OCD Flashcards
how is OCD characterized ?
OCD is characterized by the presence of persistent obsessions or compulsions or most commonly both
Obsessions are unwanted, repetitive thoughts, images or urges
Obsessions are intrusive and commonly associated with anxiety
Compressions are repetitive behavior or mental acts that the individual feels driven to perform as a response to an obsession
Diagnoses to be made obsession and compulsions must take up more than an hour per day and must result in significant stress or significant impairment to one or more important area of functioning, which is family, social or occupational
rapoports study ?
Charles with a 14-year-old boy with three hours or more showering, and another two hours, getting dressed and respective routines of holding soap in hand putting it underwater switching hands and so on
His mother reached out after the behavior has been going on for around 2years before this Charles has been a good student for the particular interest in sciences
To school because of washing rituals were making it impossible for him to attend on time
Charles was obsessed with the thought that he had something sticky on his skin that had to be washed off
He had only one friend because his rituals left him little time to leave the house. He underwent a drug trial for clomipramine after a year he had to develop the tolerance for his medication. Charles relapsed and returned to ritualistic washing and dressing.
MOCI ?
The MOCI is a short assessment tool that contains 30 items that are scored either true or false
Assess symptoms relating to checking washing, slowness and doubting
It produces range between 0 to 30
YBOCS?
The yale brown obsessive-compulsive scale developed by Goodman et al is a widely used test designed to measure the nature and severity of an individual symptoms
It involves a semi structure that takes around 30 minutes to conduct it also involves a checklist of different obsessions and compulsions with a 10 items severity
scale
Scale allows individuals to rate the time they spend on obsessions how hard obsessions are to resist, and how much distressed obsessions cause
Individuals with above are considered to to be in the clinical range of OCD
what is the biochemical explanation of OCD?
dopamine is an important transmitter for OCD research shows that those with OCD tend to have abnormally high levels of dopamine
Research to show the individuals with OCD have lower the normal levels of serotonin in the brain
Research is supported by evidence that shows the antidepressants that works specifically on in increasing levels of serotonin are more effective treatments for OCD
Bio chemical explanation of OCD related the influence of oxytocin oxytocin is referred to as the love hormone because it is involved in enhancing trust and attachment however, oxytocin has shown to distrust and fear in certain stimuli
by analyzing cerebral spinal fluid and patient account of behavior, researchers found that some forms of OCD were related to oxytocin dysfunction, but contrasting evidence shows that there is no link between oxytocin and OCD. This was done by using a blind to control study of 12 patients with OCD forgiven, synthetic oxytocin through a daily nasal spray and half were given a placebo, no reduction and obsessions or compulsions was reported in either group
genetic explanation for OCD ?
research suggest the OCD may have a genetic basis
Monzani carry out a large scale, twin study, and found a significantly higher concordance rate for monozygotic twins (52%) compared to dizygotic twins ( 21 % )
knowing that low levels of serotonin seem to be related for OCD it makes sense to consider the role of genes responsible for serotonin levels conducted the large scale study involving 1406 participants with OCD and other members of the general population to analyze and identify genes that may be linked to OCD symptoms the gene PTPRD was implicated ALONGSIDE A GENE CALLED SLITRK3
cognitive explanation for OCD ?
OCD is composed of two aspects cognitive obsessions and behavioral compulsions. The cognitive explanation considers the obsessive thinking is based on faulty reasoning,
the believe that hand are covered in harmful germs that could kill us is due to errors and thinking these mistakes and cognition, can also worsen on the stressful condition composite behaviors are the outcome of such erranous thinking attempts to alleviate unwanted thoughts
behavioral explanation ?
compulsive behavior can be explained through the principles of operant conditioning, engaging and behavior such as handwashing may Olivi obsession over germs even temporarily the handwashing has become a negative reinforcer because it has relieve something unpleasant. It is also a positive reinforcer because the person has rewarded by knowing that they have clean hands.
psychodynamic explanation ?
