OCD Flashcards
What are obsessions?
Persistent, intrusive, recurring thoughts/images
What are compulsions?
Repetitive, ritualistic behaviours
What are some common compulsions?
Excessive hand washing
Cleaning
Hoarding
How much of the world has OCD?
1.2%
Obsessive thoughts?
For 90% of sufferers, the major feature is obsessive thoughts
COGNITIVE
Accompanying depression?
Sufferers usually have depression, anxiety, low mood and lack of enjoyment in activities
EMOTIONAL
Cognitive strategies to deal with obsessions?
E.g. religious person may pray/meditate to get rid of guilt
Helps manage anxiety but makes them appear abnormal and distracts from everyday tasks
COGNITIVE
Avoidance?
Avoidance to reduce the anxiety which is triggered by the situation
Interferes with everyday life
BEHAVIOURAL
Insight into excessive anxiety?
aware it is not rational
Catastrophic thoughts about worst case scenarios
Constant alertness and focus on potential hazards
COGNITIVE
Guilt and disgust?
Irrational guilt
Disgust directed at external object/self
EMOTIONAL
Anxiety and distress?
Unpleasant emotional experience due to the anxiety it creates
Obsessions are unpleasant and frightening- anxiety can be overwhelming
Urge to repeat the behaviour creates the anxiety
EMOTIONAL
Compulsive behaviour?
Repetitive compulsions- sufferers feel compelled to repeat a behaviour creates
The compulsions are performed to reduce/manage the anxiety
BEHAVIOURAL
The OCD cycle?
Obsessions -> anxiety -> compulsions -> temporary relief
What is involved in individual vulnerability in OCD?
Genes
Lewis?
Lewis observed that 37% of his OCD patients had parents with OCD and 21% of the patients had siblings with OCD
What is passed from one generation to the next?
Genetic vulnerability not the certainty of OCD
What does the diathesis stress model say?
Certain genes leave some people more likely to develop a mental disorder
What is necessary to trigger the condition?
Environmental stress (experience)
What are genes which create vulnerability for OCD called?
Candidate genes
Is OCD caused by one single gene?
No- OCD is polygenic
230 genes may be involved in OCD
What do neurotransmitters do?
Carry, boost and regulate signals between neurons and other cells in the body
What does serotonin do?
Sends mood-relevant information
If this does not occur, then mood and mental processes may be affected
What can some cases of OCD be explained by?
A reduction in the functioning of the serotonin system
Hu 2006?
Low levels of serotonin have been found in people with OCCD
Where does serotonin play an active role in?
The orbito-frontal cortex
The caudate nucleus
What does the drug SSRI do?
Increases the levels of serotonin in the brain
How does the orbitofrontal cortex function in an OCD brain?
Detects an error when there isn’t one and sends worry signals
How does the basal ganglia function in an OCD brain?
Causes repetitive behaviours
How does the cingulate gyrus function in an OCD brain?
Adds emotions like disgust and guilt to anxious thoughts
What does the caudate nucleus do in an OCD brain?
Fails to filter anxious thoughts
What is the worry circuit?
The OFC sends signals to the thalamus via the caudate nucleus about things that are worrying
The cingulate cortex acts as a relay system
The caudate nucleus regulates signals from the OFC
When the caudate nucleus is damaged, it fails to suppress the worry signals and the thalamus is alerted which sends signals back to the OFC and the worry is confirmed
This increases compulsions and anxiety
What research supports the genetic basis of OCD?
Family studies and twin studies
What do biopsychologists investigate between family members?
Concordance rates for traits like OCD
The higher the concordance rate?
The more likely the trait was inherited
What does gene mapping indicate?
Indicates a genetic link- particular genes make some people more vulnerable to developing OCD
What did Lenane et al show evidence for?
Prevalence of OCD in related family members shows evidence for heritability
What are 3 problems with the genetic explanation?
No one is really sure what is being inherited via the genes- there is not a specific gene found
Never get 100% concordance
Some OCD forms are more genetic in nature than others (contamination, aggression)
What are 2 genes that have been implicated in OCD?
The COMT gene
The SERT gene
What does the COMT gene do?
Helps to reduce the action of dopamine
What occurs when there is variation in the COMT gene?
Decreases the amount of COMT available- therefore dopamine is not controlled
Too much dopamine
What does the SERT gene affect?
Affects the transport of serotonin- creating lower levels of the neurotransmitter
Lower levels of serotonin have been implicated with OCD
What is used to treat OCD if CBT does not work?
Drug treatment
What is the most common drug treatment for OCD?
Antidepressant medication
What do antidepressants act on?
The levels of serotonin at the synapse
What drugs are used to raise serotonin levels?
Fluoxetine or sertraline
How do drugs raise serotonin levels?
Block the reuptake from the synapse back into the releasing neuron- therefore more serotonin is available for a longer period
Is the dosage for OCD higher than the dosage used for depression? (Antidepressants)
Yes
How long may it take for antidepressants to work?
Up to 12 weeks
AND some people do not respond to medication
How do tricyclics/ SNRI’s function?
By inhibiting serotonin and norepinephrine repute within the pre synaptic terminals which results in elevated concentrations of these transmitters within the synaptic cleft
Is there more or less side effects with tricyclics/SNRI’s than antidepressants?
More side effects as they are working on more chemical processes
When are tricyclics/SNRI’s used?
If SSRI’s fails
What are benzodiazepines (BZs)
A group of anti-anxiety drugs that include Valium and diazepam
How do BZs work?
They increase the action of a neurotransmitter called GABA
This means it makes the receiving neuron less likely to fire, which slows down the brain
Anxiety is therefore reduced and the obsessive thoughts in OCD
What is CBT recommended by?
NICE
Is CBT goal oriented and is it quick or slow?
Yes- is goal oriented
Relatively quick- a course of CBT runs for 3 months
What are the 2 components to CBT?
Cognitive component- focuses on changing thought processes
Behavioural component- focuses on changing actions/behaviours
What is the aim of CBT?
Not to remove the intrusive thoughts but to change the beliefs that they trigger
What does CBT begin with?
The thoughts that are the least anxiety provoking
What is habituation training?
The client is asked to think about their obsessive thoughts and they will then become less anxiety provoking and the compulsion is not needed to reduce the anxiety
What is the most common behavioural therapy used as part of CBT for OCD?
Exposure and response prevention therapy (ERPT)
What does ERPT focus on?
The compulsions found in OCD- complements the use of cognitive therapy which targets the obsessions
What 4 steps make up ERPT?
1) informing the client about ERPT and what the therapy will involve
2) using an exposure hierachy- starts with mildly anxiety raising situations and goes through to the highest level of anxiety
3) repeated exposure to situations that cause high anxiety until the level of anxiety reduces
4) getting the client to resist and refrain from performing the compulsive behaviour
