Learning Objectives

1. Learning Objectives • ALL will understand biological explanations and treatments for OCD • MOST will be able to explain biological explanations and treatments for OCD • SOME will be able to explain and evaluate biological explanations and treatments for OCD DO NOW: look at the PSYB2 paper on your desk, would you be confident on which sections you ought to answer?

2. What’s changed? • Nothing which you have been taught is ‘wrong’ it can all still be used as evaluation in your essays • What has changed is that the exam board want you to know for OCD only bio and cog explanations and treatments • These should be the explanations and treatments you should focus on for your revision as you could be asked about them directly

3. OCD re-cap • With the person next to you write down two symptoms which a person diagnosed with OCD would have.

4. Biological explanation of OCD: A01 • This breaks down into 3 components: • Genetic • Biochemical • Neurophysiological

5. Biological explanation of OCD: A01 • This breaks down into 3 components: • Genetic • It has been proposed that there is a genetic component to OCD which means some individuals might be more likely to get it according to their family history of anxiety disorders • McKeon and Murray (1987) found that patients with OCD are more likely to have an immediate (first degree) relative with an anxiety disorder suggesting a genetic link • Pauls et al (1995) found a much higher percentage of OCD sufferers (10.3%) in relatives of patients with OCD than in a control group without OCD (1.9%)

6. Biological explanation of OCD: A01 • This breaks down into 3 components: 2. Biochemical • OCD only responds to those drugs that affect serotonin; this suggests that OCD is related to low levels of the neurotransmitter serotonin in the brain. • Drugs which increase the amount of serotonin known as ‘SSRIs’ reduce OCD symptoms, therefore providing support for the theory that low levels of serotonin may be responsible for OCD.

7. Biological explanation of OCD: A01 • This breaks down into 3 components: 3. Neurophysiological • Neuroimaging techniques (e.g. PET scans) have shown that a part of the brain known as the basal ganglia may have a part to play in OCD. • Rapoport and Wise (1988) suggested that hypersensitivity of the basal ganglia gives rise to repetitive motor behaviours such as those found in OCD patients, e.g. repetitive handwashing.

8. Biological explanation of OCD: A02 • Genetic explanation evaluation • (-) findings from family studies used to support the genetic explanation could be explained by environmental influences, e.g. observing and imitating behaviour shown by relatives (SLT)

9. Biological explanation of OCD: A02 • Biochemical explanation evaluation • (-) Studies on SSRIs which increase levels of serotonin only report a 50% improvement in symptoms suggesting that there are other explanations of OCD • (-) There is a time delay before any improvement in OCD is noticed, taking SSRI medication doesn’t improve symptoms for 4-12 weeks

10. Biological explanation of OCD: A02 • Neurophysiological explanation evaluation • (-) evidence for structural abnormality in the basal ganglia is inconsistent. Aylward et al (1996) found no significant differences in the basal ganglia structures of OCD patients and controls.

11. Past Paper Short Answer Questions which have come up on the biological explanation of OCD • January 2009 (b) Outline one of the biological explanations for obsessive-compulsive disorder. (3 marks) • Answer this now to test your knowledge and understanding

12. January 2009(b) Outline one of the biological explanations for obsessive-compulsive disorder. (3 marks) • Likely answers for genetic, biochemical and physiological explanations: • Genetic explanation: some people are genetically predisposed to develop the disorder. Support for the proposal from family studies which indicate that first degree relatives of OCD sufferers are more likely to also exhibit the disorder. • Biochemical explanation: treatment with drugs which increase serotonin levels results in improvement suggesting that low levels of serotonin are a cause of OCD. • Physiological explanation: basal ganglia is an area of the brain responsible for psychomotor functions, some researchers have suggested that OCD sufferers might have hypersensitivity of the basal ganglia which results in repetitive movements

13. Biological Treatments for OCD: A02 points • SSRIs are a group of anti-depressant medications which are the most widely prescribed drugs for anxiety disorders. • SSRIs increase the levels of the neurotransmitter serotonin in the brain by preventing the reabsorption of serotonin at synapses (spaces between nerve cells). Because depression frequently accompanies OCD, SSRIs are particularly beneficial for this anxiety disorder. • MAOIs are an older type of anti-depressant which are sometimes used for those who gain no benefit from SSRIs • http://www.youtube.com/watch?v=HryOhK4E7aU

14. Biological Treatments for OCD: A02 points • Evaluation of biological treatments of OCD • (+)SSRIs are easily tolerated and are safe, even for older patients. They are not addictive and can be used in the long-term. • (+) Drug treatment is quicker and cheaper than psychological therapies

15. Biological Treatments for OCD: A02 points • (-) SSRIs cause side effects (headaches, nausea, sexual dysfunction), there can be relapse when coming off the medication • (-) SSRIs take 4-12 weeks before any therapeutic effect is noticed, this, together with side effects, this can cause people to stop taking the medication • (-) MAOIs are effective but they are last in line to be used for treatment due to side effects e.g. weight gain, sexual dysfunction. • (-) A serious rise in blood pressure can occur when MAOIs are combined with foods containing the amino acid tyramine found in certain foods e.g. cheese, wine.

16. Biological treatments: Essay • Describe and evaluate two therapies for obsessive-compulsive disorder. (10 marks) • If this type of question comes up your A01 must consist of bio and cognitive treatments • You can use what we have learnt for A02 as part of the comparison • You should bullet point your A01s and A02s for this question now, you can complete it fully once we cover cognitive treatments next week

17. Describe and evaluate two therapies for obsessive-compulsive disorder. (10 marks) • [AO1 = 5, AO2 = 5] • AO1 • Up to 5 marks for description of two of the following possible therapies. Likely points • include: • Drug therapy – treatment of anxiety by use of drugs that increase serotonin levels, eg SSRIs. Other effects of these drugs on orbital frontal cortex. • Cognitive therapy – procedures: describing misinterpretation of thoughts, raising awareness, use of ritual to neutralise obsessions, habituation training. • Combined behaviour and cognitive therapy described O’Kearney (1993). • Credit description of evidence up to 1 mark. • AO2 Up to 5 marks for discussion and evaluation of the therapies. Likely discussion points • include: • Drug therapy: improvement found in 50-80% cases Julien (2005), reduction of symptoms not elimination, relapse when drugs not taken, dual approach with other therapy eg ERP effective and reduced need for surgery. • Cognitive therapy: how cognitive strategies work, effectiveness Rufer et al (2005) • Credit use of evidence. • Maximum 6 marks if only one therapy • Maximum 6 marks if no explicit link to OCD

18. Learning Objectives • ALL will understand biological explanations and treatments for OCD • MOST will be able to explain biological explanations and treatments for OCD • SOME will be able to explain and evaluate biological explanations and treatments for OCD Write down on your post-it note 3 things you have learnt and 1 question you still have