Psychopathology

What are the 4 definitions of abnormality?

• Statistical infrequency 

• Deviation from social norms

• Failure to function adequately 

• Deviation from ideal mental health 

What is statistical infrequency? An example of it

Statistical norms: any commonly seen behaviour 

Statistically infrequent: unusual behaviour  that is rarely seen is abnormal, doesn't fit with the normal distribution

E.g. intellectual disability disorder. When someone's IQ is in the bottom 2% of the population (below 70). Not considering the top 2% because intelligence is valued, although it’s still abnormal.

Evaluation for statistical infrequency

• Saying that anything that is statistically rare is abnormal, is stigmatizing even the people that fall above the average as well as below, because unusual characteristics can be positive. E.g. a high IQ is not necessarily a negative thing but by being stigmatised people with a high IQ may feel targeted and try to hide it. Therefore, this definition is socially sensitive because it can insight prejudice toward certain groups based on a score. Also, it doesn't mean a high IQ needs to be treated, which is what the definition is essentially saying

• A real life application of this definition is that it helps identify those who need medical help through statistical infrequency. E.g. Someone who is identified as in the bottom 2% of the distribution of the population in weight tells us they need extreme help quickly. It can offer them psychological and physical help to improve their health and move their statistics to be in line with the average. This has practical value in more fields than just IQ

Define deviation from social norms? An example

Deviation from social norms: Behaviour that is different from the accepted standards of behaviour in a society. Not the expected behaviour. Groups of people choose to define behaviour as abnormal if it offends their sense of the norm. Behaviour that goes against the unwritten rules of society 

Social norms: ways in which most people behave, established by a social group 

E.g. Antisocial personality disorder (APD): impulsive, aggressive, irresponsible, lacks empathy, fails to conform to lawful and culturally normative ethical behaviour

Evalaution for deviation from social norms

• This definition is subject to cultural relativism because social norms in one culture may be very different to that of another culture. E.g. There is an under diagnosis of schizophrenia in African countries because hallucinations and hearing voices are seen as connecting with ancestors rather than worrying symptoms of schizophrenia. The UK even has an over diagnosis of black people with schizophrenia. The only reason for this difference is that the social norms surrounding the diagnosis of schizophrenia are different, so we cannot make universal definitions or diagnostic criterias

• A limitation of this definition is that previous classifications of abnormality based on social norms aren’t temporally valid, and some people still base their assumptions on these terms. E.g. nymphomania which is when women were sexually attracted to working class men. Society has moved away from these historical social norms, but in doing so, have adopted new ways of classifying people as abnormal such as subconsciously judging women who are married to men of a lower social class, making this still relevant today. The norms of society have changed, but they are covertly still there

What is failure to function adequately? An example

Unable to cope with everyday life and its demands.
E.g. hoarding disorder, in order to have a diagnosis the individual must not be coping with everyday life as well as distress to self and/or others.

Criteria for diagnosis

• Not contributing to society adequately (unemployed)

• Irrationality (not thinking, impulsive)

• Not maintaining eye contact or respecting personal space

• Observer discomfort (make others comfortable)

Evaluation for failure to function adequately

• This is a deterministic definition because it suggests that doing certain behaviours means you are abnormal, but this may be normal behaviour for certain people. Some ‘dysfunctional’ behaviour can be functional and adaptive for the individual (not causing problems, doing them good). E.g. university students. The independent living habits may lead to bad hygiene, poor eating habits, lack of sleep. These are all characteristics of failing to function adequately, but in reality they are functioning fine because they are learning towards a degree

• Another limitation is that not all behaviours of this definition mean one is failing to function, like risk taking, but could mean a personality factor or a lifestyle choice that isn’t necessarily bad. E.g. people that go skydiving is seen as risky in that it threats their life, but it is not abnormal to do it and is therefore a limitation of this definition, as it is classing them as being strange when its a common behavior

What is deviation from ideal mental health?

Failing to have any one of Jahoda's criteria for good mental health. We have a picture of how we should be psychologically healthy and identify who differs from this ideal

What is Jahoda’s criteria for ideal mental health?

Jahoda’s criteria: if meet this, we have good mental health 

• Self actualisation: personal growth, becoming what capable of 

• Personal autonomy: independent, personal decisions, self-reliant

• Positive attitudes towards the self: self-respect, pos self-concept 

• Environmental mastery: capable all aspects of life, meet demands any sit, good relationships, adapt changing circumstances

• Accurate perception of reality: in a non-distorted way, objective/realistic

• Resistance to stress: effective coping strategies, cope everyday anxiety

Evaluation for deviation from ideal mental health

• A positive approach: a strength of the approach is that it adopts a more positive approach to defining abnormality. For example, it focuses on the ‘ideal’ - desirable, rather than undesirable behaviours, which has influenced the ‘positive psychology’ movement. This definition has therefore played an important role in the development of the Humanistic approach in psychology.

