Psychopathology - OCD

Question 1

What is the genetic explanation of OCD?

Answer 1

Genes come in different forms (alleles) these could be the main cause of OCD. OCD might be inherited hence sufferers may have a genetic vulnerability or genetic predisposition. Psychologists often use family or twin studies to investigate genetics. OCD has been classed as polygenic where many genes might be responsible, these are known as candidate genes

The COMT gene:
- The COMT gene causes OCD by regulating the production of the neurotransmitter dopamine where high levels are associated with OCD dopamine is responsible for drive, motivation and aggression. The COMT gene has been found to be more common in OCD patients.

The SERT gene (serotonin transport gene):
- This gene affects transportation of serotonin, therefore resulting in low levels of serotonin which produces low mood and depressive symptoms
- Individuals have the SERT gene on chromosome 17. A mutation in this gene may cause OCD.
- Ozaki (2003), found evidence that 6/7 family members who had OCD had a mutation in the SERT gene. This mutation, then causes low levels of serotonin to be produced. There seems to be a link with OCD and depression. Therefore OCD does seem to have a genetic basis.

Question 2

What are the strengths of the genetic explanations for OCD

Answer 2

• One strength of this model is that Nestadt (2000) supports the genetic explanation for OCD as he found that people who had a first-degree relative who already had OCD five times more likely to also get the illness. This supports the idea that OCD is transmitted genetically.
• Another strength of this model is that Billett (1998) supports the idea that OCD is transmitted genetically because he found from a meta analysis of 14 twin studies that OCD is 2x more likely to be concordant in identical monozygotic twins, rather than dizygotic nonidentical twins therefore supporting the idea that OCD is transmitted by genetics.

Question 3

Describe the research related to genetic explanation of OCD

Answer 3

• research was done by Beekman and Cath into genetics and OCD (2005)
• A meta analysis was conducted of twin studies and OCD
  – Monozygous twins were compared with dizygous twins
• The psychologists also examined studies whereby OCD patients had been diagnosed using DSM criteria
  – 10034 twin were studied overall and the results found that in children OCD is inherited via genes, and genetic influence ranges from 45 to 65%. Whereas in adults, OCD is inherited via genes, and the genetic influence ranges from 27 to 47%.
• The conclusion was that OCD is transmitted genetically, and this was more apparent when examining children rather than adults.

Question 4

What does ICD and DSM stand for?

Answer 4

• ICD: international classification of diseases is a classification system for all physical and mental disease is produced by the world health organisation (WHO)
• DSM: the diagnostic and statistical manual of mental disorders is the handbook used by healthcare professionals in the US and much of the world as the authoritative guide to the diagnosis of mental disorders

Question 5

Evaluate the research surrounding the genetic explanation for OCD (3p)

Answer 5

• by Beekman and Cath (2005)
• this research can be criticised because the majority of the twin studies were not performed in controlled conditions. Therefore the data is not very objective of scientific and this might affect the validity and reliability of the results gain from this research. We can question the idea that OCD is genetic.
• Another weakness of this research is that the gene mapping was not taken into consideration when looking at whether OCD is genetic. Gene mapping would have looked closely at the DNA of the twins that had OCD and would compare this with twins that did not have OCD, and this comparison would make the results more valid and robust.
• One strength of this research is that the amount of patients that were studied overall can provide a very comprehensive and complete statistic for genetic influence ranges as twins, children and adults were all studied.

Question 6

What is the neural explanation of OCD?

Answer 6

Dopamine:
- Dopamine is a neurotransmitter that affect the mood and might be a cause of OCD. The frontal lobes in the brain have been linked to dopamine activity.
- OCD sufferers have high levels of dopamine
- Research conducted on animals has found that high doses of drugs produce movements resembling compulsive behaviour similar to what OCD sufferers would experience
- Hi, dopamine levels have also been linked to overactivity in the basal ganglia area in the brain which controls motor functioning and learning.

