Psychopathology L13 - The Biological Approach To Treating OCD - Drug Therapy

Question 1

Two drugs used for treatments

Answer 1

-SSRI drugs (Anti-depressants)
-BZ drugs

Question 2

What does SSRI stand for

Answer 2

Selective Serotonin Re-uptake Inhibitors

Question 3

What does BZ stand for

Answer 3

Benzodiazepines

Question 4

SSRI examples

Answer 4

Prozac & Fluoxetine

Question 5

What do SSRI drugs do?

Answer 5

• SSRI drugs aim to prevent the reuptake of serotonin and prolong its activity in the synapse
• This means the person will feel less anxious and have a higher level of serotonin available
• Therefore drugs are given to OCD patients that will increase serotonin levels and help to regulate mood and reduce anxiety levels
• Increasing serotonin via SSRI drugs will also help to normalize and reduce the “worry circuit”
• High levels of serotonin provided by SSRI drugs help the orbital frontal cortex to function at normal levels.
• SSRI drugs will help stabilize moods and emotions and improve memory (therefore will reduce compulsive behaviour and checking)

Question 6

How long are SSRI drugs given for?

Answer 6

Prescribed for 12-16 weeks

Question 7

What’s a synapse

Answer 7

A small gap at the end of a neurone that allows an electrical/chemical signal to transmit from one neurone to the next

Question 8

What’s the orbital frontal cortex?

Answer 8

A region of the brain that’s involved in processing rewards/punishments, involved in cognitive processing

Question 9

What happens if there are low serotonin levels

Answer 9

• Low levels of serotonin are implicated in the, “worry circuit” whereby damage to the caudate nucleus in the brain fails to suppress minor worry signals
• A message is then sent to the orbital frontal cortex and the worrying and anxiety get worse

Question 10

What does SNRI stand for

Answer 10

Selective Norepinephrine Reuptake Inhibitors

Question 11

What is SNRI

Answer 11

• a new type of drug that increase serotonin and noradrenaline/norepinephrine
• These drugs are suitable for OCD patients that cannot tolerate SSRI drugs
• Norepinephrine/noradrenaline is a neurotransmitter released from the sympathetic nervous system in response to stress. It aims to mobilize the brain and body for action
• SNRI’s act on the reuptake of noradrenaline/norepinephrine

Question 12

SSRI evaluation

Answer 12

strengths
Research support
Relatively effective
Relatively cheap/cost effective
weaknesses
Don’t work for all patients
Side effects
Critisied use of them

Question 13

Research support (SSRI)

Answer 13

• There is supporting evidence that SSRI’s are an effective treatment for OCD
• Soomro (2009) reviewed 17 studies that compared SSRI’s to placebo drugs for treating OCD and found that all 17 studies showed that SSRI drugs were more effective than placebos, especially when SSRI’s were combined with CBT

Question 14

Relatively effective

Answer 14

• An advantage of SSRI drugs is that they are relatively effective and 70% of patients have experienced a decline in OCD symptoms when taking them
• However, the remaining 30% of patients tend to opt for psychological therapies or a combination of SSRI’s and psychological therapies for treating their OCD, which meant that maybe SSRI drugs are most effective if combined with other treatments too?

Question 15

Relatively cheap/cost effective

Answer 15

• SSRI’s have the benefit of being relatively cheap and cost effective in comparison to psychological therapies, such as CBT, counselling or family therapy
• Using SSRI drugs to treat OCD is good value for money for the NHS, and is economical compared to other treatments

Question 16

Don’t work for all of them

Answer 16

• SSRI’s can be criticised because they do not work for all OCD patients
• For some patients SSRI drugs will not alleviate their OCD symptoms and they will have to take an alternative drug such as tricyclics instead which might be more effective for them

Question 17

Side effects

Answer 17

• A problem with SSRI drugs is that they have terrible 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 18

Criticised use of them

Answer 18

• Koran (2007) has criticised the use of drugs and medication to help relieve OCD symptoms.
• Koran stated that drug therapy might be a common or popular treatment, but psychotherapies such as CBT should be tried first to help reduce OCD symptoms
• Drug therapy requires little effort and may be effective short term, but it does not provide a lasting cure for OCD, and many patients relapse within a few weeks if the medication is stopped

Question 19

BZ examples

Answer 19

Valium & Xanax

Question 20

What do BZ drugs aim to do?

Answer 20

• BZ drugs reduce anxiety and aim to control the action of neurotransmitters
• BZ drugs reduce the activity in the central nervous system and reduce brain arousal
• BZ aim to reduce blood pressure and reduce heart rate
• BZ aim to increase GABA (Gamma-Amino butyric Acid)

Question 21

How does BZ work?

Answer 21

• GABA is a neurotransmitter in the brain that slows down the firing of neurons and makes the person less anxious and calmer
• It helps to reduce physiological activity in the body
• BZ drugs bind to the GABA receptor site of the post synaptic neurone
• This increases the flow of chloride ions into the post synaptic neurone
• The chloride ions make it more difficult for the neuron to be stimulated by other neurotransmitters, thus slowing down its activity and making the person feel more relaxed
• Neurons in the brain become less active and the person feels calmer
• BZ help to reduce the anxiety that an OCD patient might experience when they are having their obsessional thoughts

Question 22

Disadvantage of BZ (AO1)

Answer 22

• BZ also decreases serotonin levels in the brain
• This means that the person has lower arousal and reduces anxiety, but they are less happy and are more likely to get depressed

Question 23

What’s a post synaptic neuron

Answer 23

A neurone that receives neurotransmitters/a signal

Question 24

Evaluation of BZ

Answer 24

strengths
Effective
Quicker and effective compared to other treatments
Short term without side effects
weaknesses
Long term has side effects
Become dependent
Cause impairment

Question 25

Effective

Answer 25

• A strength of BZ drugs is that they are very effective at reducing anxiety and OCD symptoms
• They are used by millions of people worldwide, so they are very good at reducing anxiety and OCD on a global basis

Question 26

Quicker and effective compared to other treatments

Answer 26

• BZ drugs have the advantages that they work very quickly and effectively to cure OCD symptoms compared to other psychological treatments (such as CBT)
• BZ drugs can begin to reduce anxiety levels and OCD symptoms in a short period of time so that the patient will see some immediate benefits of relief

Question 27

Short term without side effects

Answer 27

• BZ drugs have the strength that they can be used for short periods of time and they will produce hardly any real serious side effects unlike other types of drugs
• Therefore side effects are kept to a minimum with BZ (in the short term) and this is a good point for the OCD patient

Question 28

Long term has side effects

Answer 28

• However a problem of BZ drugs is that if they are used long term then several unwanted side effects can begin to appear, examples include drowsiness, depression and unpredictable interactions with alcohol
• Patients have a high chance of being involved in accidents
• Therefore BZ drugs should not be used as a long term treatment for OCD

Question 29

Become dependent

Answer 29

• Ashton (1997) found that BZ have their weaknesses
• 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 or drug escalation whereby patients need to take very large doses of the drug in order to reduce their OCD symptoms (if they take the drug for a long period of time)

Question 30

Cause impairment

Answer 30

• Stewart (2005) criticised long term use of BZ drugs as they cause impairment in speed and processing of verbal learning
• These effects are temporary but are still negative
• Stewart carried out a Meta analysis and found clear evidence that long term use of BZ leads to cognitive impairments
• Cognitive ability seems to improve once the BZ drugs are withdrawn, but the cognitive ability is still below that of control patients who have never taken BZ