Psychopathalogy

Question 1

Psychopathology

Answer 1

Psychopathology is the scientific study of mental disorders (abnormalities) such as depression, phobias and obsessive compulsive disorder.

In order to diagnose someone with a mental disorder we must first decide in what way their behaviour differs from what is ‘normal’ i.e. what is abnormal?

Question 2

Deviation from social norms

Answer 2

Under this definition, abnormal behaviour is that which goes against the unwritten rules in a given society or culture.

All societies have their social norms. These are the standards of acceptable behaviour that are created by a social group, and adhered to by all those who are socialised into that group. For example, do not stand too close a person you have just met.

Anyone who behaves differently (deviates) from these social norms is classed as abnormal by this definition.

Question 3

Deviation from social norms AO3 (3n)

Answer 3

• In some instances it can be beneficial to break social norms, for example the Suffragettes broke many social norms but this led to women gaining the right to vote.
• The social norms of a society change over time. For example, homosexuality was classed as a mental illness in the International Classification of Diseases (ICD) until 1990 but is no longer considered an abnormality.
• Deviation from social norms does not always have mental health consequences. Those who do not conform to social norms may very well not be abnormal but merely eccentric. For example, naturists break social norms but are not often perceived as having mental health problems.

Question 4

Failure to function adequately

Answer 4

Under this definition, abnormal behaviour is that which causes an inability to cope with everyday life. A person’s behaviour may disrupt their ability to work or conduct satisfying interpersonal relationships.

Rosenhan and Seligman (1989) suggest personal dysfunction has seven features. The more features an individual has the more abnormal they are considered to be.

1. Personal Distress – Feeling sad, anxious, worried or scared.
2. Maladaptive Behaviour – Behaviour stopping individuals from attaining life
   goals, both socially and occupationally.
3. Unpredictability – Displaying unexpected behaviours characteristiced by the loss of control.
4. Irrationality – Displaying behaviours which cannot be explained in a logical way.
5. Observer Discomfort – Displaying behaviour which causes discomfort in others.
6. Violation of Moral Standards – Displaying behaviour, which violates society’s ethical standards.
7. Unconventionality – Displaying behaviour which does not conform to what is generally done in a certain situation.

Question 5

Failure to function AO3 (1p,3n)

Answer 5

+ This definition of abnormality recongises the patient’s perspective (e.g. personal distress).

• Abnormality is not always accompanied by a failure to function. Psychopaths can commit murders while still appearing normal. Harold Shipman, the English doctor who murdered 215 patients over 23 years, maintained the outward appearance of a respectable member of his profession, and had a family, the entire time he was committing the murders.
• There are times in a person’s life when it is normal and psychologically healthy to suffer from personal distress, like when a loved one dies. It would be abnormal not to feel distress under these circumstances.
• Behaviour may cause distress to other people and be regarded as dysfunctional when the person themselves feels no personal distress. Stephen Gough has been imprisoned for breaching the peace because he insists on hiking while naked, this makes other people experience observer discomfort, but he himself feels no distress.

Question 6

Deviation from ideal mental health

Answer 6

Under this definition, behaviour is abnormal if it fails to meet prescribed criteria for psychological normality.

Jahoda (1958) devised the concept of ideal mental health. She identified six characteristics that individuals should exhibit in order to be classed as ‘normal’. An absence of these characteristics indicates that an individual is abnormal. The more criteria individuals fail to meet the more abnormal they are

Question 7

Jahoda characteristics for deviation from ideal mental health

Answer 7

1. Positive Attitudes Towards Oneself - Having self-respect, high self- esteem, confidence and a positive self-concept.
2. Self-Actualisation – Experience personal growth and development. Reach one’s full potential and feel fulfilled.
3. Autonomy – Being independent, self-reliant and able to make personal decisions for oneself.
4. Resistance to Stress – Having effective coping strategies and being able to manage everyday anxiety-provoking and stressful situations.
5. Accurate Perception of Reality – Perceiving the world in a non- distorted fashion and having an objective and realistic view of the world (not having hallucinations or delusions).
6. Environmental Mastery – Being competent in all aspects of life and the ability to meet the demands of any situation and the flexibility to adapt to changing life circumstances.

