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
16
Q
evaluation: serious side-effects with the tricyclic clomipramine
A
- more than 1 in 10 people experience erection problems and weight gain
- 1 in 100 become aggressive and experience heart-related problems
- this means that some people have a reduced quality of life as a result of taking drugs and may stop taking them altogether, meaning the drugs cease to be effective
17
Q
evaluation: biased evidence
A
- there is always some controversy over the evidence of for the effectiveness of drugs
- some psychologists believe that the evidence for drug effectiveness is biased because researchers are sponsored by drug companies and may selectively public positive outcomes for the drugs their sponsors are selling (goldacre 2013)
- there is also a lack of independent studies of drug effectiveness and also research on psychological therapies may be bieased
- however, the best evidence available is supportive of the usefulness of drugs for OCD