Serotonin:
- Serotonin is a neurotransmitter affecting mood, and it might be the cause of OCD
- The frontal lobes in the brain have been linked to serotonin activity
- OCD sufferers tend to have low levels of serotonin, which can cause depressive like symptoms and obsessive thoughts. This is why many OCD sufferers are depressed.
- Serotonin plays a key role in operating the caudate nucleus in the brain, and it seems low levels of serotonin can cause this to malfunction.

Question 7

Where are the frontal lobes located. What are they responsible for?

Answer 7

• located in the brain right at the front
• responsible for higher cognitive functions like memory, emotions, impulse control, problem solving, and motor function

Question 8

Where is the caudate nucleus located? What function does it perform?

Answer 8

• located deep inside the brain near the thalamus
• responsible for: learning, memory, reward, motivation, movement

Question 9

Give the strengths of the neural explanation of ocd (dopamine/serotonin)

Answer 9

• One advantage of this theory is that there has been a lot of research support to stage that neurotransmitters do cause OCD. Anti-depressant drugs, increase serotonin levels in OCD patients which leads to a reduction in symptoms. Therefore evidence suggests low levels of serotonin cause OCD.
• An advantage is that research conducted by Ciccerone (2000) supports the neural explanation because by giving OCD patients low doses of the drug Risperidone dopamine levels were lowered, and some symptoms of OCD were alleviated. Hence, high levels of dopamine could be a cause of OCD.
• A strength; Menzies (2007) produced evidence that supported genetic link to abnormal levels of neurotransmitters. MRI scans were studied in OCD patience and immediate family members these within compared to healthy controls. OCD patients plus family had reduced grey matter in here regions of the brain and had unusual neuroanatomy. Hence, OCD could be caused by abnormal brain structure, inherited via genes

Question 10

Describe the study which supports the neural explanation of ocd. (Neuroanatomy by Jenike and Rauch)

Answer 10

(Neuroanatomy by Jenike and Rauch)

• There may be a relationship between OCD, been caused by some type of brain damage possibly caused by a virus. Brain damage may cause short-term memory, leading to person doubting whether they have performed an action. This is a sypmptom of OCD resulting in repetitive behaviour (compulsions) like checking the door is locked.
• OCD patients were studied using PET scans (position emission tomography). They were shown an image of something dirty. If they had a cleaning obsession, evidence found frontal lobes, and basal ganglia were most active compared to non-OCD sufferers
• Basal ganglia seems to malfunction in OCD sufferers: a series of interconnected brain structures that are at the front of the brain near the orbital frontal cortex, which also seems to be overactive in OCD patients. Basal ganglia is responsible for control of voluntary motor movements, procedural, learning, habit, learning, eye movements, cognition, emotion. Hence, an overactive basal ganglia can lead to repetitive motor functions
• Patient who have Tourette’s syndrome also seem to suffer with overactive basal ganglia
• Further research shows that OCD sufferers may have damage to the frontal cortex of the brain which is involved in selecting, controlling and inhibiting behaviour, which OCD patients struggle with

Question 11

What is a PET scan? How does it work?

Answer 11

Positron emission tomography (PET) scans produce detailed 3D images of inside the body. You usually ingest a radiotracer and this travels around the body. It will be later detected by the scanner and will help to highlight areas

Question 12

What is Tourette’s syndrome?

Answer 12

This is a condition of the nervous system causing people to have “tics” and these can be movements gestures or sounds. They may repeat these and have no control over them

Question 13

Evaluate the neural explanations of ocd in relation to virus/brain

Answer 13

• One problem with this neural explanation is cause-and-effect
• A strength of this neural explanation is that it uses PET scanning
• The strength is that the psychologist Rapaport (1990), found supporting evidence about neural cases of OCD. An epidermic occurring in Europe between 19 16–1918 called “the Great sleeping sickness. “this was a widespread viral brain infection and it was found that after this epidemic there was a major rise in the number of OCD cases reported maybe because the viral infection cause damage or brain abnormality, which contributed to the development of OCD.
• One weakness of this research is that it was conducted a very long time ago and therefore may not have temporal validity and the validity of the findings can also be questioned because it is uncertain whether scientific methods were used

Question 14

What is the biological approach to treating OCD? What are the two types of drugs used?