Question 8

Deviation from ideal mental health AO3 (2p, 3n)

Answer 8

+ This is a comprehensive criteria for mental health which is based on similar models for physical health. However, mental health may not be the same.

+ This definition of abnormality is a positive, holistic approach to diagnosis.

• This criteria is very demanding and unrealistic. At any given moment most people do not meet all the ideals. For example, few people experience self-actualisation at all times in their life.
• Many of the criteria, such as self-actualisation are vague and difficult to measure and are therefore subjective. How can we tell that someone has reached their full potential?
• The criteria used to judge ideal mental health can be accused of cultural bias. Collectivist cultures (e.g. India and Japan) emphasise communal goals and regard autonomy as undesirable, unlike individualistic cultures (e.g. USA and Germany). Therefore people from these collectivist cultures may be seen as abnormal using the criteria

Question 9

Statistical infrequency

Answer 9

Under this definition, abnormal behaviour is that which is statistically rare.
In statistical terms, instances of abnormality would lie at both extremes of a normal distribution.

Question 10

Statistical infrequency AO3 (3n)

Answer 10

• This definition fails to account for behaviour that is statistically rare but desirable. For example, someone who has an IQ above the normal average would not be seen as abnormal; on the contrary they would be very highly regarded for their intelligence.
• Some psychological disorders are not statistically rare. Depression may affect 27% of elderly people (NIMH, 2001). This would make it common but that does not mean that it is not a problem.
• Many rare behaviours or characteristics have no bearing on normality or abnormality (e.g. left handedness).

Question 11

Behavioural characteristics of phobias

Answer 11

Panic: The person might panic in the presence of the phobic object. They might show behavioural characteristics of crying, running, screaming, freezing, fainting, collapsing, or vomiting.

Avoidance: When faced with the phobic object the response is to evade the object. This can interfere with the person’s normal daily life.

Endurance – The person may remain in the presence of the phobic object frozen and unable to move.

Question 12

Emotional characteristics of phobias

Answer 12

Fear: Persistent, excessive and unreasonable worry and distress might be felt
in the presence of the phobic object.

Anxiety: When they encounter their phobic object the person will feel terror
and be uncertain and apprehensive about what is going to happen.

Question 13

Cognitive characteristics of phobias

Answer 13

Irrational Beliefs: The person’s thoughts about their phobia do not make logical sense, and they will resist rational arguments that counter it. For example someone who is scared of flying will not listen to the fact that, “flying is the safest form of transport.” The person will also have a distorted perception of the stimulus. For example, a person with arachnophobia may believe that all
spiders are dangerous and deadly, despite the fact that no spiders in the UK are
actually deadly.

Selective Attention: When the person encounters the phobic object, they will become fixated on it because of their irrational beliefs about the danger posed.

Question 14

Behavioural explanations of phobias

Answer 14

The Two-Process Model
1. The phobia is initiated through classical conditioning.
2. The phobia is maintained through operant conditioning.

Question 15

Classical conditioning

Answer 15

Classical conditioning is learning through association. A stimulus produces the same response as another stimulus because they have been constantly presented at the same time. This could be how phobias develop, as the stimulus the person is afraid of has, in the past, been associated with another stimulus.

Watson and Raynor (1920) managed to give an infant boy referred to as ‘Little Albert’, a phobia of a white rat.

1. An infant is born with certain reflexes (that they do not have to learn); the stimulus of a loud noise is an unconditioned stimulus and produces the reflex of fear as an unconditioned response.
2. A white rat is a neutral stimulus as it produces no reflexes. However, over time the white rat became associated with unconditioned stimulus of a loud noise.
3. The white rat then becomes a conditioned stimulus that produces fear as a conditioned response.
4. This conditioned response of fear can then be generalised to other objects or situations. Albert became scared of any object that was white or fluffy.

Question 16

Operant conditioning

Answer 16

Operant conditioning is learning through the consequences of one’s behaviour.

