5.1 Clinical content Flashcards

1
Q

List just the names of the 4 Ds of diagnosis.

A
  1. Deviance
  2. Dysfunction
  3. Distress
  4. Danger

Some researchers (Davis) have also considered that there may be a possible 5th D - Duration. Many clients could be seen has having all these 4 Ds in the short term but if they persist then this is where the problem may be seen as a symptom of an illness that requires psychiatric attention.

These four dimensions of diagnosis can be used as a tool to decide whether behaviour is ‘abnormal’ and therefore worthy of further investigation and diagnosis.

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2
Q

Describe ‘Deviance’ when referring the the 4 Ds of diagnosis.

A

Clinicians look at the extent to which the behaviour is ‘rare’ within society. If the behaviour is considered rare enough, and ‘deviant’ from the norm, then this could suggest that a clinical disorder is present.

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3
Q

Describe ‘Dysfunction’ when referring the the 4 Ds of diagnosis.

A

If the behaviour is significantly interfering with the person’s life then a mental illness may be present.

The clinician should discuss with the patient all aspects of. their everyday life to assess the extent to which the problematic behaviour is disturbing this. Although there may be no obvious day-to-day impact of the behaviour, the clinician should look carefully into all aspects of the patents life because disturbances could be present in areas that are not immediately obvious.

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4
Q

Describe ‘Distress’ when referring the the 4 Ds of diagnosis.

A

This feature of the diagnostic decision is related to the extent to which the behaviour is causing upset to the individual. This should be treated in isolation from other features of the 4 Ds because the patient may be serenely distressed by their current situation bu still able to function completely normally in other areas of their life. The subjective experience of the patient is very important here because the patient may be facing a great deal of difficulty in. their life but be feeling no distress, and similarly someone else may be very distressed by something that other may view as trivial.

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5
Q

Describe ‘Danger’ when referring the the 4 Ds of diagnosis.

A

The patients behaviour has to be assessed under two key elements of danger:
Danger to themselves and danger to others. If the person’s saviour is putting their own life or other peoples lives in considerable danger then this may indicate that an intervention is needed. This could be considered on a scale of severity because behaviour is extremely risky and not being addressed then a diagnosis may be necessary

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6
Q

Evaluate the 4Ds if diagnosis.

A

(see page 284 in the thick blue text book)

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7
Q

What are clinical interviews?

Give some issues and debates about them.

A

The diagnostic process is often conducted through clinical. interviews with patients by clinicians. These are unstructured or semi-structured interviews.

(see the yellow box on page 284 in the thick blue text book)

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8
Q

Which organisation was the ICD created by?

A

The World Health Organisation (WHO)

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9
Q

Which organisation was the DSM created by?

A

The American Psychiatric Association (APA)

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10
Q

Why are reliable diagnoses essential?

A

Reliable diagnoses are essential for guiding treatment recommendations, to ensure that a patient receives the correct treatment for their condition and an accurate prognosis can be given.

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11
Q

Read the yellow box on page 285 in the thick blue text book.

A

Understand?

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12
Q

What does the ICD contain?

A
  • Mental health disorders and all diseases.

see the bottom of page 285 in the thick blue text book

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13
Q

What are the cultural differences between the ICD and the DSM?

A

(see the yellow box on page 286 in the thick blue text book)

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14
Q

The DSM V is a manual divided into three section, what do these three sections contain?

A

(see the side box on page 286 in the thick blue text book)

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15
Q

What is the reliability of diagnosis?

A

The reliability of diagnosis refers to the extent to which clinicians agree on the same diagnosis for the same patient.

Diagnosis is complex, especially as the same symptoms can occur across different disorders, such that two clinicians might see the same symptoms but assign their cause to different disorders. This would suggest that the diagnosis is unreliable.

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16
Q

What is some supporting evidence to saying that diagnoses is unreliable?

A
  • Ward et al. (1962)

Studied 2 psychiatrists diagnosing the same patient.

