4.5: The biological approach to treating OCD Flashcards by Young Dave

Biological treatments are based on the idea of correcting the biological abnormalities seen as causing OCD.
Drugs are the most common form of biological therapy, but what is also occasionally used as a treatment?

Drugs are the most common form of biological therapy
,but
Psychosurgery is also occasionally used as a treatment

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Drug therapy

Drug therapy is treatment involving drugs - chemicals that have a particular effect on:
1. The functioning of the brain
Or,
2. Some other body system

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Drug therapy is treatment involving drugs - chemicals that have a particular effect on the functioning of the brain or some other body system.
In the case of psychological disorders, what do such drugs usually do?

In the case of psychological disorders, such drugs usually affect neurotransmitter levels

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Antidepressants are used to treat OCD, such as what?

Antidepressants are used to treat OCD, such as SSRIs

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Antidepressants are used to treat OCD, such as SSRIs, which do what?

Antidepressants are used to treat OCD, such as SSRIs, which:

Elevate levels of serotonin
Cause the orbital frontal cortex to function at more normal levels

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Antidepressants are used to treat OCD, such as SSRIs, which elevate levels of serotonin and cause the orbital frontal cortex to function at more normal levels.
What is the most common SSRI used with adults?

The most common SSRI used with adults is fluoxetine (Prozac)

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For children aged 6 years, sertraline is usually prescribed

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For children aged 8 years and older, fluvoxamine is usually prescribed

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Treatment usually lasts for between:
1. 12
2. 16
weeks

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Antidepressants are used to treat OCD, such as SSRIs, which elevate levels of serotonin and cause the orbital frontal cortex to function at more normal levels.
The most common SSRI used with adults is fluoxetine (Prozac).
For children aged 6 years, sertraline is usually prescribed.
For children aged 8 years and older, fluvoxamine is usually prescribed.
Treatment usually lasts for between 12 and 16 weeks.
What are also used due to their anxiety-lowering properties?

Anxiolytic drugs are also used due to their anxiety-lowering properties

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Antidepressants are used to treat OCD, such as SSRIs, which elevate levels of serotonin and cause the orbital frontal cortex to function at more normal levels.
The most common SSRI used with adults is fluoxetine (Prozac).
For children aged 6 years, sertraline is usually prescribed.
For children aged 8 years and older, fluvoxamine is usually prescribed.
Treatment usually lasts for between 12 and 16 weeks.
Anxiolytic drugs are also used due to their anxiety-lowering properties.
What have also proven useful in treating OCD?

Antipsychotic drugs that have a dopamine lowering effect have also proven useful in treating OCD

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Antidepressants are used to treat OCD, such as SSRIs, which elevate levels of serotonin and cause the orbital frontal cortex to function at more normal levels.
The most common SSRI used with adults is fluoxetine (Prozac).
For children aged 6 years, sertraline is usually prescribed.
For children aged 8 years and older, fluvoxamine is usually prescribed.
Treatment usually lasts for between 12 and 16 weeks.
Anxiolytic drugs are also used due to their anxiety-lowering properties.
Antipsychotic drugs that have a dopamine lowering effect have also proven useful in treating OCD, but when are they only generally given?

Antipsychotic drugs that have a dopamine lowering effect have also proven useful in treating OCD, but they are only generally given when treatment when SSRIs:
1. Hasn’t proved effective
Or,
2. Incurs serious side effects

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What do SSRIs stand for?

SSRIs stand for selective serotonin reuptake inhibitor

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SSRIs stand for selective serotonin reuptake inhibitor - they are a what type of antidepressant drug?

SSRIs stand for selective serotonin reuptake inhibitor - they are a specific type of antidepressant drug

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SSRIs stand for selective serotonin reuptake inhibitor - they are a specific type of antidepressant drug.
What do SSRIs work on?

SSRIs work on the serotonin system in the brain

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SSRIs stand for selective serotonin reuptake inhibitor - they are a specific type of antidepressant drug.
SSRIs work on the serotonin system in the brain.
How is serotonin released?