Positive Reinforcement – The behaviour leads to a reward.

Negative Reinforcement – The behaviour stops something unpleasant.

Punishment – The behaviour leads to something unpleasant.

The avoidance of a phobic object reduces fear and so is reinforcing. This is an example of negative reinforcement (escaping from something unpleasant).

Question 17

Two-process model AO3 (2p,3n)

Answer 17

+ This model does not label people with the stigma of being mentally ill. Such labels can be damaging because they tend to be difficult to remove. Instead the model is positive, perceiving phobias as incorrect responses that can be corrected

+ King (1998) reviewed several case studies and found that children acquire phobias after having traumatic experiences with the phobic object. This supports the idea that phobias are initiated because they are learned through classical conditioning.

• Many people who have a traumatic experience, such as a car accident, do not then go on to develop a phobia (e.g. of cars/driving), so classical conditioning does not explain how all phobias develop.
• Some people are scared of an object, but they have not had a negative experience or even encountered the object before (e.g. being scared of snakes even though you have never seen one), so learning cannot have been a factor in causing them to develop a phobia.

-This model focuses on learning and the environment but does not take account of biological factors that can cause phobias. Some people could have a genetic vulnerability to phobias.

Question 18

Systematic desensitisation

Answer 18

Systematic desensitization (SD) is a behavioural therapy developed by Wolpe (1958) to reduce phobias by using classical conditioning. A person experiences fear and anxiety as a behavioural response to a phobic object. SD replaces this fear and anxiety with relaxed responses instead. The central idea of SD is that it is impossible to experience two opposite emotions at the same time e.g. fear and relaxation; this is called reciprocal inhibition. Therefore if the patient can learn to remain relaxed in the presence of their phobia, they can be cured. This is called counter-conditioning.

Question 19

Stages of systematic desensitisation

Answer 19

1. Anxiety Hierarchy - A hierarchy of fear is constructed by the therapist and the patient. Situations involving the phobic object are ranked from least fearful to most fearful. If a person has a phobia of snakes the therapist might at first get the patient to merely look at a photo of a snake, then at a snake in a tank, until eventually they are asked to hold a snake.
2. Relaxation Training - Patients are taught deep muscle relaxation techniques, such as progressive muscular relaxation (PMR) and the relaxation response. The idea behind PMR is to tense up a group of muscles so that they are as tightly contracted as possible, hold them in a state of extreme tension for a few seconds and then relax the muscles to their previous state. Finally, consciously relax the muscles even further so that you are as relaxed as possible. When doing the relaxation response patients are asked to sit quietly and comfortably and close their eyes.
3. Gradual Exposure - The patient is introduced to their phobic object and they work their way up the anxiety hierarchy starting with the least frightening stage. They use their relaxation techniques whilst they are exposed to the phobic object. When they feel comfortable with one particular stage of the hierarchy they move on to the next stage in the hierarchy. Eventually through repeated exposure to phobic objects with relaxation and no fear, the phobia is eliminated.

Question 20

Systematic desensitisation AO3 (2p, 1n)

Answer 20

+ Jones (1924) supports the use of SD to eradicate ‘Little Peter’s’ phobia. A white rabbit was presented to Little Peter at gradually closer distances and each time his anxiety levels lessoned. Eventually he developed affection for the white rabbit.

+ Klosko et al. (1990) supports the use of SD. He assessed various therapies for the treatment of panic disorders and found that 87% of patients were panic free after receiving SD, compared to 50% on medication, 36% on a placebo and 33% receiving no treatment at all.

• Behavioural treatments address the symptoms of phobias. However some critics believe the symptoms are merely the tip of the iceberg and claim that underlying causes of the phobia will remain. In the future the symptoms will return or symptom substitution will occur, when other abnormal behaviours replace the ones that have been removed.

