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OCD - Coggle Diagram
OCD
Evaluation
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Genetics Weakness - Family studies also explain environmental influences, close relatives could develop OCD symptoms through observation (SLT) and it is difficult to untangle this from genetics.
Drug therapies are effective - Soomro 2009 - evidence that SSRIs are effective in reducing symptoms of OCD.
Drugs are more cost effective and non-disruptive - cheap compared to psychological therapies and don't disrupt patients' lives so they can continue to be at work etc.
Drugs have side effects - a significant minority receive no benefit from drugs, coming off a drug is a slow process as the dosage is reduced over 6 months, risk of relapse.
Alternative explanation - two process model, NS (e.g. dirt) is mixed with anxiety, association maintained as stimulus avoided, obsession forms to link compulsive behaviours with reducing anxiety. Supported by Exposure and Response Prevention (ERP) - Albucher 1998 found 60 to 90% of adults with OCD improved considerably with ERP.
Explanation: Genetic
COMT Gene - regulates dopamine, one variation results in higher levels of dopamine and is more common in OCD patients.
SERT Gene - linked to transport of serotonin, causes lower levels of serotonin which is associated with OCD and depression.
Taylor 2013 - as many as 230 genes implicated in development of OCD. Suggests that there is a predisposition for some individuals to develop OCD.
Nestadt 2010 - reviewed twin studies. Mz concordance rate of 68%. Dz concordance rate of 31%, implies role of environmental factors on development of OCD. Also recognised not everyone in the family gets OCD so must be additional factors. Diathesis-Stress model.
Explanation: Neural
The key areas of the brain thought to be associated with OCD is the Orbitofrontal Cortex (OFC) and the Thalamus.
Thalamus' function includes checking, cleaning and safety behaviours. OFC is involved in decision making and worry about social and other behaviours.
Overactive thalamus would result in increased motivation for safety behaviours and would likely lead to an overactive OFC. This would result in increased anxiety and increased planning to avoid anxiety.
Worry Circuit - OFC sends 'worry' signal to thalamus, normally Caudate Nucleus suppresses these but if damaged the thalamus is alerted, thalamus confirms worry to OFC creating a circuit.
Treatment: Drug Therapy
Most common type of treatment for OCD, assumes there is a chemical imbalance in the brain so drugs can lower or increase levels of neurotransmitters in the brain.
If SSRIs don't work for the individual, other anti-anxiety medication or tricyclics could be used instead. (GABA)
SSRIs - increase serotonin levels in the brain by preventing re-absorption, this increases levels in the synapse and stimulate post-synaptic neuron.