OCD – Therapies

OCD – Biological Therapies

Chemotherapy – Antidepressants  Are the most commonly used drugs for reducing anxiety associated with OCD.  Recall, Serotonin regulates mood and anxiety. Low levels of it are associated with the “worry circuit” (see page 208)  There are two main types of drugs here: SSRIs and Tricyclics.  Are the most commonly used drugs for reducing anxiety associated with OCD.  Recall, Serotonin regulates mood and anxiety. Low levels of it are associated with the “worry circuit” (see page 208)  There are two main types of drugs here: SSRIs and Tricyclics.

Chemotherapy – Antidepressants  SSRIs  increase serotonin  Are effective compared to placebos (Soomro et al., 2008)  More long term studies need to be conducted (Koran et al.)  SSRIs  increase serotonin  Are effective compared to placebos (Soomro et al., 2008)  More long term studies need to be conducted (Koran et al.)

Chemotherapy – Antidepressants  Tricyclics  block re-uptake of serotonin and noradrenaline  Shown to be more successful than SSRIs (Koran et al., 2007)  Associated with more side effects (hallucinations and irregular heartbeat)  Tricyclics  block re-uptake of serotonin and noradrenaline  Shown to be more successful than SSRIs (Koran et al., 2007)  Associated with more side effects (hallucinations and irregular heartbeat)

Chemotherapy – Anti-anxiety drugs.  Anti-anxiety drugs (Benzodiazepines, D-Cycloserine) also reduce anxiety.  These drugs work by enhancing the activity of GABA (Gama-amino-butyric- acid)  GABA has a quietening effect on many neurons – this can result in relaxation.  GABA increases the flow of chloride ions into neurons, making stimulation harder.  Anti-anxiety drugs (Benzodiazepines, D-Cycloserine) also reduce anxiety.  These drugs work by enhancing the activity of GABA (Gama-amino-butyric- acid)  GABA has a quietening effect on many neurons – this can result in relaxation.  GABA increases the flow of chloride ions into neurons, making stimulation harder.

Chemotherapy – Evaluation in General  Most drugs have side effects  They are easy to take and require little motivation.  They are effective at reducing symptoms.  They do not treat the cause, and so relapse is likely.  Most drugs have side effects  They are easy to take and require little motivation.  They are effective at reducing symptoms.  They do not treat the cause, and so relapse is likely.

Ethics and Chemotherapy – A Mind Map

Psychosurgery  Part of the brain is damaged or stimulated to reduce undesirable symptoms (in this case anxiety)  Found to be effective in people who do not respond to drugs.  Part of the brain is damaged or stimulated to reduce undesirable symptoms (in this case anxiety)  Found to be effective in people who do not respond to drugs.

Psychosurgery – Different methods  The capsule and cingulum are both associated with emotion and are part of the limbic system. Capsulotomy and Cingulatomy are ablative procedures that involve removing these structures.  Dougherty et al. (2002) – 45% of cingulotomies were at least partially effective.  Korhan et al. (2007) – suggests this might be biased.  Sachdev and Hay (1995) – Suggests that the results of psychosurgery may be global on behaviour  The capsule and cingulum are both associated with emotion and are part of the limbic system. Capsulotomy and Cingulatomy are ablative procedures that involve removing these structures.  Dougherty et al. (2002) – 45% of cingulotomies were at least partially effective.  Korhan et al. (2007) – suggests this might be biased.  Sachdev and Hay (1995) – Suggests that the results of psychosurgery may be global on behaviour

Psychosurgery – Different methods  Deep brain stimulation involves placing wires in targeted areas od the brain and attaching them to an implanted battery pack.  The idea is to interfere with stimulation in the brain to reduce symptoms  Deep brain stimulation involves placing wires in targeted areas od the brain and attaching them to an implanted battery pack.  The idea is to interfere with stimulation in the brain to reduce symptoms

Psychosurgery – Different methods  Transcranial magnetic stimulation (TMS ) – an electromagnetic coil is used to pass electric current through the scalp to stimulate areas associated with OCD and mood regulation (like the frontal cortex)  Greenberg et al. (1997) – Showed significant reduction in compulsive urges  Rodrigues-Martin et al. (2003) – Showed that such success may be due to a placebo effect.  Transcranial magnetic stimulation (TMS ) – an electromagnetic coil is used to pass electric current through the scalp to stimulate areas associated with OCD and mood regulation (like the frontal cortex)  Greenberg et al. (1997) – Showed significant reduction in compulsive urges  Rodrigues-Martin et al. (2003) – Showed that such success may be due to a placebo effect.