Found:
Disagreement occurred because of,
- inconsistency of the information provided by the patient (5%)
- inconsistency of the psychiatrists interpretation os symptoms (32.5%)
- inadequacy of the classification system (62.2%).

This research suggests that the main reliability issue at the time was with the diagnostic tool being used.

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17
Q

For a system of diagnosis to be reliable what test does it need to pass?

A

An inter-rater reliability. test.

This involves showing two or more clinicians the details of a persons case history and assessing the level of agreement between them.
If all the clinicians (raters) agree on the same diagnosis then we can say that the system of diagnosis has high inter-rater reliability.

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18
Q

What is some supporting evidence for saying there is low inter-rater reliability in the early diagnostic systems?

Over the years the systems have developed, what further study supports reliability has improved?

A
  • Beck (1954)

Found the same set of symptoms were only diagnosed as the same disorder in about half of cases, suggesting low reliability.

  • Brown (2001)

Tested the reliability and validity of DSM IV diagnoses for anxiety and mood disorders.

Found them to be good to excellent.

There are still some disorders, however, for which a reliable diagnosis is harder to obtain, for. example, PTSD has a high degree of symptom overlap with other psychiatric disorders and may be under diagnosed as a result.

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19
Q

How can patient factors cause unreliable diagnosis?

A

(read the middle section on page 287 in the thick blue text book)

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20
Q

How can clinician factors cause unreliable diagnosis?

A

(read the bottom section on page 287 in the thick blue text book)

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21
Q

What is inter-rater reliability?

A

The degree of agreement and consistency between raters about the thing being measured.

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22
Q

Describe some individual differences that can cause problems in diagnosis.

A

(read the yellow box on page 288 in the thick blue text book)

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23
Q

What us concurrent validity?

A

A way of establishing validity that compares evidence from several studies testing the same thing to see if they agree.

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24
Q

What is aetiological validity?

A

The extent to which a disorder has the same cause or causes.

Aetiological validity exists when a diagnosis reflects known causes, such as family history, in a disorder that is known to have a genetic cause.

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25
Q

What is predictive validity?

A

The extent to which results from. a test such as DSM, or study can predict future behaviour.

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26
Q

What is implicit bias?

A

A positive or negative mental attitude towards a person, thing, or group that a person holds at an unconscious level.

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27
Q

Why is the validity of diagnosis important and what ways can clinicians establish validity?

A

(read page 288 in the thick blue text book)

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28
Q

What is comorbidity?

A

The presence of more than one disorder In the same person at the same time.

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29
Q

What are delusions?

A

Beliefs that are contrary to fact.

These are beliefs held by the individual that, despite not being true, cannot be changed by others even where clear evidence can be demonstrated that challenges the belief.

One very specific example of a delusion would be thought insertion where the individual believes that their thoughts have been implanted by some kind of external force over which they have no control.

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30
Q

What are hallucinations?

A

Perceptual experiences that occur in the absence of external stimulation of the corresponding sensory organ.

Such as, hearing or seeing something around you, but can happen without any stimulus being present.

For example, a person with a psychotic illness may hear voices talking to them that are not really there, or see people in front of them then there is no one there.

Hallucinations can occur in any sensory modality, however it is thought that the most common type of hallucination associated with Sz are auditory hallucinations (hearing things that are not there)

The hallucination must be experienced when the patients fully awake and conscious to be classified as an actual symptom of disorder.

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31
Q

What is disorganised thinking/speech.

A

An inability to make connections between thoughts, resulting in incomprehensible language and ideas that seem loosely connected.

May be referred to as ‘word salad’ .

The person randomly skips from topic to topic during a conversation, and will answer questions with bizarre statements that do not seem to fit.

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32
Q

What is disorganised behaviour?

A

Behaviour that is not necessarily expected in the situation, or that changes rapidly and is out of context.

Ranges from fidgeting to childish ‘messing about’ or even dressing bizarrely.

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33
Q

What is catatonia?