Question 21

Flooding

Answer 21

Flooding involves directly exposing the patient to their phobic object. Flooding stops phobic responses very quickly. This is because the patient does not have the option for any avoidance behaviour, and they quickly learn that the phobic object is harmless, and therefore extinction occurs. In some cases the patient might achieve relaxation in the presence of their phobic object because they are so exhausted by their own fear response. Flooding is ethical, even though it can cause a great deal of initial psychological harm; the patient would have to give their fully informed consent so that they were fully prepared for the flooding session. Patients are given the choice of either having SD or flooding. Flooding therapy sessions usually last 2-3 hours, which is much longer than SD sessions.

Question 22

Flooding AO3 (1p, 1n)

Answer 22

+ Wolpe (1960) supports the use of flooding to remove a patient’s phobia of being in cars. The girl was forced into a car and driven around for four hours until her hysteria was eradicated. This demonstrates how effective flooding is as a treatment for phobias.

• A disadvantage of flooding is that it is a highly traumatic experience and many patients might be unwilling to continue with the therapy until the end. Time and money might be wasted preparing patients for the flooding experience, and then the patient might decide that they do not want to take part or complete the treatment, and their phobia remains uncured. Because flooding is traumatic it is unsuitable for children.

Question 23

Behavioural characteristics of depression

Answer 23

Change in Activity Levels: Some people with depression experience lethargy (lack of energy) and withdrawal from activities that were once enjoyed (anhedonia). They may also neglect personal hygiene. Other people with depression experience increased activity levels/agitation.

Disruption to Sleep: Depression is often characterised by constant insomnia whereby they have difficulty falling asleep and staying asleep. Alternatively they might require large amounts of sleep and they might oversleep (hypersomnia).

Disruption to Eating Behaviour: Significant increase or decrease in weight is associated with depression. Some people might eat a great deal when they are depressed and therefore put on weight. Other people have a reduced appetite and eat very little, and therefore lose weight.

Aggression: Sufferers of depression are often irritable and they can become physically or verbally aggressive. They might also be physically aggressive towards themselves in the form of self-harming, such as cutting themselves or attempting suicide.

Question 24

Emotional characteristics of depression

Answer 24

Low Mood: A key characteristic of depression is the ever present and
overwhelming feelings of sadness/hopelessness and feeling empty.

Feelings of Worthlessness: Sufferers of depression often have constant feelings of reduced worth and/or inappropriate feelings of guilt. They might also experience very low levels of self-esteem.

Anger: The person might feel anger towards others, or towards themselves. Depression may arise from feelings of being hurt and wishing to retaliate.

Question 25

Cognitive characteristics of depression

Answer 25

Negative Schema: Depressed people often have a negative view of the world, themselves and the future. This leads to the self-fulfilling prophecy whereby if you expect negative things to happen, they will happen because you make them happen. Positive factors in their life will be ignored.

Poor Concentration: There can be difficulty in paying/maintaining attention, and the person might feel that they cannot stay on task for long periods of time. They might have slower thought processes than normal and difficulty making decisions. Depressed people will also have trouble retrieving memories.

Question 26

The negative triad

Answer 26

Beck (1967) believed that depressed people have acquired a negative schema (cognitive framework that helps us organise and interpret information and make sense of new information) during childhood and so have a tendency to adopt a pessimistic view of the world. This may be caused by a number of factors, including parental/peer rejection and criticism from teachers.

These negative schemas (e.g. expecting to fail) are activated whenever the person encounters a new situation (e.g. an exam) that resembles the original conditions in which the schema was learned. Negative schemas lead to cognitive biases in thinking. For example, overgeneralisations (e.g. ‘I am stupid’) on the basis of one small piece of negative feedback (e.g. failing one class test).

Negative schemas and cognitive biases maintain the negative triad. This is an irrational view of three elements in the person’s belief system.
 The Self (‘There is nothing to like about me, I am boring’).
 The World (‘Nobody likes me, everyone would prefer someone else’s
company’).
 The Future (‘I am always going to be on my own, nobody will ever love
me’).

Question 27

The negative triad AO3 (1p,2n)

Answer 27

+ There is a great deal of supporting evidence to suggest that negative and irrational thinking causes depression. Terry (2000) assessed 65 pregnant women for cognitive vulnerability before and after they gave birth. It was found that women who had a high cognitive vulnerability (they thought negatively) were more likely to suffer post-partum depression. This supports the cognitive approach that negative thinking can cause depression.

