Biological treatment of OCD PPO

Question 1

drug therapy

Answer 1

Treatment, involving drugs that have an effect on brain functioning

Question 2

what does drug therapy do?

Answer 2

• Increases or decreases levels of neurotransmitters and their activity in the brain
• Increase serotonin levels to treat OCD

Question 3

SSRIs

Answer 3

standard treatement- selective serotonin reuptake inhibitor

Question 4

how do SSRIs work?

Answer 4

• Serotonin is released by neurons in the brain and travels across a synapse, e.g: presynaptic neurons
• Neurotransmitter chemically conveys signal from presynaptic neuron to the postsynaptic neuron which is broken down and reused
• SSRIs prevent reabsorption and breakdown, so increases levels of serotonin in the synapse and stimulate postsynaptic neuron

Question 5

how SSRIs are delivered

Answer 5

Available as capsules or liquid- 20mg of fluoxetine (average dosage)

Question 6

combining SSRIs with other treatment

Answer 6

• Often used alongside CBT to treat OCD
• Drugs reduce emotional symptoms, so engagement with CBT is effective

Question 7

Alternative to SSRIs

Answer 7

Dose can be increased (up to 60 mg a day) or combined with other drugs:
* Tricyclics (antidepressant)
* SNRIs (serotonin-noradrenaline reuptake inhibitors)

Question 8

tricyclics

Answer 8

acts on systems (e.g: serotonin system). More severe side effects, so reserved for people who don’t respond to SSRIs

Question 9

SNRI

Answer 9

different class of antidepressants, second option for people who don’t respond to SSRIs- increase serotonin and noradrenaline levels

Question 10

evidence for effectiveness

Answer 10

• Soomro et al reviewed 17 studies, comparing SSRIs to placebos
• All 17 studies show better outcomes for SSRIs
• Symptoms reduce by 70%- remaining 30% can be helped alternatively
• SSRIs reduce symptom severity and improve quality of life
  This means drugs appear to be helpful for OCD

Question 11

better alternatives

evidence for effectiveness counterpoint

Answer 11

• Evidence suggests even if drug treatments are helpful, they may not be the most effective
• Skapinakis et al carried out a systematic review of outcome studies, concluding cognitive and behavioural therapies were more effective
  This means drugs may not be the optimum treatment for OCD

Question 12

cost effective and non disruptive

Answer 12

• Drug treatments are cheap compared to psychological treatment
• Using drugs to treat OCD is good value for public health systems (NHS) and represents a good use of limited funds
• SSRIs are non-disruptive: take drugs until symptoms decline vs psychological therapy: attend sessions

Question 13

serious side effects

Answer 13

• Small minority do not benefit from SSRIs
• Side effects include: indigestion, blurred vision, loss of sex drive
• Usually temporary effects, but can be distressing and long-lasting
• 1 in 10 taking clomipramine experience erection problems and weight gain, and 1 in 100 experience aggression and heart-related problems
• This means drugs reduce the quality of life, so they cease to be effective