Answer 14

Drug therapy:
- taking antidepressants, for example, SSRI drugs (selective serotonin, reuptake, inhibitors) Some examples of these would be Prozac and fluoxetine.
- Benzodiazepines are also used. Examples would be Valium and Xanax.

Question 15

Explain in detail SSRI drugs

Answer 15

• Low levels of serotonin are associated with OCD and depression. Therefore, these drugs into prevent the re-uptake of serotonin and prolong its activity in the synapse mean in the person will feel less anxious and have higher level of serotonin available.
• Low levels of serotonin are implicated in the “worry circuit “whereby damage to caudate nucleus in brain fails to suppress minor worry signals. A message is sent to the orbital, frontal, cortex and worrying and anxiety get worse.
• Hence drugs given to OCD patients will increase serotonin levels and help regulate mood and reduce anxiety levels, the worry circuit will also be normalised and reduced, high levels of serotonin provided by SSRI drugs, help orbitofrontal cortex to function at normal levels
• SSRI, drugs, help, stabilise moods and emotions, plus improve memory, which would help produce compulsive behaviour and checking

Question 16

Define:
Synapse
Orbital front cortex

Answer 16

• synapse: point of contact between neurons were information is passed from one neurone to the next
• Orbital frontal cortex: region of the brain, which receives olfactory information and processes this into rewards/punishment

Question 17

Give the strengths of SSRI

Answer 17

• advantage: There is evidence that SSRI’s are effective treatment for OCD. Soomro (2009) reviewed 17 studies comparing SSRI’s to placebo drugs for treating OCD and found that all 17 studies showed that SSRI drugs were more effective than placebos, especially when combined with CBT
• advantage: SSRI drugs are relatively effective and 70% of patients have experienced a decline in OCD symptoms when taking them. However, remaining 30% of patients tend to opt for psychological therapies or a combination of SSRI’s and psychological therapies for treating their OCD, which meant that maybe SSRI drugs are most effective if combined with other treatments too? (+) (-)

3) SSRI’s have the benefit of being relatively cheap and cost effective in comparison to psychological therapies, such as CBT, counselling or family therapy. Using SSRI drugs to treat OCD is good value for money for the NHS, and is economical compared to other treatments (+)

Question 18

Explain in detail Benzodiazepines

Answer 18

• reduce anxiety, and aim to control the action of neurotransmitters
• Reduce activity in central nervous system and reduce brain arousal
• Reducing blood pressure and heart rate, aims to increase GABA ( gamma-amino, butyric acid) which is a neurotransmitter in the brain, which slows down firing of neurons and makes the person less anxious and more calm. It also helps to reduce physiological activity in the body
  -BZ drugs find to the GABA receptor site of the postsynaptic neuron, which increases the flow of chloride ions into the postsynaptic neuron, which makes it more difficult for the neuron to be stimulated by other neurotransmitters, and slows down its activity, making the person feel more relaxed
• Neurons in the brain become less active, and the person feels calmer
• BZ helps to reduce anxiety that an OCD patient experience and also decreases serotonin levels in the brain, which means lower arousal and reduced anxiety, but also less happiness and higher likeliness to become depressed

Question 19

What is the central nervous system made up of?

Answer 19

The brain and spinal cord

Question 20

What is a post synaptic neuron?