• Unrealistic criteria: A major criticism is that it is difficult to fulfil all 6 criteria. Additionally, some criteria are difficult to measure. E.g. environmental mastery. This means that it is an interesting concept, but not very usable when defining abnormality

Characteristics of phobias (behavioural, emotional, cognitive)

PEA,PAF,CIS

Phobia - an irrational fear of an object or situation. Immediate anxiety response. Fear is out of proportion to danger posed. Avoidance, extreme distress. 6 month duration. Life-limiting. Not caused by another disorder.

Behavioural characteristics

• Panic (uncontrollable physical response. Crying, screaming, running away, freezing)

• Avoidance (behavioural adaptations, unless making a conscious effort to face fear)

• Endurance (alternative to avoidance, remain in presence of phobic stimulus but still high anxiety) 

• Failure to function (inability to do normal necessary behaviours)

Emotional characteristics

• Fear

• Panic

• Anxiety (it is classed as an anxiety disorder, high arousal, fear = immediate response) E.g. arachnophobia, anxiety increases when sees a spider or place associated with spiders 

• Emotional responses are unreasonable. E.g. very strong emotional response to a spider is disproportionate to the danger posed by a spider

Cognitive characteristics

• Selective attention to the phobic stimulus (hard to look away, good when dangerous and keeps us safe, but not good if irrational as distracting 

• Irrational beliefs (e.g. i must always sound intelligent, pressure to perform well in social situations)

• Cognitive distortions -(seeing the phobic stimulus as distorted or different to how it actually looks, or visualising a situation that has not happened)

Characteristics on depression (behavioural, emotional, cognitive)

RAPI,ALL,PAD

Depression - a mental disorder characterised by low mood and low energy levels

Behavioural characteristics 

• Reduced energy levels (reduced energy/ lethargic. E.g. withdraw from school)

• Disruption to sleep and eating behaviour (insomnia, hypersomnia, inc/decr appetite, weight gain/loss)

• Aggression and self harm (irritable so may end relationship/ quit job, suicide attempts)

• Poor personal hygiene (lack of motivation)

Emotional characteristics

• Lowered mood (feeling lethargic and sad, worthless and empty)

• Anger (directed at others or self, lead to aggression or self-harm)

• Lowered self-esteem (like themselves less than usual, even self-loathing)

Cognitive characteristics 

• Poor concentration (can’t do tasks, hard to make decisions)

• Attending to and dwelling on the negative (pay attention to negatives, ignore positives, e.g. seeing half glass empty. Recall unhappy events rather than happy ones)

• Absolutist thinking (thinking in terms of all-good or all-bad, black and white thinking) 

Characteristics of OCD (behavioural, emotional, cognitive)

AC,AGA,COI

OCD - obsessive compulsive disorder. A condition characterised by obsessions and/or compulsive behaviour

Behavioural characteristics

• Repetitive compulsions (checking behaviour, tidying, ordering, hand washing). Done to reduce anxiety as responding to an obsessive behaviour 

• Avoidance (attempt to reduce anxiety by keeping away from situations that trigger anxiety). Bad as can’t lead normal life if avoid daily situations like taking out bins

Emotional characteristics 

• Anxiety and distress (obsessive thoughts are unpleasant and frightening, the urge to repeat creates anxiety) 

• Accompanying depression (OCD is usually accompanied by depression, so results in low mood and lack of enjoyment in activities. Compulsive behaviour gives temporary relief from anxiety  

• Guilt and disgust (irrational guilt, disgust at self or something external)

Cognitive characteristics

• Obsessive thoughts (thoughts recur over and over again, unpleasant, e.g. being contaminated by germs or certain that left door unlocked)

• Cognitive strategies to deal with obsessions (coping strategies e.g. praying for obsessive guilt. Helps manage anxiety but makes someone seem abnormal and can distract from everyday tasks) 

• Insight into excessive anxiety (people are aware that their obsessive thoughts and compulsions are not rational)

What does the 2 process model suggest about how we explain phobias. Who created the 2 process model?

It suggests that we use the behaviourist approach in explaining phobias.

It states that phobias are learned and created by classical conditioning, and then continue to exist through operant conditioning

Proposed by Mowrer

Little Albert in the acquisition of phobias through classical conditioning

Aim - Watson & Raynor did a lab experiment to see whether a fear response could be learned through classical conditioning in humans. They classically conditioned him to be scared of a white rabbit. They noted that Albert showed no response to various different objects, in particular a white rat before conditioning. 

At first, they showed Little Albert the white fluffy animals and he showed interest and no fear. Then during conditioning, Watson & Raynor struck a metal bar with a hammer behind Little Albert’s head, causing a very loud noise, every time he went to reach for the rat. They did this three times. Thereafter, when they showed Little Albert the white rat, he began to cry. This experiment demonstrated that a fear response could be induced through the process of classical conditioning.

Little Albert also developed a fear towards similar objects, including a white Santa Claus beard. The experiment revealed that Little Albert had generalised his fear to other white furry objects.