A

Various motor disturbances characterised by abnormality of movement and behaviour.

A significant decrease in the individuals responsiveness to the environment,
They may sit completely still in odd postures, or refuse to speak to others, or even show continued, repetitive movements such as foot-tapping to hair-twirling that has no real meaning.

Categorised in abnormal motor behaviour.

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34
Q

What are negative symptoms?

A

Symptoms that mean the person has ‘lost’ an element of normal functioning.

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35
Q

What are the positive symptoms of Sz?

A

Positive symptoms add to the experience of the patient.

  • Delusions
  • Hallucinations
  • Disorganised thinking/speech
  • Abnormal motor behaviours.
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36
Q

What are the negative symptoms of Sz?

A

Negative symptoms subtract from normal behaviour. The behaviours persist longer and result in a huge burden of care compared to positive symptoms.

  • Lack of energy + enthusiasm
  • Poverty of speech
  • Poor motivation
  • Social withdrawal

Two of the most common:

EMOTIONAL EXPRESSION
Characterised by the patient showing less and less emotion in their general use of non-verbal communication, such as facial expressions, eye contact and physical gestures.

AVOLITION
A behavioural. state. characterised. by a general lack. of motivation to complete usual, set-motivated. activities such as work.

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37
Q

How many symptoms do patients have to present to be diagnosed with Sz?

A

The patient must have describe 2 or more of the key symptoms having been present for a high proportion of the last month.

One of them must be:

  • delusions
  • hallucinations
  • disorganised thinking/speech
  • disorganised behaviour
  • catatonia
  • negative symptoms

(read bottom paragraph on page 289 in the thick blue text book)

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38
Q

What are grandiose delusions?

A

The individual believes they have remarkable qualities such as being famous or having special powers.

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39
Q

What are persecutory delusions?

A

The individual reports believing that others are ‘out to get them’ and trying to harm them in some way.

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40
Q

What are referential delusions?

A

The individual holds a belief that certain behaviours or language from others is being directed at them personally.

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41
Q

What are auditory hallucinations?

A

Hearing things that are not there.

42
Q

What is the % likelihood of a person developing Sz?

A

0.3-0.7%

Depending on factors such as their racial/ethnic background, where in the world they live, and their country of birth.

43
Q

Which, men or women,

are more likely to develop a higher proportion of negative symptoms and have a longer duration of Sz, which are both associated with poor prognosis.

A

Men

44
Q

When is the most likely age for episodes Sz to start to appear in men and women?

A

Episodes of psychosis associated with Sz tend to appear between late adolescence and mid-thirties, with the peak of onset being around being around early mid-twenties in males, and late twenties in females.

Often episodes develop gradually over time and may not be obvious at first. Patients who show psychotic episodes earlier than in late adolescence appear to have worse prognosis over the long term.

45
Q

What is the approximate percentage of patients with Sz that will respond well to treatment?

A

20% of those diagnosed will respond well to treatment, with a small number regaining a good quality of life. However a large % will remain chronically ill, requiring regular treatment and interventions to support them.

Doctors, as yet, have not found a way to be able to accurately predict what an individuals prognosis will be after diagnosis.

46
Q

Describe 2 other features associated with the diagnosis of Sz.

A
  • COGNITIVE FUNCTIONING DEFICITS:
    in areas such as working memory, language functioning and speed of information processing.
  • MOOD ABNORMALITIES:
    many patients describe periods of low mood similar to those experienced in depressive episodes, as well as inappropriate displays of mood such as laughing for no reason.
47
Q

What is one biological explanation of Sz? (neurotransmitters)

Give a supporting study.

A

The function of neurotransmitters.
Psychosis associated with dopamine

RANDRUP AND MUNKVAD (1966)

  • Raised dopamine levels in the brains of rate by injecting them with amphetamine.
  • Rats behaviour changed, becoming more stereotyped, aggressive and isolated.
  • Showing that chaining the dopamine levels resulted in psychotic-type behaviour consistent with that shown in patients with Sz.
  • Found that amphetamine increases the level the neurotransmitter dopamine.