• Cause and effect is not clear. Can we say that negative and irrational thoughts cause depression to develop; or could we say that depression develops first (from a different source e.g. genetics) and then this causes the patient to think in a negative and irrational way?
• The negative triad can be criticised, because it does not explain how some symptoms of depression might develop. Some depression patients are very angry and Beck’s theory fails to account for this. Beck’s theory also does not explain the manic phases experienced by patients with Bipolar Disorder.

Question 28

ABC model

Answer 28

Ellis (1962) proposed that depression is caused by irrational beliefs. He devised
the ABC model to explain how irrational and negative beliefs are formed.

A = Activating Event: An incident in someone’s life (e.g. getting fired from
work).

B = Beliefs: The thoughts that occur after the activating event. These could be rational (e.g. ‘the company was overstaffed’) or irrational (e.g. ‘they have always had it in for me’).

C = Consequences: The emotions that are caused by these beliefs. Rational beliefs are likely to lead to healthy emotions (e.g. acceptance), whereas irrational beliefs are likely to lead to unhealthy emotions (e.g. depression).

Question 29

ABC model AO3 (2p,2n)

Answer 29

+ There is research to support the idea of the ABC model as a cause of depression. Bates (1999) found that depressed participants who were given negative thought statements became more and more depressed; supporting the view that negative thinking helps to cause depression.

+ practical application - can be applied to CBT in treating depression which has been found to be successful

• Although the ABC model gives the client some power to change the situation and improve their symptoms of depression; it blames the client for the depression.
• doesn’t explain the origins of irrational thoughts - is depression a cause or consequence of irrational beliefs

Question 30

Beck’s CBT

Answer 30

The first step it to identify irrational thoughts, this is known as thought- catching. The patient is then encouraged to generate a hypothesis to test the validity of their irrational thoughts, this is known as patient as scientist.

Several strategies are used in CBT to test patient’s hypothesis. The patient may be asked to gather data about behaviour and incidents and then compare the evidence with their hypothesis to check whether they match. The patient may also be asked to complete homework assignments in between therapy sessions to test irrational thoughts out in the real world and then evaluate the evidence. Patients could be asked to keep a diary to record events and identify situations in which negative thinking occurs so these can be targeted.

When patients report positive thoughts they are praised by the therapist, which provides positive reinforcement.

The aim of this therapy is cognitive restructuring; learning to identify, dispute, and therefore change, irrational thoughts.

Question 31

Rational emotive behavioural therapy.

Answer 31

Ellis (1994) developed a CBT therapy for depression called Rational Emotive Behavioural Therapy (REBT). This therapy aims at challenging automatic negative thoughts and replacing them with rational beliefs.

The therapist uses logical arguments to show patients that their self-defeating beliefs do not logically follow from the information available (e.g. just because your friend does not say hello to you does not mean they hate you, it could be that they just didn’t see you).

The therapist also uses empirical arguments to show patients that their self- defeating beliefs are not consistent with reality (e.g. it does not make sense to believe everyone hates you when they keep inviting you out for dinner).

Patients undertaking REBT are encouraged to engage in behavioural activation; becoming more active and taking part in pleasurable activities. Many depressed patients often do not engage in activities that they used to enjoy.

Question 32

Cognitive behavioural therapy AO3 (2p,3n)

Answer 32

+ March et al. (2007) found that CBT was as effective as antidepressants in treating depression. The researchers examined 327 adolescents with depression. They looked at the effectiveness of CBT, anti-depressants and a combination of the two. After 36 weeks, 81% of the anti-depressant group and 81% of the CBT group significantly improved. However, 86% of the combination group had significantly improved. This suggests that a combination of CBT and anti-depressants is the most effective treatment.

+ David (2008) found that CBT is a better treatment for depression in the long- term than anti-depressants. He compared 170 patients with depression who had 14 weeks of CBT with patients who were treated with the drug fluoxetine. Six months later it was found that patients who had received CBT were less likely to have relapsed.