Answer 20

The part of the nerve cell which receives impulses

Question 21

Give the strengths of Benzodiazepines

Answer 21

• strength: very effective at reducing anxiety and OCD symptoms. Used by millions of people worldwide, so very good at reducing anxiety and OCD on a global basis
• strength: work very quickly and effectively to cure OCD symptoms compared to other psychological treatments (e.g CBT). BZ drugs can begin to reduce anxiety levels and OCD symptoms in a short period of time so that the patient will see some immediate benefits of relief.
• strength: can be used for short periods of time and will produce hardly any real serious side effects unlike other types of drugs. Therefore side effects are kept to a minimum with BZ (in the short term) and this is a good point for the OCD patient

Question 22

What 3 key factors may influence dosage of drugs when treating OCD biologically?

Answer 22

Weight, severity of illness, other medication

Question 23

What are the cognitive characteristics of ocd?

Answer 23

• Obsessions: recurrent, intrusive thoughts or impulses that are perceived as inappropriate or forbidden. May be frightening or embarrassing and the person might not want to share them with others. Common obsessions or themes include ideas, doubts (have they checked the cooker is switched off?) impulses (to shout and swear in public) or images (sexual). These thoughts, impulses and images are not excessive worries about everyday problems; instead they are uncontrollable and cause anxiety. The person will realise that their obsessions are unreasonable. Obsessions are internal (because they are thoughts that occur internally inside the mind)
• Recognised as self generated: Most sufferers understand that their obsessional thoughts, impulses and images are self invented and are not inserted externally by others
• Realisation of inappropriateness: Most sufferers understand their obsessive thought and compulsive behaviours are inappropriate and irrational, but they cannot consciously control or stop them.
• Attention bias: Perception tends to be focused on anxiety generating stimuli. For instance a piece of dust on a table that has just been cleaned. They tend to be hyper vigilant and tend to look for things that will justify their high anxiety levels.

Question 24

What are the behavioural characteristics of ocd?

Answer 24

• Compulsive behaviours: performed to reduce the anxiety created by obsessions. They are repetitive and unconcealed, such as hand washing or checking things. This could include mental acts such as praying or counting. Patients feel they must perform these actions otherwise something dreadful might happen, and this creates anxiety. Some patients experience compulsions without obsessions, such as they compulsively avoid certain objects such as the cracks in the pavement. The behaviours are external components that can be seen by others.
• Hinder everyday functioning: Having obsessive or forbidden/inappropriate ideas creates a great deal of anxiety. This could then lead to compulsions and repetitive behaviour (washing hands over and over again so the person is very late for work) that can seriously hinder the ability to perform everyday functions, for example the person might not be able to have a job and work effectively.
• Social impairment: The anxiety levels created by the obsessions, and the performance of repetitive, compulsive behaviour might become so high that the person might not be able to conduct meaningful interpersonal relationships
• Repetitive: Sufferers feel compelled to repeat behaviours over and over again as a response to their obsessive thoughts, ideas and images. For example they might have obsessions about dirt and feel compelled to wash their hands over and over again
• Avoidance: Some OCD sufferers attempt to reduce their anxiety by avoiding situations that might trigger it. Sufferers who wash their hands continuously might avoid coming into contact with germs, so they might never empty their bins which can lead to further problems.

Question 25

What are the emotional characteristics of ocd?

Answer 25

• Anxiety and distress: The obsessions and compulsions are a source of considerable anxiety and distress. Sufferers are aware that their obsessions and compulsive behaviour are excessive and this causes feelings of embarrassment and shame. Sufferers might also be aware that they cannot consciously control their compulsive behaviours which leads to strong feelings of distress.
• Accompanying depression: Anxiety might be accompanied by low mood and a lack of enjoyment of activities. Compulsive behaviour tends to bring some relief from anxiety, but this is temporary.
• Guilt and disgust: OCD sometimes involves other negative emotions such as irrational guilt over minor issues, or disgust which may be directed against something external like dirt or the self.

Question 26

What does the biological approach to explaining OCD assume?