1967, a paper published by J.M. Van Rossum made a significant link between overstimulation of dopamine receptors and Sz.

Most recent version of dopamine hypothesis centres on hypersensitivity of certain dopamine receptors (D2 receptors) in the brain, which mean that patients with the disorder are likely to ‘overreact’ to the presence of the neurotransmitter.
Research by LIEBERMAN ET AL. (1987):
75% of patients with Sz show new symptoms or an increase in psychosis after using drugs such as amphetamine and methylphenidate, which mimic the action of dopamine in the brain.

(Read more on page 292 in the thick blue text book cuz skipped some stuff out)

48
Q

What are some ethical issues surrounding the biological explanation of Sz studies done on patients?

A

(read the yellow box on page 292 in the thick blue text book)

49
Q

Evaluate the neurotransmitter theory of Sz.

A

(read page 292 + 293 in the thick blue text book)

50
Q

What is amphetamine?

A

A drug that stimulates the CNS. Its effects include increased activity and energy, as well as appetite suppression and difficulty sleeping.

51
Q

What is methylphenidate?

A

A psycho-stimulant drug that acts on the CNS. It is used medically to treat attention-deficit hyperactivity disorder (ADHD) in children and adolescents.

52
Q

What are antagonists?

A

Drugs that produce an antagonist effect bind to the receptor sites on neurone to prevent the substance form being absorbed in large quantities, therefore reducing the effect of the neurotransmitter.

53
Q

What is up-regulation?

A

Homeostatic mechanism where the brain produces more of something in response to a depletion.

54
Q

What is a mesocortiyal pathway?

A

A dopamine pathway associated with motivation and emotion.

55
Q

What is the mesolyombic system?

A

A dopamine pathway associated with reward and pleasure, and often linked with addictive behaviours.

56
Q

What is one biological explanation of Sz? (genetics)

Give one supporting study.

A
  • Risk of developing Sz at some point in your lifetime for the general population is less than 1%.
  • 2º relative (aunt…) 2% - 6%
  • 1º relative (sibling…) 6% - 17%

GOTTESMAN (1991)
48% chance MZ twins would be diagnosed with Sz if their twin had it.

57
Q

Evaluate the genetic explanation of Sz.

A

(read page 294 + 295 in the thick blue text book)

58
Q

What is a concordance rate?

A

The probability that if one twin/family member has a certain characteristic (such as Sz) then the other twin/another family member will also have it.

59
Q

What is the non-biological explanation of Sz?

A

Social causation hypothesis. - The human world is a major cause of Sz, or at least precipitates relapse in those already diagnosed.

Environmental factors include; family dysfunction and childhood trauma but the best supported factors are; social adversity, urbanicity, social isolation and immigration/minority group status.

(details to these factors are on drive on docs)

60
Q

Evaluate the non-biological explanation of Sz.

A

(on sheet in folder, (social causation hypothesis))

61
Q

What is a diathesis-stress model?

A

A theory that explains behaviour through a mixture of biological and environmental factors. A dormant genetic disposition could be triggered by an environmental life event.

62
Q

What is the biological treatment of Sz?

A

Drug therapy.

CHLORPROMAZINE
Blocks dopamine receptor sites
HALOPERIDOL
Blocks dopamine receptor sites
CLOZAPINE
Blocks dopamine + serotonin receptor sites
RISPERIDONE
Blocks dopamine + serotonin receptor sites

(see powerpoint on classroom for supporting studies and side reacts fo each drug)

63
Q

Evaluate the biological treatment of Sz.

A

Idk look it up lol

64
Q

What is the non-biological treatment of Sz?

A

CBT

see docs in Sz folder for description of how CBT works

65
Q

Evaluate the non-biological treatment of Sz.

A

(see docs in Sz folder)

66
Q

What is OCD?

