1. OCD REVISION CAROUSEL

2. What do you need to know for the exam?
The behavioural, emotional and cognitive characteristics of phobias, depression and obsessive compulsive disorder (OCD).
The biological approach to explaining and treating OCD: Genetic and neural explanations and drug therapy.

3. Carousel Activity There are 3 stations around the room…
What is OCD? B/E/C characteristics
Explaining OCD using the biological approach – Neural
Explaining OCD using the biological approach – Genetic
Treating OCD using the biological approach – Drug therapy
Take your exam questions with you and complete them as you go around the stations.

4. Station 1 What is OCD?

5. obsession
An obsession is an unwanted and unpleasant thought, image or urge that repeatedly enters a person's mind, causing feelings of anxiety, disgust or unease.
Forbidden or inappropriate ideas and visual images that aren’t based on reality, such as being convinced germs are lurking everywhere, leading to anxiety.
– EXTREME OCD CAMP
– OCD the war inside

6. compulsion
intense uncontrollable urges to repetitively perform tasks and behaviours like washing hands to get rid of germs.
Compulsions are an attempt to reduce distress or prevent unwanted feared events.
Most sufferers realise their compulsions are excessive but cannot do anything to control them, resulting in further anxiety.
– EXTREME OCD CAMP
– OCD the war inside

7. Obsessive compulsive disorder
Obsessions
Things people think about
Compulsions
What people do as a result of the obsessions

11. Station 2 Bio explanation Genetic

12. OCD – Genetic Explanations AO1
It has been proposed that there is a genetic component to OCD which predisposes some individuals to the illness
“genetic vulnerability not certainty”
Candidate genes are ones which, through research, have been implicated in the development of OCD.
A possible candidate gene is the SERT gene which is involved in regulating serotonin, a neurotransmitter which facilitates message transfer across synapses, causing lower levels of serotonin, hence, causing OCD.
Another possible candidate gene is the COMT gene. This regulates the production of dopamine, which may result in higher levels of dopamine, this variation of the COMT gene is more common in OCD patients. Dopamine effects motivation and drive.
OCD is thought to be polygenic – this means that its development is not determined by a single gene but a few (maybe as many as 230 genes) – this means that there is little predictive power from this explanation.
The COMT gene is associated with the production of , which regulates the neurotransmitter dopamine. One variation of the COMT gene results in higher levels of dopamine and this variation is more common in patients with OCD, in comparison to people without OCD.
A second gene which has been implicated in OCD is the SERT gene (also known as the 5-HTT gene). The SERT gene is linked to the neurotransmitter serotonin and affects the transport of the serotonin (hence SERotonin Transporter), causing lower levels of serotonin which is also associated with OCD (and depression)

13. OCD – Genetic Explanations AO3
P: The role of genetic factors is supported by family studies of OCD
E: Evidence from Pauls et al- there is a much higher percentage of OCD sufferers in relatives of patients with OCD than in the control group without OCD.
E: therefore this suggests that OCD does have a genetic basis and genes that cause OCD can be passed down through families.
L: This therefore increases the truth of the explanation as there is supporting evidence to support the explanation.
The COMT gene is associated with the production of , which regulates the neurotransmitter dopamine. One variation of the COMT gene results in higher levels of dopamine and this variation is more common in patients with OCD, in comparison to people without OCD.
A second gene which has been implicated in OCD is the SERT gene (also known as the 5-HTT gene). The SERT gene is linked to the neurotransmitter serotonin and affects the transport of the serotonin (hence SERotonin Transporter), causing lower levels of serotonin which is also associated with OCD (and depression)

14. OCD – Genetic Explanations AO3
E:This explanation solely explains OCD through biological explanations, ignoring environmental influences.
E: Individuals may gain a vulnerability towards OCD through genes that is then triggered by an environmental stressor.
E:Cromer (2007) found that over half the OCD patients in their sample had a traumatic event in the past, and that OCD was more severe in those with more than one trauma.
L:This means that it may more productive to focus on environmental causes as it seems that not all OCD is entirely genetic in origin
The COMT gene is associated with the production of , which regulates the neurotransmitter dopamine. One variation of the COMT gene results in higher levels of dopamine and this variation is more common in patients with OCD, in comparison to people without OCD.
A second gene which has been implicated in OCD is the SERT gene (also known as the 5-HTT gene). The SERT gene is linked to the neurotransmitter serotonin and affects the transport of the serotonin (hence SERotonin Transporter), causing lower levels of serotonin which is also associated with OCD (and depression)

15. Station 3 Bio explanation Neural

16. OCD – Neural Explanations AO1 - Neurotransmitters
The role of serotonin – depleted levels
Neurotransmitter which regulates everything from mood, anxiety, to memory, to sleep
Neurotransmitters relay information from one neuron to the other.
If a person has low levels of serotonin then normal transmission of mood-relevant information doesn’t take place
Therefore mood and other mental processes are affected
At least some cases can be explained through this
Medications such as SSRIs which increase serotonin are used to treat OCD – supporting that this could be the cause.