Serotonin is released by certain neurons in the brain

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Serotonin is released by certain neurons in the brain, by the presynaptic neurons

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Serotonin:

Is released by certain neurons in the brain, by the presynaptic neurons
Travels across a synapse

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The neurotransmitter chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron

The neurotransmitter chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron and then it is reabsorbed by the presynaptic neuron

The neurotransmitter chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron and then it is reabsorbed by the presynaptic neuron, where it is:

Broken down
Re-used

By preventing the re-absorption and breakdown of serotonin, SSRIs effectively:

Increase its levels in the synapse
Therefore continue to stimulate the postsynaptic neuron

This compensates for whatever is wrong with the serotonin system in OCD

SSRIs stand for selective serotonin reuptake inhibitor - they are a specific type of antidepressant drug.
SSRIs work on the serotonin system in the brain.
Serotonin is released by certain neurons in the brain, by the presynaptic neurons and travels across a synapse.
The neurotransmitter chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron and then it is reabsorbed by the presynaptic neuron, where it is broken down and re-used.
By preventing the re-absorption and breakdown of serotonin, SSRIs effectively increase its levels in the synapse and therefore continue to stimulate the postsynaptic neuron.
This compensates for whatever is wrong with the serotonin system in OCD.
What vary according to which SSRI is prescribed?

Dosage
Other advice
vary according to which SSRI is prescribed

SSRIs stand for selective serotonin reuptake inhibitor - they are a specific type of antidepressant drug. SSRIs work on the serotonin system in the brain. Serotonin is released by certain neurons in the brain, by the presynaptic neurons and travels across a synapse. The neurotransmitter chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron and then it is reabsorbed by the presynaptic neuron, where it is broken down and re-used. By preventing the re-absorption and breakdown of serotonin, SSRIs effectively increase its levels in the synapse and therefore continue to stimulate the postsynaptic neuron. This compensates for whatever is wrong with the serotonin system in OCD. Dosage and other advice vary according to which SSRI is prescribed. What is a typical daily dose of fluoxetine?

A typical daily dose of fluoxetine is 20mg

SSRIs stand for selective serotonin reuptake inhibitor - they are a specific type of antidepressant drug. SSRIs work on the serotonin system in the brain. Serotonin is released by certain neurons in the brain, by the presynaptic neurons and travels across a synapse. The neurotransmitter chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron and then it is reabsorbed by the presynaptic neuron, where it is broken down and re-used. By preventing the re-absorption and breakdown of serotonin, SSRIs effectively increase its levels in the synapse and therefore continue to stimulate the postsynaptic neuron. This compensates for whatever is wrong with the serotonin system in OCD. Dosage and other advice vary according to which SSRI is prescribed. A typical daily dose of fluoxetine is 20mg, but this may be increased, why?

A typical daily dose of fluoxetine is 20mg, but this may be increased, if it is not benefitting the patient

SSRIs stand for selective serotonin reuptake inhibitor - they are a specific type of antidepressant drug. SSRIs work on the serotonin system in the brain. Serotonin is released by certain neurons in the brain, by the presynaptic neurons and travels across a synapse. The neurotransmitter chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron and then it is reabsorbed by the presynaptic neuron, where it is broken down and re-used. By preventing the re-absorption and breakdown of serotonin, SSRIs effectively increase its levels in the synapse and therefore continue to stimulate the postsynaptic neuron. This compensates for whatever is wrong with the serotonin system in OCD. Dosage and other advice vary according to which SSRI is prescribed. A typical daily dose of fluoxetine is 20mg, but this may be increased, if it is not benefitting the patient. How is the drug available?