A

Obsessive compulsive disorder (OCD) is an anxiety disorder which focuses on worry about things (obsessions), and reducing the anxiety related to the worry (compulsions).

Compulsions are response to obsessions because an individual may believe the compulsions will reduce anxiety.

People with OCD recognise the difficulties and that their behavior is irrational.

OCD is not psychosis it is neurosis.

The WHO has ranked it among the top ten most disabling illnesses in terms of impaired quality of life and loss of earnings.

67
Q

What are obsessions in OCD?

A

Recurrent and persistent thoughts, urges or images that are experienced as intrusive or unwanted.

68
Q

What are compulsions in OCD?

A

Repetitive behaviours or mental acts that an individual feels driven to an obsession or according to rules that must be applied rigidly.

69
Q

How does the DSM V list the symptoms of OCD?

A

DSM criteria: obsessions and compulsions

CHECKING
CONTAMINATION
HOARDING
RUMINATION

(also see page 320 in the thick blue text book)

70
Q

What is the prevalence rate of OCD in the population?

A

The prevalence rate of OCD is between 1.1% - 1.8% of the population.

71
Q

Who is a more frequent sufferer of OCD as an adult, makes or females?

A

Females are more frequent sufferers of OCD as adults although males are more commonly affected as children.

72
Q

For most people what is the age of onset of OCD?

A

For most people the age of onset of OCD is late teens or early twenties , but it is possible for it to be earlier or later and for 25% of males sufferers it started before the age of 10. Generally the symptoms develop gradually, but in some cases they can be acute right from onset.

73
Q

When is the risk greater for people to develop OCD?

A

The risk is greater for people with higher negative emotionality, and those who tend to internalise issues. IT is also more frequent in the who suffered physical and sexual abuse in childhood. There may be a genetic risk as the rate of OCD among first-degree relatives of adult s with OCD is approximately twice that of those whose family have no history of the disorder.

74
Q

Is the rate of OCD different in different cultures?

A

OCD occurs across cultures at a similar rate and shows a similar age of onset and comorbidity with other disorders. There is a similar symptom structure involving cleaning, hoarding, taboo thoughts and symmetry, however there are regional differences suggesting that cultural factors can affect the nature of the symptoms.

75
Q

What are the 5 biological explanations of OCD?

Explain them all.

A
  • Genetics
  • Polygenics
  • Candidate genes
  • Worry circuit
  • Diathesis-stress

(look on docs in OCD folder for explanation of each)

76
Q

Evaluate the biological explanation for OCD.

A

(look on docs in OCD folder)

77
Q

What is the OCD cycle?

A

…obessions,
anxiety,
compulsions,
relief…

78
Q

How do we measure obsessions and compulsions?

Evaluate this method.

A

Y-BOCS

see docs, the introduction to OCD

79
Q

Describe the reliability of diagnosing OCD.

A

(see docs, the introduction to OCD)

80
Q

Describe the validity of diagnosing OCD.

A

(see docs, the introduction to OCD)

81
Q

In CBT, what is validity testing?

A

The therapist asks the patient to defend his or her thoughts and beliefs. If the patient cannot produce objective evidence supporting his or her assumptions, the invalidity, or faulty nature, is exposed.

82
Q

In CBT, what is cognitive rehearsal?

A

The patient is asked to imagine a difficult situation he or she has encountered in the past, and then works with the therapist to practice how to successfully cope with the problem. When the patient is confronted with a similar situation again, the rehearsed behavior will be drawn on to deal with it

83
Q

In CBT, what is homework?

A

In order to encourage self-discovery and reinforce insights made in therapy, the therapist may ask the patient to do homework assignments. These may include note-taking during the session, journaling (see above), review of an audiotape of the patient session, or reading books or articles appropriate to the therapy. They may also be more behaviourally focused, applying a newly learned strategy or coping mechanism to a situation, and then recording the results for the next therapy session

84
Q

In CBT, what is cognitive restructuring?

