et al 2010).
Genes associated with OCD are likely to affect levels of neurotransmitters, as well as brain structures.
Decision making systems
- Some cases are associated with impaired decision making, which can be associated with the lateral (side bits)not the frontal lobes of the brain. These are responsible for logical thinking and decisions.
Also evidence to suggest that an area called left parahippocampal associated with processing unpleasant emotions is abnormal in OCD sufferers.
Role of serotonin
- Mood regulator, neurotransmitters are responsible for relaying information from one neurone to another. Low levels of serotonin affects mood, and some cases of OCD can be explained by reduction in serotonin system.
- Some mental disorders appear to have a higher biological link Genes are involved in vulnerability to OCD. Lewis (1936) observed that 37% of OCD patients had OCD parents, and 21% with OCD siblings. Suggests OCD runs in families. According to
diathesis stress model
certain genes leave some people more vulnerable to inheriting a mental disorder.
OCD is polygenic
- Caused by multiple genes. Taylor (2013) found evidence that up to 230 genes may be involved in OCD. Includes those associated with dopamine as well as serotonin, both neurotransmitters involved in mood regulation.
Types of OCD
- Different genes cause different OCD. Term used is aetiologically heterogenous, meaning origin has different causes.
Good supporting evidence
- Evidence given from a variety of studies. Best example are twin studies. Nestadt et al (2010) found 68% of identical twins share Ocd, compared to 31% of non-identical twins.
Too many candidate genes
- Psychologists cannot pin down every gene involved. This means it provides little predictive value.
Environmental risk factors
- Environmental factors can trigger or increase risk of OCD. Cromer et al (2007) found that over half the OCD patients had experienced a traumatic event in their past, suggesting its not entirely genetic.
- Thoughts that recur over and over again. Always unpleasant and vary. Example- worrying about being contaminated by dirt.
Dealing with obsessions
- People find strategies to deal with their thoughts to reduce anxiety. For example theists pray or meditate.
Insight into excessive anxiety
- People with these problems know they are irrational. However they suffer catastrophic thoughts, about worse case scenarios that may result if anxieties were justified. Tend to be hyper vigilant (always alert).
- They are repetitive or they reduce anxieity. EX hand washing, people will do it several times a day and it can also be done as a response to fear of germs.
- Behaviour can be characterised by avoidance of situations that trigger anxiety. EX: hand washers may avoid anything with germs.
Anxiety and distress
- Unpleasant emotional stress because of ansxiety that accompoanies compulsions and obsessions. Thoughts are unpleasant and frightening, and urge to repeat behaviour creates anxiety.
- Often with depression, so anxiety can be accompanied by low mood. Compulsive behaviour may bring temporary relief.
Guilt and disgust
- OCD sufferers suffer irrational guilt over minor issues or disgust which may be directed at self or external things like dirt.
DSM-5, categories of OCD.
- characterised by either obsessions (recurring thoughts) oir compulsions (repetitive behaviours).
- Compulsive hair pulling
- Gathering possessions.
- compulsive skin picking