The psychodynamic approach explains OCD through looking at unconscious belief and desires
Psychodynamic theorist claimed that the symptoms of OCD appear as a result of internal conflict between the ID and the
ego
Suggested that conflict arises in the stage of psychosexual development around the time most children begin toilet training
This process may involve attention between the child and their parents who may wish to control how and when the child defecates
In an attempt to regain control, the child may soil themselves or become annally expulsive which causes upset and argument
Or the child may begin to retain feces or urine to regain control, also known as anally retentive
Both of these behaviors can lead to behavioral disturbances as the individual has become fixated in the stage
The argument is obsessive thoughts come from the rational part of the extent that it may lead to compulsive cleaning and tidying rituals later in life in order deal with earlier childhood trauma
biological treatment of OCD ?
OCD can be treated with the range of different drug therapies, including antidepressants and anxiety medication most used medication to treat OCD are SSRI
These medications work by blocking the serotonin from being re-absorbed once a mess has been passed from one year to another meaning that serotonin levels remain higher
Met analysis conducted researcher reviewed the results of studies compared effectiveness of SRRI with placebo
The studies used YBOCS to measure OCD symptoms and all studies SSRI as a group or more effective than placebos introducing OCD symptoms SSRI reduce the severity of obsessive compulsive symptoms as they seem to lessen an anxiety associated with a disorder
psychological treatment?
Exposure and response prevention therapy is a form of CBT
Individuals are exposed to stimuli that provoked their obsessions and associated distress while at the same time they help to prevent their compulsive behaviors
The individual is not wash their hands, but instead to anxiety and learn to accept their obsessions and become habituated to it
The key is to prevent the behavior as responsible, obsessive thoughts in visual to learn the uncomfortable will eventually go away without even performing the compulsive behavior
lehmkuhl?
It’s a case study with a 12-year-old boy who referred to as Jason who had both OCD and ASD
Jason had been diagnosed with high functioning, autism and experience, contamination, fear, excessive, handwashing, counting, and checking. He would spend several hours each day, engaged in compulsive behavior and reported significant anxiety when prevented from completing his ritual.
Jason attended 10 50 minCBT sessions over 16 weeks
Some of the ERP techniques were modified to meet Jason specific ASD needs
He was not asked to visualize exercise as he would find it impossible to imagine pretend situations he identified feelings of distress and help the therapist learn coping mechanisms for when he felt anxious
The next step involved exposing to stimuli which were contaminated and produced anxiety and disgust
These included common objects, such as doorhandles or elevator buttons exposure involved Jason being asked to touch these items and repeatedly to do so until he became habituated, and his anxiety levels dropped
Exposures became increasingly difficult behaviors, increasing anxiety between sessions. He practices exposure through specific tasks and his normal environment such as handing out papers after completing his therapy Jason score on the YBOCS had dropped from severely high pre-therapy 18 to 3
lovel et al aim ?
The aim was to compare the effectiveness of CBT carried out by telephone with CBT carried out face-to-face and treatment of OCD
design of lovel et al ?
randomized control tried was used to compare exposure therapy and response prevention delivered by traditional 60 minute face-to-face sessions or by shorter telephone sessions up to 30 minutes each 10 weekly sessions were provided for participants in each condition
The sample consisted the 72 part spins diagnosed with OCD and age between 16 and 65 years old. All participants from the UK and attended one of two outpatient clinics
participants all scored at least 16 on the YBOCS and did not suffer from substance misuse or other conditions such as severe depressive disorder
Participants were randomly assigned to either the telephone or the face-to-face, making this an independent design
Experienced therapist carried out the treatment consistency of treatment was maintained by use of therapist manuals and four monthly training days
Prior to treatment all parts were assessed twice four weeks apart, using the YBOCS to measure the severity of their OCD and BDI to measure feelings of depressive disorder
Participants were assisted using these measures immediately after the treatment then at one month three months and six month follow-up
The researchers who assessed the participants before, and after treatment did not know which condition they were in to protect, protect against any potential bias from the researchers
results for LOVEL et al ?
results showed that the mean YBOCS score prior to treatment was 25 prior to treatment. There was no significant difference between the main course for YBOCS or the BDI between two conditions.
All four times points clinical outcomes was equivalent for each condition. Main score on the YBOCS dropped significantly between the initial scores and those following treatment
Treatment was class as clinically relevant if the treatment score dropped by two standard deviations or more after treatment
Patients were very satisfied with their treatment, and these results were similar across both conditions