17. Neural explanations abnormal brain functioning –AO1
OCD can be associated with impaired decision making
This may be associated with abnormal functioning of the frontal lobes of the brain - Frontal lobes are responsible for logical thinking and making decisions.
Other brain areas believed to be involved in OCD include the orbitofrontal cortex (OFC) and the thalamus.

18. The orbital frontal cortex
Neural explanations abnormal brain functioning –AO1
The OFC is involved in decision making and worry about social and other behaviour. In OCD the OFC and the thalamus are believed to be overactive.
An overactive thalamus would result in an increased motivation to clean or check for safety. If the thalamus was overactive the OFC would also become overactive as a result.
An overactive OFC would result in increased anxiety and increased planning to avoid anxiety.
The orbital frontal cortex

19. OCD – Neural Explanations AO3
There is evidence to support the role of some neural mechanisms in OCD. For example antidepressants work purely on the serotonin system, increasing levels of neurotransmitter. Such drugs are effective in reducing OCD symptoms and this suggests the serotonin system is involved in OCD.
Studies of decision making have shown that these neural systems are the same systems that function abnormally in OCD. However, research has also identified other brain systems that may be involved sometimes but no system has been found that always plays a role. We therefore, cannot really claim to understand the neural mechanisms involved in OCD.

21. Station 3 Biological treatment of ocd

22. SSRIS = treatment of ocd
Selective serotonin reuptake inhibitors (anti- depressants)
SSRIs work on the serotonin system in the brain
SSRIs prevent reabsorption between synapses by blocking receptor sites.
This leaves serotonin in the synaptic gap for longer, hence increasing the effects of serotonin.
Continues to stimulate postsynaptic neuron, which compensates for the disturbances in the serotonin system for OCD.
– how do SSRIs work?

23. SSRIS = treatment of ocd
When serotonin is released from the pre-synaptic cell into the synapse, it travels to the receptor sites on the post-synaptic neuron. Serotonin which is not absorbed into the post-synaptic neuron is reabsorbed into the sending cell (the pre-synaptic neuron). SSRIs increase the level of serotonin available in the synapse by preventing it from being reabsorbed into the sending cell. This increases level of serotonin in the synapse and results in more serotonin being received by the receiving cell (post- synaptic neuron).
– how do SSRIs work?

25. Alternatives to ssriS
Tricyclics: Tricyclics are an older type of anti-depressant for example Clomipramine. These have the same effect on the serotonin system as SSRIs, they have more severe side effects so they are generally kept for patients that don’t respond to SSRIs
SNRIs: (serotonin-noradrenaline reuptake inhibitors). In the last 5 years, a different class of anti-depressant drugs called SNRIs have also been used to treat OCD. These are, for patients who don’t respond to SSRIs. SNRIs increase levels of serotonin as well as a different neurotransmitter – noradrenaline.
– how do SSRIs work?

26. Evaluation of drug treatment
P: A problem with using drug treatment to treat OCD is that they have lots of unpleasant side effects. E: For example, loss of appetite, dizziness and sleeping problems E: therefore, the treatment for OCD may decrease OCD sufferer’s quality of life rather than improving it. L: patients may stop taking the drug treatment, leading to a relapse in symptoms.

27. Evaluation of drug treatment
Drug therapy is effective at tackling OCD symptoms
There is clear evidence for the effectiveness of SSRIs in reducing the severity of OCD symptoms and so improving quality of life for OCD patients. Soomro et al (2009) reviewed studies comparing SSRIs to placebos in the treatment of OCD. He concluded that all 17 studies reviewed – showed significantly better results for the SSRIs than placebo conditions. Symptoms decline for around 70% of patients taking SSRIs.

28. Evaluation of drug treatment
Drugs are cost effective and non-disruptive
An advantage of drug treatments in general are that they are cheap compared to psychological treatments. Using drugs to treat OCD is therefore it is good value for the NHS and has impacts for the economy. Compared to psychological therapies SSRIs are non-disruptive to patient’s lives. You can simply take the SSRIs until symptoms decline without having to engage with psychological therapy which can often be time consuming and has long waiting lists

29. Questions on drug treatment
“Outline and evaluate the biological approach to treating OCD” (12/16)

30. Time yourself:
3 minutes
Time yourself:
6 minutes

31. Answer:
Obsessions are intrusive thoughts
Compulsions are repetitive actions

32. Answer:
OCD is at least partly genetic according to the study above as a 45-65% concordance rate was found in 4000 pairs of twins. However, we do need to consider other factors as it is not 100%. Factors such as environment, learnt behaviour etc.

33. Time yourself:
3 minutes

34. Answer:
Cognitive characteristic – ‘I think I might catch it and die’ This shows what Steven thinks about catching illnesses in a public place.
Behavioural characteristic – ‘ I have to get away and clean myself quickly.’ This shows how Steven behaves to avoid catching illnesses in a public place.