Ethics and Psychosurgery – Mind Map Continued

Additional Evaluation  The biological approach may be reductionist (simple link between biology and OCD).  There are individual differences in how treatments effect people.  Real life application – the better we understand the effects of different treatment, the better we can improve conditions.  The biological approach may be reductionist (simple link between biology and OCD).  There are individual differences in how treatments effect people.  Real life application – the better we understand the effects of different treatment, the better we can improve conditions.

OCD – Psychological Therapies The long term answer to OCD?

Behavioural Therapy – Exposure and Response Prevention  Behavioural therapies are based on the premise that obsessions and compulsions are acquired and maintained with conditioning and that treatment should focus on reconditioning.  For example, Exposure and Response Prevention (ERP) therapy tries to recondition patients with OCD. There are two components to this: Exposure and Response Prevention.  Behavioural therapies are based on the premise that obsessions and compulsions are acquired and maintained with conditioning and that treatment should focus on reconditioning.  For example, Exposure and Response Prevention (ERP) therapy tries to recondition patients with OCD. There are two components to this: Exposure and Response Prevention.

Behavioural Therapy – Exposure  Exposure – involves forcing the patient to experience the stimulus and learn, through association with relaxation, that it no longer produces anxiety.

Behavioural Therapy – Response Prevention  Response prevention – Concurrently the patient is also prevented from engaging in their usual compulsive rituals. The idea is to learn that anxiety can be reduced without the compulsive ritual.

Mode of action.  (watch this for a demo)  (watch this for a demo)  Psychiatrist identifies list of target symptoms using Y-BOCS  List of items ranked by patient from least to most anxiety provoking.  weekly sessions (average)  Sometimes monthly booster sessions set up to prevent relapse.  Psychiatrist identifies list of target symptoms using Y-BOCS  List of items ranked by patient from least to most anxiety provoking.  weekly sessions (average)  Sometimes monthly booster sessions set up to prevent relapse.

Behavioural Therapy - Evaluation  Albucher et al. (1998). Between 60 and 90% improve considerably with ERP.  Huppert and Franklin (2005) – Improved effectiveness alongside cognitive therapies.  Foa et al. (2005) Effective when combined with medication.  Greist et al. (2002) Self directed ERP may be useful for mild OCD.  ERP is not as successful if patient is depressed or has hording behaviour.  Success relies heavily on patient commitment (and not all people do their “homework”).  There are major ethical issues here (see “blue box”).  Albucher et al. (1998). Between 60 and 90% improve considerably with ERP.  Huppert and Franklin (2005) – Improved effectiveness alongside cognitive therapies.  Foa et al. (2005) Effective when combined with medication.  Greist et al. (2002) Self directed ERP may be useful for mild OCD.  ERP is not as successful if patient is depressed or has hording behaviour.  Success relies heavily on patient commitment (and not all people do their “homework”).  There are major ethical issues here (see “blue box”).

Cognitive Therapy (CT)  Cognitive therapy focuses on changing thoughts (that produce behaviour). It aims to identify, challenge, and modify dysfunctional beliefs.

Cognitive Therapy (CT)  Obsessions- therapist questions patient’s interpretation of their beliefs so that they can change their thinking to reduce anxiety.  Compulsions- therapist questions the true value of compulsive behaviour so that a person can recognise that their beliefs are false (which may give them control over their behaviour.  Obsessions- therapist questions patient’s interpretation of their beliefs so that they can change their thinking to reduce anxiety.  Compulsions- therapist questions the true value of compulsive behaviour so that a person can recognise that their beliefs are false (which may give them control over their behaviour.

Cognitive Therapy (CT)  Patients are often expected to keep a journal of thoughts and compulsions ( a thought record) to discuss with their therapist.  This takes considerable effort and relies on the patient “doing their homework”  CT is rarely used on its own but still proven to be somewhat effective (Wilhelm et al., 2005).  Patients are often expected to keep a journal of thoughts and compulsions ( a thought record) to discuss with their therapist.  This takes considerable effort and relies on the patient “doing their homework”  CT is rarely used on its own but still proven to be somewhat effective (Wilhelm et al., 2005).

A HUGE POINT: The most effective treatments use a combined approach.