The drug is available as: 1. Capsules Or, 2. Liquid

SSRIs stand for selective serotonin reuptake inhibitor - they are a specific type of antidepressant drug. SSRIs work on the serotonin system in the brain. Serotonin is released by certain neurons in the brain, by the presynaptic neurons and travels across a synapse. The neurotransmitter chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron and then it is reabsorbed by the presynaptic neuron, where it is broken down and re-used. By preventing the re-absorption and breakdown of serotonin, SSRIs effectively increase its levels in the synapse and therefore continue to stimulate the postsynaptic neuron. This compensates for whatever is wrong with the serotonin system in OCD. Dosage and other advice vary according to which SSRI is prescribed. A typical daily dose of fluoxetine is 20mg, but this may be increased, if it is not benefitting the patient. The drug is available as capsules or liquid. It takes how long of daily use for SSRIs to have much impact on symptoms?

``` It takes: 1. 3 to 2. 4 months of daily use for SSRIs to have much impact on symptoms ```

Drugs are often used alongside cognitive behaviour therapy (CBT) to treat OCD. What do the drugs reduce?

The drugs reduce a patient's emotional symptoms

Drugs are often used alongside cognitive behaviour therapy (CBT) to treat OCD. The drugs reduce a patient's emotional symptoms, for example what?

The drugs reduce a patient's emotional symptoms, for example, feeling: 1. Anxious Or, 2. Depressed

Drugs are often used alongside cognitive behaviour therapy (CBT) to treat OCD. The drugs reduce a patient's emotional symptoms, for example, feeling anxious or depressed. What does this mean?

This means that patients can then engage more effectively with the CBT

In practice: 1. Some people respond best to CBT alone ,while 2. Other people benefit more from drugs like fluoxetine

Drugs are often used alongside cognitive behaviour therapy (CBT) to treat OCD. The drugs reduce a patient's emotional symptoms, for example, feeling anxious or depressed. This means that patients can then engage more effectively with the CBT. In practice, some people respond best to CBT alone, while other people benefit more from drugs like fluoxetine. Occasionally, what?

Occasionally, other drugs are prescribed, alongside SSRIs

Alternatives to SSRIs: | Where an SSRI is not effective after 3 to 4 months, what?

Where an SSRI is not effective after 3 to 4 months: 1. The dose can be increased (for example, up to 60mg a day for fluoxetine) Or, 2. It can be combined with other drugs

Sometimes, different antidepressants are tried

Patients respond very differently to different drugs

Tricyclics are an older type of antidepressant

Tricyclics are sometimes used, such as clomipramine

These have the same effect on the serotonin system as SSRIs

Clomipramine is generally kept in reserve for patients who do not respond to SSRIs, because it has more severe side effects than SSRIs

Alternatives to SSRIs: Where an SSRI is not effective after 3 to 4 months, the dose can be increased (for example, up to 60mg a day for fluoxetine) or it can be combined with other drugs. Sometimes, different antidepressants are tried. Patients respond very differently to different drugs and alternatives work well for some people and not at all for others. Tricyclics are an older type of antidepressant. Tricyclics are sometimes used, such as clomipramine. These have the same effect on the serotonin system as SSRIs. Clomipramine is generally kept in reserve for patients who do not respond to SSRIs, because it has more severe side effects than SSRIs. What do SNRIs stand for?

SNRIs stand for serotonin-noradrenaline reuptake inhibitors

In the last 5 years, a different class of antidepressant drugs called SNRIs has also been used to treat OCD

These are, like clomipramine, a second line of defence for patients who don't responde to SSRIs

SNRIs increase the: 1. Levels of serotonin ,as well as 2. Another different neurotransmitter - noradrenaline

Low levels of serotonin are associated with both obsessions and compulsions, so what do OCD drug treatments mainly target (select)?

Low levels of serotonin are associated with both obsessions and compulsions, so OCD drug treatments mainly target (select) the serotonin re-uptake system

Drug therapy research: Pigott and Seay (1999) reviewed studies testing the effectiveness of drug therapies, finding SSRIs to be consistently effective in reducing OCD symptoms. While the tricyclic antidepressant drug clomipramine proved slightly more effective, it had more serious side effects. This suggests that SSRIs should be given as a first attempt drug treatment and clomipramine should only be used when SSRIs have not proven effective. Ciccerone et al. (2000) investigated the effect of low doses of the antipsychotic drug risperidone in treating OCD, finding treatment effective due to the drug's dopamine lowering effect. Julien (2007) reported that studies of SSRIs show that although symptoms do not fully disappear, between 50% and 80% of OCD patients improve, allowing them to live a fairly normal lifestyle, which they wouldn't be able to do without the treatment. Soomro et al. (2008) reviewed 17 studies of SSRIs vs placebo treatments involving 3,000 patients and found SSRIs to be moderately effective in the short term in treating OCD of varying duration in adults, lending a degree of support to the treatment.