Answer 26

It assumes that OCD is caused by genetics and neural explanations such as neurotransmitters and abnormal brain circuits

Question 27

What are the weaknesses of the genetic explanations for OCD

Answer 27

• One weakness of this explanation is that the concordance rate for OCD is not 100% therefore OCD cannot be caused entirely by genetic factors. The genetic explanation fails to take into account psychological and environmental factors which might contribute
• another weakness is OCD is poly genic and one single gene is not responsible. OCD has been genetically linked to other illnesses such as Tourette’s syndrome and autism. Therefore it seems that the genetic cause of ocd is very complex and might be related to other illnesses too, it could be that one specific gene is not responsible, but it is rather a predisposing factor.
• Another criticism of this explanation is that the two process model would suggest that OCD can be learnt by classical conditioning and then rewarded through operant conditioning (reinforcement). The behavioural approach has gained a great deal of support in explaining the cause of OCD, especially when treated using behavioural therapy such as exposure (similar to SD)
• The last criticism would be that the diathesis stress model would argue that OCD can be caused by a combination of genes and a trigger in environment (stress) therefore, genes alone cannot be the only cause of OCD. They need to be combined with other factors for this disorder to develop the model would weaken the genetic argument.

Question 28

Give the weaknesses of the neural explanation of ocd (dopamine/serotonin)

Answer 28

• A disadvantage is that neurotransmitters (dopamine/serotonin) may not cause OCD because low levels of serotonin/high levels of dopamine might be an affect of OCD, therefore we need to be careful when looking at cause and affect

-A disadvantage is that OCD is co morbid with depression (exists alongside depression). Therefore, it’s not clear whether low levels of serotonin cause OCD or depression or both. Therefore the link between low levels of serotonin causing OCD is not clear and needs further investigation.

• Disadvantage: dopamine is role in causing OCD has been questioned because high levels of dopamine can cause other psychological illness as well e.g. bipolar depression/schizophrenia. Therefore, not enough research evidence to suggest high levels of dopamine causes OCD. Perhaps it is caused by a combination of factors.

Question 29

Give some weaknesses of SSRI

Answer 29

5) A problem with SSRI drugs is that they have terrible side effects which might mean that the OCD patient might stop taking the medication. Side effects are temporary but include indigestion, blurred vision and loss of sex drive. (-)

4) SSRI’s can be criticised because they do not work for all OCD patients. For some patients SSRI drugs will not alleviate their OCD symptoms and they will have to take an alternative drug such as tricyclics instead which might be more effective for them (-)

6) Koran (2007) has criticised the use of drugs and medication to help relieve OCD symptoms. Koran stated that drug therapy might be a common or popular treatment, but psychotherapies such as CBT should be tried first to help reduce OCD symptoms. Drug therapy requires little effort and may be effective short term, but it does not provide a lasting cure for OCD, and many patients relapse within a few weeks if the medication is stopped. (-)

Question 30

Give the weaknesses of Benzodiazepines

Answer 30

• weakness: if they are used long term then several unwanted side effects can begin to appear, examples include drowsiness, depression and unpredictable interactions with alcohol. Patients have a high chance of being involved in accidents. Therefore BZ drugs should not be used as a long term treatment for OCD
• weakness: Ashton (1997) found long term users of BZ became very dependent on the drug and a sudden withdrawal of the drug leads to a return of high levels of anxiety and OCD symptoms. There is also the problem of tolerance or drug escalation whereby patients need to take very large doses of the drug in order to reduce their OCD symptoms (if they take the drug for a long period of time).
• weakness: Stewart (2005) criticised long term use of BZ drugs as they cause impairment in speed and processing of verbal learning. These effects are temporary but are still negative. Stewart carried out a Meta analysis and found clear evidence that long term use of BZ leads to cognitive impairments. Cognitive ability seems to improve once the BZ drugs are withdrawn, but the cognitive ability is still below that of control patients who have never taken BZ.

Question 31

What are the biological explanations of ocd?

Answer 31

• the genetic causes : the COMT / SERT gene
• the neural causes : dopamine / serotonin
• the neural causes : neuroanatomy