biological approach to treating OCD Flashcards
1
Q
what is the aim of drug therapy for mental disorders?
A
- to increase or decrease the levels of neurotransmitters in the brain or to increase / decrease their activity
- since low levels of serotonin are associated with OCD, drugs to treat OCD work to increase the level of serotonin in the brain
2
Q
SSRs (selective serotonin reuptake inhibitor)
A
- increase the level of serotonin available in the synapse by preventing it from being reabsorbed into the presynaptic cell
- this means the serotonin remains available at the synapse, thus increasing the amount of serotonin available to bind with the post synaptic receptors
- this compensates for whatever is wrong with the serotonin system in OCD
3
Q
how can SSRIs be prescribed?
A
- a typical daily dose of fluoxetine (eg. brand name prozac) is 20mg, but this can be increased if it is not benefiting the person
- available as capsules or liquid
- it takes 3-4 months of daily use of SSRIs to have much impact on symptoms
- dosage and other advice vary according to which SSRI is prescribed
4
Q
how can SSRIs be combined with other treatments?
A
- drugs are often used alongside CBT to treat OCD
- the drugs reduce a person’s emotional symptoms, such as feeling anxious or depressed
- this means that people with OCD can engage more effectively with the CBT
- occasionally, other drugs are prescribed alongside SSRIs
5
Q
when should an alternative to SSRIs be used?
A
- if an SSRI is not effective after 3-4 months, the dose can be increased (eg. up to 60mg a day for fluoxetine) or it can be combined with other drugs
- sometimes different antidepressants are tried
- people respond very different to different drugs and alternatives work well for some people and not at all for others
6
Q
what are tricyclics?
A
- an older type of antidepressant, such as clomipramine
- this acts on various systems including the serotonin system where it has the same effect as SSRIs
- clomipramine has more severe side-effects than SSRIs so it is generally kept in reserve for people who do not respond to SSRIs
7
Q
what are SNRIs?
A
- serotonin-noradrenaline reuptake inhibitors
- different class of antidepressant drugs, and, like clomipramine, are only used for people who don’t respond to SSRs
- SNRIs increase levels of serotonin as well as another different neurotransmitter, noradrenaline, which contributes to an anxiolytic effect
- they have more dangerous side effects compared to SSRIs, are less well studied and are more expensive
8
Q
evaluation: evidence of effectiveness - G. mustafa soomro et al. (2009)
A
- reviewed 17 studies that compared SSRIs to placebos in the treatment of OCD
- all 17 studies showed significantly better outcomes for SSRIs than the placebo conditions
9
Q
evaluation: helpful for most people with OCD
A
- typically, symptoms reduce for around 70% of people taking SSRIs (sansone and sansone 2011)
- for the remaining 30%, most can be helped by either alternative drugs or combinations of drugs and psychological therapies
10
Q
evaluation: evidence of effectiveness - other?
A
- fineberg (2018) reviewed adult patients
- paediatric OCD study team (2004) reviewed children and adolescents
- both found that CBT and drug therapy are effective on their own, but CBT and drug therapy combined are more effective than monotherapy
11
Q
evaluation: evidence of effectiveness for alternative to SSRIs - bogetto et al. (2000)
A
- trialled a drug called olanzapine with 23 people who had not responded to SSRIs
- 10 of these people responded to olanzapine
- the mean symptom rating improved from 26.8 to 18.9 on the ‘yale brown obsessive compulsion scale’
12
Q
evaluation: even if drug treatments are helpful for most people with OCD, they may not be the most effective treatments available
A
- skapinakis et al. (2016) carried out a systematic review of outcome studies and concluded that both cognitive and behavioural (exposure) therapies were more effective than SSRIs in the treatment of OCD
- therefore, drugs may not be the optimum treatment for OCD
13
Q
evaluation: cost-effective
A
- generally cheap compared to psychological treatments because many thousands of tablets or liquid doses can be manufactured in the time it takes to conduct one session of a psychological therapy
- using drugs to treat OCD is therefore good value for public health system like the NHS and represents a good use of limited fund
14
Q
evaluation: non-disruptive
A
- if you wish you can simply take drugs until your symptoms decline
- this is quite different from psychological therapy which involves time spent attending therapy sessions
- also don’t require much effort; you just have to remember to take the drugs
- this means that drugs are popular with many people with OCD and their doctors
15
Q
evaluation: potentially serious side-effects
A
- although drugs such as SSRIs help most people, a small minority will get no benefit
- some people also experience side-effects such as indigestion, blurred vision and loss of sex drive
- these side-effects are usually temporary, but can be quite distressing for people and for a minority they are long-lasting