Drug therapy evaluation: For: 1. Generally, drugs don't 'cure' OCD, but reduce obsessive thoughts and compulsive behaviour to such a level that a more normal lifestyle can be achieved. 2. Drug treatments are widely used to treat the symptoms of OCD, as they are relatively cheap, don't require a therapist to administer them and are a user-friendly form of treatment, as people are used to taking medicines for illnesses. 3. Drug therapy is effective at tackling OCD symptoms. There is clear evidence for the effectiveness of SSRIs in reducing the severity of OCD symptoms and so improving the quality of life for OCD patients. Soomro et al. (2009) reviewed studies comparing SSRIs to placebos in the treatment of OCD and concluded that all 17 studies reviewed showed significantly better results for the SSRIs than for placebo conditions. Effectiveness is greatest when SSRIs are combined with a psychological treatment, usually CBT. Typically, symptoms decline significantly for around 70% of patients taking SSRIs. Of the remaining 30%, alternative drug treatments or combinations of drugs and psychological treatments will be effective for some, so drugs can help most patients with OCD. 4. Drugs are cost-effective and non-disruptive. An advantage of drug treatments in general is that they are cheap, compared to psychological treatments. Using drugs to treat OCD is therefore good value for a public health system like the National Health Service. As compared to psychological therapies, SSRIs are also non-disruptive to patients' lives. If you wish, you can simply take drugs until your symptoms decline and not engage with the hard work of psychological therapy. Many doctors and patients like drug treatments for these reasons. 5. A meta-analysis by Greist et al. (1995) reviewed placebo-controlled trials of the effects of 4 drugs on OCD. All 4 drugs were significantly more effective than the placebos, with clomipramine the most effective, more than fluoxetine, fluvoxamine and sertraline. 6. Cognitive neuroscience applied to OCD is now producing biological treatments that involve direct deep brain stimulation using electrodes in affected areas to reduce the presence of obsessions. It is hoped that these treatments may take the place of drugs in severe cases. 7. The cost of biological drug therapy is relatively cheap in comparison to cognitive treatments like CBT and requires less effort to administer. For health services with budget constraints, this may lead to drug therapies being the preferred treatment. Against: 1. A limitation of drug therapy is the side effects that patients may experience. Loss of sexual appetite/ability is common, as is irritability, sleep pattern disturbance (insomnia/drowsiness), headaches and loss of appetite. 2. Antidepressant medication may be more suitable for adults, as they are more able to tolerate and understand side effects. 3. It is not sure if drug treatments effective in treating OCD reduce obsessive symptoms, or instead lessen the depressive symptoms that often accompany the condition. 4. Some would argue that because of the risk of side effects and the tendency of antidepressants to produce heightened levels of suicidal thinking, plus the effectiveness of psychological treatments, drug treatments shouldn't be used to treat OCD. 5. Drugs can have side effects. Although drugs like SSRIs are often helpful to sufferers of OCD, a significant minority will get no benefit. Some patients also suffer side effects such as indigestion, blurred vision and loss of sex drive, but these side effects are usually temporary. For those taking clomipramine, side effects are more common and can be more serious. According to the NHS, more than one in 10 patients suffer erection problems, tremors and weight gain and more than one in 100 become aggressive and suffer disruption to blood pressure and heart rhythm. Such factors reduce effectiveness, because people stop taking the medication. 6. Unreliable evidence for drug treatments. Although SSRIs are fairly effective and any side effects will probably be short term, like all drug treatments they have some controversy attached. For example, some psychologists believe that the evidence favouring drug treatments is based, because the research is sponsored by drug companies, who do not report all the evidence (Goldacre, 2013). 7. Some cases of OCD follow trauma. OCD is widely believed to be biological in origin. It makes sense, therefore, that the standard treatment should be biological. However, it is acknowledged that OCD can have a range of other causes and that in some cases, it is a response to a traumatic life event. 8. Publication bias is a major concern when considering the effectiveness of drug treatments. It has been shown that positive results are more likely to be published than negative. It is argued that this is because the drug companies that run the trials have a financial incentive to show that their drug is effective. 9. Although drug therapies may address some symptoms of OCD, while taken they can produce side effects of insomnia and nausea. As well as this, when the patient stops taking them, such as at the end of treatment, Simpson (2004) found that relapse (the symptoms return) occurs in 45% of cases within 12 weeks. This is compared to only 12% of cases for CBT patients, suggesting that drugs don't treat the cause of OCD.