P: Biological approach to treating OCD

Question 1

GABA

(gamma-aminobutyric acid)

Answer 1

Neurotransmitter that regulates excitement in the nervous system, thus acting as a natural form of anxiety reducer.

Question 2

Noradrenaline

Answer 2

Neurotransmitter found mainly in areas of the brain that are involved in governing autonomic nervous system activity, eg. blood pressure or heart rate.

Question 3

Serotonin

Answer 3

Neurotransmitter implicated in many different behaviours and physiological processes, including aggression, eating behaviour, sleep and depression.

Question 4

What is the most commonly used treatment for OCD, according to Gava 2007?

Answer 4

Drug therapy.

Question 5

Neurotransmitter that regulates excitement in the nervous system, thus acting as a natural form of anxiety reducer.

Answer 5

GABA

(gamma-aminobutyric acid)

Question 6

Neurotransmitter found mainly in areas of the brain that are involved in governing autonomic nervous system activity, eg. blood pressure or heart rate.

Answer 6

Noradrenaline

Question 7

Neurotransmitter implicated in many different behaviours and physiological processes, including aggression, eating behaviour, sleep and depression.

Answer 7

Serotonin

Question 8

What are the types of drug therapies for OCD?

Answer 8

• SSRIs (antidepressants)
• Tricyclics (antidepressants)
• Anti-anxiety drugs
• D-Cycloserine

Question 9

What are the most commonly used drugs for treating OCD?

What is the main purpose of these?

Answer 9

Antidepressants

To reduce the anxiety associated with OCD

Question 10

What is associated with both OCD and depression?

What does this mean in terms of treatment?

Answer 10

Low levels of serotonin

Means that drugs used to increase levels of serotonin are used with both mental disorders.

Question 11

In OCD, what are low levels of serotonin implicated with?

Answer 11

The ‘worry circuit’ - so increasing levels of serotonin may normalise this circuit.

Question 12

SSRIs

Answer 12

Selective serotonin re-uptake inhibitors.

Preferred drug for treating anxiety disorders.

Question 13

What is the role of SSRIs?

Answer 13

Increase levels of the neurotransmitter serotonin, which regulates mood and anxiety.

Question 14

How do SSRIs work?

Answer 14

• Serotonin released into synapse from one nerve (neuron).
• Targets receptor cells on receiving neuron at receptor sites.
• Without SSRIs, serotonin is then re-absorbed by intial neuron sending the message.
• SSRIs block the re-uptake of serotonin at pre-synaptic membrane, increasing serotonin concentratiopn at receptor sites on the post-synaptic membrane - this increases stimulation there.

Question 15

What was the first antidepressant to be used for OCD?

Answer 15

Tricyclic clomipramine.

Question 16

Tricyclic clomipramine

Answer 16

First antidepressant used for OCD.

Today is primarily used in the treatment of OCD rather than depression.

Question 17

What do tricyclics do?

What is a result of this?

Answer 17

Block the transporter mechanism that reabsorbs both serotonin and noradrenaline into the pre-synaptic cell after it has fired.

More neurotransmitters are left in the synapse, prolonging their activity and easing transmission of the next impulse.

Question 18

Briefly compare tricyclics to SSRIs:

Answer 18

• Tricyclics can target more than one neurotransmitter - this is good.
• Tricylics have greater side effects so are used as a second-line treatment for patients where SSRIs are not effective.

Question 19

Give an example of an anti-anxiety drug:

Answer 19

Benzodiazepines (BZs)

Question 20

What do BZs do?

Answer 20

Slow down the activity of the central nervous system by enhancing the activity of the neurotransmitter GABA.

Question 21

What is the general effect of GABA?

Answer 21

Quietening effect on many neurons in the brain.

Question 22

How does GABA quieten the neurons of the brain?

Answer 22

• GABA is released from one neuron into synaptic gap.
• Locks onto GABA receptors on the ends of receiving neurons at synapse.
• This opens a channel that increases the flow of chloride ions into the neuron.
• Chloride ions make it harder for neuron to be stimulated by other neurotransmitters.
• So, the activity in the brain is slowed down and a person feels more relaxed.

Question 23

What do chloride ions do to neurons?

Answer 23

Make it harder for them to be stimulated by other neurotransmitters, thus slowing down brain activity and making the person feel more relaxed.

Question 24

What other drugs may be suitable for treating OCD?

Why?

Answer 24

D-Cycloserine

It has an effect on reducing anxiety and may be useful used in conjuntion with psychotherapy.

Question 25

What is D-Cycloserine? ## Footnote *What does it appear to effect?*

Answer 25

An antibiotic used in the treatment of tuberculosis. ## Footnote *Appears to enhance the transmission of GABA and thus reduce anxiety.*

Question 26

Write a PEEL paragraph discussing **the economical benefits of drug therapies** for OCD:

Answer 26

**P -** Economical advantages and more accessible for all patients. **E -** Drug therapy requires littel input from patients in terms of time and effort, whereas CBT requires the pateint to attend regular meetings and put considerable thought into tackling problems. **E -** Also a lot cheaper for the health service because they require little monitoring and cost much less than psychological treatments. **L -** Drug therapies are more economical for the health service than psychological therapies.

Question 27

Write a PEEL paragraph discussing the **side effects of drug therapies** for OCD.

Answer 27

**P -** Limitation is side effects - some drugs have more servere ones than others. **E -** For SSRIs, this is nausea, headaches and insomnia. These are often enough to make patient stop taking the drug. **E -** Tricylcic antidepressants have more severe ones - hallucinations and irregular heartbeat - so can only be used when SSRIs are not effective. **E -** For BZs, side effects include increased aggression and long-term impairment of memory. Also possibility of addiction - so can only be used for 4 weeks maximum. **L -** Limits the usefulness of drug treatments for OCD.

Question 28

What are the side effects of SSRIs?

Answer 28

Tend to be mild - nausea, headaches and insomnia. ## Footnote *But these are often enough to stop patient taking the drug.*

Question 29

What are the side effects of tricyclic antidepressants?

Answer 29

More severe than SSRIs - hallucinations and irregular heartbeat. ## Footnote *So can only be used if SSRIs have been tried and haven't worked.*

Question 30

What are the side effects of BZs?

Answer 30

Increased aggressiveness and long-term impairment of memory. ## Footnote *Possibility of addiction - so can only be used for a maximum of 4 weeks.*

Question 31

Write a PEEL paragraph about how **drug therapies are not a lasting cure** for OCD:

Answer 31

**P -** Not a lasting cure for OCD **E -** 2001 study found that patients relapse within a few weeks if medication is stopped. **E -** 2007 review of treatments for OCD sponsored by APA suggested that, although drug therapy may be more commonly used, psychotherapies such as CBT should be tried first. **L -** While drug therapies may require little effort and also may be relatively effective in short term, it does not provide a lasting cure for OCD.

Question 32

What is the APA?

Answer 32

American Psychiatric Association.

Question 33

What are the discussion points for the biological approach to treating OCD?

Answer 33

* Economical benefits * Side effects * Not a lasting cure

Question 34

Give an example of an SSRI:

Answer 34

Prozac

Question 35

Give an example of a tricyclic:

Answer 35

Anafranil

Question 36

Give an example of a benzodiazepine:

Answer 36

Xanax