1. OCD – Therapies

2. OCD – Biological Therapies

3. 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.

4. 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.)

5. 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)

6. 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.

7. 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.

8. Ethics and Chemotherapy – A Mind Map

9. 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.

10. 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

11. 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

12. 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.

13. Ethics and Psychosurgery – Mind Map Continued

14. 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.

15. OCD – Psychological Therapies The long term answer to OCD?

16. 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.

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

18. 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.

19. Mode of action.  https://www.youtube.com/watch?v=wvodgCQ5F-0 (watch this for a demo) https://www.youtube.com/watch?v=wvodgCQ5F-0  https://www.youtube.com/watch?v=wvodgCQ5F-0 (watch this for a demo) https://www.youtube.com/watch?v=wvodgCQ5F-0  Psychiatrist identifies list of target symptoms using Y-BOCS  List of items ranked by patient from least to most anxiety provoking.  13-20 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.  13-20 weekly sessions (average)  Sometimes monthly booster sessions set up to prevent relapse.

20. 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”).

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

22. 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.

23. 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).

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