• One issue with CBT is that it requires commitment and motivation. Patients with severe depression may not engage with CBT, or even attend the sessions, and therefore this treatment will be ineffective in treating these patients. Alternative treatments, for example, anti-depressants, do not require the same level of motivation and may be more effective in these cases.
• CBT attempts to address the cause of depression as it assumes that the root cause of depression is irrational thought processes. However, psychologists have criticized CBT, as it suggests that a person’s irrational thinking is the primary cause of their depression and therefore ignores other factors or circumstances that might contribute to a person’s depression. For example, a patient who is suffering from domestic violence or abuse does not need to change irrational thoughts, but in fact needs to change their circumstances. Therefore CBT would be ineffective in treating these patients until their circumstances have changed.
• CBT relies on patients self-reporting their thoughts as thoughts cannot be objectively observed or measured. These self-reports could be unreliable and it is difficult to verify if they are accurate or not.

Question 33

Behavioural characteristics of OCD

Answer 33

Compulsions: Compulsions are repetitive actions that could seriously hinder the person’s ability to perform everyday functions. Compulsive behaviours reduce anxiety that is created by obsessions. The person feels they must perform these actions otherwise something dreadful might happen. The person may wash their hands over and over again so that they are very late for work.

Avoidance: Some sufferers of Obsessive Compulsive Disorder (OCD) attempt to reduce their anxiety by avoiding situations that might trigger it. Sufferers who wash their hands continuously might avoid coming into contact with germs by never empting their bins.

Question 34

Emotional characteristics of OCD

Answer 34

High Anxiety: The obsessions and compulsions are a source of considerable anxiety and distress. Sufferers are aware that their obsessions and compulsive behaviours are excessive and this causes feelings of embarrassment and shame. Sufferers might also be aware that they cannot consciously control their compulsive behaviours, which leads to strong feelings of distress.

Disgust: Feelings of disgust may be directed against something external like dirt, germs or the self.

Question 35

Cognitive characteristics of OCR

Answer 35

Obsessions: These are recurrent, intrusive, irrational thoughts that are perceived as inappropriate or forbidden. They may be frightening or embarrassing and the person might not want to share them with others. Common obsessions include doubts (have they checked the cooker is switched off?) impulses (to shout and swear in public) or images. These obsessions are not worries about everyday problems; instead they are uncontrollable and cause anxiety.

Awareness that Behaviour is Irrational: Most sufferers understand their compulsive behaviours and obsessive thoughts are inappropriate and irrational, but they cannot consciously control or stop them.

Catastrophic Thinking – People with OCD are scared that something terrible will happen if they do not carry out their compulsion.

Question 36

Genetic explanations of OCD

Answer 36

OCD has been classed as polygenic; this means that one single gene is not responsible for the disorder. Instead, as many as 230 genes might be responsible for causing OCD; and they are known as candidate genes.

The COMT gene may have a role in causing OCD. This gene regulates the production of a neurotransmitter called dopamine, which in high levels is associated with OCD. One variation of the COMT gene results in higher levels of dopamine. This variation has been found to be more common in OCD patients than in people who do not have the disorder.

A second gene which has been implicated in OCD is the SERT gene. This gene affects the transportation of serotonin, causing lower levels of serotonin. Low levels of serotonin have been linked to OCD (and depression).

Question 37

Genetic explanations for OCD AO3 (2P,1N)

Answer 37

+ Nestadt (2000) supports the genetic explanation for OCD. He found that people who had a first-degree relative who already had OCD were five times more likely to also get the disorder.

+ Billett (1998) supports the idea that OCD is transmitted genetically. He found from a meta-analysis of 14 twin studies that OCD is twice as likely to be concordant (inheriting the same disorder) in identical (monozygotic) twins compared with non-identical (dizygotic) twins.

• A criticism of the genetic explanation is that the concordance rate for OCD in identical twins is not 100%. Therefore OCD cannot be caused entirely by genetic factors.

