OCD treatment & management

Question 1

biological treatments

Answer 1

tricyclics
SSRIs
SSRIs augmented w:
antipsychotics
serotonin antagonists

Question 2

tricyclics

Answer 2

increase serotonin dopamine and noradrenaline

rapoport charles used clomipramine
after 12 months built tolerance so not working

Question 3

SSRIs

Answer 3

increase serotonin in synapse by blocking presynaptic transporter molecules

synaptic serotonin is immediately increased but improveemnt in symptoms not observed for some time

suggests that improvements is bc downregulation
> brain compensates for more serot by reducing amount released from presynaptic cell

due to interactions between diff brain chemicals its also possible that serot levels regulate release of other neurochemicals
which reduce symptoms

Question 4

SSRIs w antipsychotics

Answer 4

enhance effects of SSRIs
if treatemtn resistant b4

risperidone > atypical antipsychotic

clincally effective, reduce Y-BOCS score of 35% in 72% of ps selvi et al 2011

Question 5

SSRIs w serotonin antagonists

Answer 5

paradoxical???
SSRI and granisteron a serot antagonist > blocks serot receptors
100% success rate askari et al 2012
all ps improved by 35% on YBOCS and 90% no symptoms after 2 months

bio treatments can be slayful w correct combos and measures taken place to help w side effects

Question 6

bio treatment STRENGTH

Answer 6

supported by research, applications

not j placebo effect
meta analysis of 17 RCTs issari et al 2016 found improevemtn w treatment than placebo
relief diminish over time but moderated by higher doses

SSRIs cheap and low effort
swift relief for people w OCD

Question 7

bio treatment weakness

Answer 7

non compliance

unpleasant side effects in initial weeks and longer

constipation diarrhoea nausea vom headaches dizzy anxiety insomnia

psych therapies may be better if severe side effects and cannot cope bc make feel more out of control

Question 8

individual and situational explanations

Answer 8

weakness of bio treatment is that 60% no improvement mcdougle et al 1993
following standard drug treatment
those w relief only 20-30% pigott and seay 1999

polygenic nature means over time meds may become personalised
doctors can decode what genes influencing symptoms and tailor treatments

BUT even sitch factors needed w bio treatment
> quality of therapeutic alliance impacts effectiveness of treatment

Question 9

psych therapies

Answer 9

exposure and response prevention
CBT

Question 10

exposure and response prevention

Answer 10

type of CBT used specifically w OCD

exposure makes it similar to SD used for phobias

Question 11

diff between ERP and SD

Answer 11

identify obsessional thoughts that trigger compulsive behaviours
identify environmental triggers that cue these thoughts
cues given subjective units of distress scale SUDS ratings like in chapman and delapp 2013

triggering situations are arranged into a hierarchy from the lowest to highest SUDS rating and at this point client and therapist embark on first exposure

Question 12

effectiveness

Answer 12

if exposures last long enough for person to habituate to the stimulus
meaning arousal levels reduce to the point where the person is not anxious

assessment done by asking person to report SUDS rating
w exposure ending when SUDS reduced by 50%

prevent ps from carrying out maladaptive behaviours
learn anxiety can and will reduce
work on exposures many times until situation is given SUDS rating 0
ERP therapists like all CBT encourage to practice everyday hw keep record and share progress in next session

no training in relaxation strats
no use anti anxiety meds b4
advised to avoid safety behaviours like touching objects w fingertips rather than touching stuff like doorknobs or taps w whole hand

Question 13

ERP strength

Answer 13

more effective than drug treatments like clomipramine

double blind RCT placebo trial foa et al 2005 86% achieved reduction
only 48% in clomi grp

credible alternative thats tolerated better and more effective

Question 14

ERP practical applications STRENGTH

Answer 14

lemkuhl et al and lovell et al

Question 15

ERP weakness accessibility

Answer 15

difficult for inexperienced therapists to deliver

gilihan et al 2012
7 pitfalls of erp efficacy
less experienced therapists must be supervised by experienced
increases wait time

Question 16

ERP weakness core fear

Answer 16

compulsions replaced until core fear underlying found

gilihan et al 2012 religious person thoughts of 666 trigger bc devil

rituals to neutralise

ERP may help unless core fear revealed like fear of going to hell the person will j get new compulsions