A

Cognitive restructuring refers to the process in cognitive behavioral therapy of identifying and changing inaccurate negative thoughts that contribute to the development of depression. This is done collaboratively between the patient and therapist, often in the form of a dialogue.

85
Q

In CBT, what is behavioural activation?

A

Behavioral activation aims to help patients engage more often in enjoyable activities and develop or enhance problem-solving skills.

86
Q

What are the strengths of using CBT?

A
  • 75% helpful
  • Useful having individualised support
  • Reduces relapse more effectively than drugs
  • Own patients pace
  • No side effects
  • Most evidence based therapy, adapted to be most culturally sensitive
87
Q

What are the limitations of using CBT?

A
  • Can be expensive and time consuming
  • People must be willing and motivated
  • Not for everyone
  • CBT best in combination
  • ERP more beneficial
  • Does not address past experiences
  • Ethical concerns, clinicians decision whether something is irrational or not
88
Q

What is socratic questioning in CBT?

A

This is to seek basic understanding of the patients thought processes. Sessions can be more effectively used if the therapist knows how the patient is thinking.

89
Q

Evaluate using CBT to treat OCD.

A
  • ERP is just as effective as CBT. There is conflicting evidence between ERP, CT and CBT e.g. some find that ERP is more effective than CBT. However, depending on their most overpowering symptom a different treatment might be better, e.g. CBT tends to treat symptoms such as hoarding better than CT alone.
  • Research suggests the cognitive model on its own is not sufficient to provide the best and most successful treatment for OCD. It is helpful, but works best alongside a behaviour explanation as well(hence CBT and ERP).
  • This is supported by a meta-analysis by NICE (2009) which concluded that CBT was effective in reducing rates of readmission to hospital and duration of admission. It was also judged to be effective in reducing overall symptom severity, both at the end of treatment and after up to 12 months’ follow-up.
  • Despite its efficacy for OCD, many individuals with clinically significant symptoms fail to initiate CBT when recommended by a mental health professional, receive treatments that are less intensive than those used in clinical trials, or drop out of treatment prematurely. Financial costs of CBT, difficulty attending sessions, and fears regarding treatment are significant barriers to initiating and completing therapy.
90
Q

What are the 4 drugs used for drug therapy for OCD?

A
  1. SSRI - Antidepressant
  2. D-CYCLOSERINE - Anti-anxiety
  3. TCA’s - antidepressants
  4. BZS - anti-anxiety

(see docs, drug therapy for OCD)

91
Q

Evaluate the use of drug therapy for OCD.

A

(see docs, drug therapy for OCD)

92
Q

What is an issue with using drug therapy for OCD?

A

An issue with use of drugs is socially sensitive. YOu could argue that research that hspowers drugs as being effective may be ‘abusing’ the people they claim to help. This is because they might be using a drug to keep someone quiet. Therefore someone with OCD doesn’t intrude with the rest of society and makes us feel like their problems are solved.

This isn’t the best interest for someone with OCD.

93
Q

What is refractory OCD?

A

OCD that is difficult to treat

94
Q

What is glutamate?

A

As a neurotransmitter, glutamate is involved in the activation of neurones, enabling neural transmission to take place.

95
Q

What is Phencyclidine (PCP, aka Angel Dust)?

A

A drugs originally created as an anaesthetic because it induces ‘numbness’ , but is no longer used for this purpose because of its other effects. These includes hallucinations, loss of touch with reality, and changes in mood, often making the user feel as if they are ‘not in control’ of their actions.

96
Q

What is the cerebral cortex?

A

The outer layer of the brain.

97
Q

What is the basal ganglia?

A

Situated within the base of the brain, this is a group of three structures associated with coordination of movement.

98
Q

What does antidopaminergic mean?

A

Blocking the activity of dopamine.

99
Q

What does antiserotonergic mean?

A

Blocking the activity of serotonin.

100
Q

What does hypoglutamatergia mean?

A

Reduced levels of glutamate.