Question 38

Neural explanations for OCD

Answer 38

Dopamine and serotonin are neurotransmitters that affect mood. Abnormal levels of these neurotransmitters are associated with abnormal transmission of mood-related information.

OCD sufferers have high levels of dopamine. High dopamine levels have been linked to over hyperactivity in the basal ganglia area in the brain. This causes repetitive motor functions (e.g. compulsions).

Serotonin plays a key role in operating the caudate nucleus in the basal ganglia of the brain, and it seems that low levels of serotonin cause the caudate nucleus to malfunction. In particular low levels of serotonin result in obsessions.

Question 39

Neural explanations for OCD AO3 (1p,2n)

Answer 39

+ Anti-depressant drugs increase serotonin levels in OCD patients, and this has lead to a reduction in OCD symptoms. Therefore there is good evidence to suggest that low levels of serotonin could be a cause for OCD.

• A disadvantage of the neural explanations of OCD is that neurotransmitters such as dopamine and serotonin might not necessarily cause OCD. Instead low levels of serotonin and high levels of dopamine might be a symptom of OCD.
• shouldn’t assume that neural mechanisms cause OCD

Question 40

Drug therapy for OCD

Answer 40

The biological approach uses medication to increase or decrease levels of neurotransmitters, or the activity of neurotransmitters, in the brain. The general purpose is to decrease anxiety, lower arousal, and lower blood pressure and decrease heart rate.

Question 41

SSRIs

Answer 41

One method of treating Obsessive Compulsive Disorder (OCD) is anti- depressant drugs called Selective Serotonin Re-Uptake Inhibitors (SSRIs). SSRIs (e.g. Prozac and Fluoxetine) work on the serotonin system in the brain.

Serotonin is released by presynaptic neurons (brain cells) and travels across the synaptic cleft (gap between neurons). It chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron and is then reabsorbed (re-uptake) by the presynaptic neuron, where it is broken down and reused.

SSRIs prevent the reabsorption and breakdown of serotonin and so increase the level of serotonin in the synapse, where it continues to stimulate the postsynaptic neuron. The effect of this should be to reduce anxiety.

Question 42

SSRI AO3 (2P,1N)

Answer 42

+ Soomro (2009) reviewed 17 studies that compared SSRIs to placebo drugs for treating OCD and found that all 17 studies showed that SSRI drugs were more effective than placebos, especially when SSRIs were combined with Cognitive Behavioural Therapy (CBT).

+ 70% of patients have experienced a decline in OCD symptoms when taking SSRIs. The remaining 30% of patients tend to opt for psychological therapies or a combination of SSRIs and psychological therapies.

• A problem with SSRIs is that they have severe side effects which might mean that the OCD patient might stop taking the medication. Side effects are temporary but include indigestion, blurred vision and loss of sex drive.

Question 43

Benzodiazepines

Answer 43

Anti-anxiety drugs, such as Benzodiazepines (BZ), are commonly used to treat OCD. BZs (e.g. Valium and Diazepam) slow down the activity of the central nervous system by enhancing the activity of the neurotransmitter GABA. This neurotransmitter has an inhibitory effect on neurons.

GABA does this by reacting with special sites called GABA receptors on the outside of neurons. When GABA locks into these receptors it opens a channel that increases the flow of chloride ions into the neuron. Chloride ions make it harder for the neuron to be stimulated by other neurotransmitters, thus slowing down neural activity and making a person feel more relaxed.

Question 44

Benzodiazepines AO3 (1p, 1n )

Answer 44

+ BZ drugs can begin to reduce anxiety levels and OCD symptoms in a short period of time, especially compared to other treatments like CBT, so that the patient experiences immediate relief.

• If BZ drugs are used long-term then several unwanted side effects can begin to appear, examples include drowsiness, depression and unpredictable interactions with alcohol. Ashton (1997) found that long- term users of BZ became very dependent on the drug and a sudden withdrawal of the drug leads to a return of high levels of anxiety and OCD symptoms. There is also the problem of tolerance whereby patients need to take larger and larger doses of the drug in order to reduce their OCD symptoms because their body gets used to the drug.