Before, during and after conditioning (NS,UCS,UCR,CS,CR) in the Little Albert experiment

Before conditioning	During conditioning	After conditioning
NS white rat -----> NR no response  UCS loud noise ---> UCR fear	NS white rat + UCS loud noise ---> UCR fear	CS white rat ---> CR fear

Maintenance of a phobia - Operant Conditioning

• Basically this state that avoidance of the phobia causes negative reinforcement (maintains the phobia)

• According to operant conditioning, phobias can be reinforced or punished.

• Negative reinforcement is where a behaviour is strengthened, because an unpleasant consequence is removed

• If a person avoids a stimulus, then they go from feeling anxious to safe, which results in the desirable outcome of reduced fear. Then we are more likely to repeat this behaviour (neg reinforcement as it's the removal/avoidance of an unpleasant stimulus). Which means that the phobia stays with us

• E.g. if a person has a fear of lakes, they would take a different route on a walk, so they are neg reinforced by avoiding the unpleasant consequence of a lake, meaning this behaviour is encouraged and the phobia stays

Classical conditioning in the acquisition of phobias

The acquisition of a phobia is acquired through association. And suggests that we associate a neutral stimulus with an unconditioned stimulus, which will then trigger an unconditioned response.

Social Learning Theory in the acquisition of phobias

• Not part of the two-process model

• Phobias may be created through the modelling of a behaviour by others e.g. your sister acts scared of spiders so you learn to be scared of spiders and acquire similar behaviours, because the behaviour seems rewarding (attention)

Evaluation for the behaviourist approach in explaining phobias

• Research support: strength of behaviourist explanation of phobias is research evidence from Watson & Raynor. Demonstrated the process of classical conditioning in the formation of phobias in Little Albert, who was conditioned to fear white rats. This supports the idea that classical conditioning is involved in the acquisition of phobias

• Application to therapy: the ideas that came from the behaviourist approach to explaining phobias has been used to develop treatments (systematic desensitisation helping people unlearn fears and flooding which prevents people from avoiding their phobias and stops neg reinforcement). Therefore, these therapies have been used successfully to treat people with phobias, providing further support to the behaviourist explanation. 

• Ignores cognitive factors: the behaviourist explanation for phobias has been criticised for being reductionist and over-simplistic. It ignores the role of cognition (thinking) in the formation of phobias. Cognitive psychologists suggest phobias may develop due to irrational thinking, not just learning. E.g. claustrophobia sufferers may think they will be trapped in a lift and die, which is an irrational thought and is not taken into account in the behaviourist explanation

What is systematic desensitisation as a treatment of phobias?

Systematic desensitisation: a behavioural therapy designed to reduce an unwanted response such as anxiety to a stimulus. Involves 3 processes. 

• 1: Anxiety hierarchy, drawing up a hierarchy of anxiety-provoking situations related to the phobic stimulus (constructed from least to most frightening).

• 2: Relaxation, teaching the patient to relax (breathing exercises, imagery, meditation). 

• 3: Exposure, exposing them to the phobic stimulus whilst in a relaxed state. The person works their way through the hierarchy little by little, if they can stay relaxed at the bottom stage, they move up and up through the anxiety hierarchy.

Done through classical conditioning because if the person learns to relax in the presence of a phobic stimulus, they will be cured. 

The learning of a different response is called counterconditioning, replacing anxiety with relaxation. Reciprocal inhibition means it is impossible to be relaxed and afraid at the same time, so one emotion prevents the other.

Example of an anxiety hierarchy

1- a snake crawling around your neck 

2- touching a real snake 

3- seeing a real, larger snake in front of you 

4- seeing a real, small snake in front of you 

5- touching the plastic snake 

6- seeing a plastic snake in front of you

7- seeing a picture of a snake 

8- imagining a snake

Evaluation for systematic desensitisation

• RS GILROY: Point: A strength of systematic desensitisation (SD) is that it is an effective treatment for specific phobias. Evidence: Research by Gilroy et al. (2003) supports this, as they found that individuals with a spider phobia who underwent SD showed greater long-term improvement compared to a control group who received relaxation training without exposure. The benefits of SD were still evident 33 months after treatment. Analysis: This suggests that SD is not only effective in reducing anxiety associated with specific phobias but also provides long-lasting results. The use of gradual exposure in a controlled setting may help individuals develop coping mechanisms, leading to sustained improvements in real-life situations. Link: Therefore, SD is a valuable treatment for specific phobias, particularly as it offers long-term benefits, making it a more reliable approach than methods that focus solely on relaxation without exposure

• SD is suitable for a wide range of patients. Compared to flooding it is more suitable because flooding can’t be used on children, elderly, or people with heart problems, as this is unethical, they may not understand what’s happening, may cause more trauma than good, and may cause health problems. So SD is better at a gradual exposure, so it is a more appropriate and ethical treatment

• Preferred over flooding as it involves less trauma. A further strength of SD is that patients tend to prefer SD over flooding given the choice. This is because it doesn’t cause the same amount of trauma as flooding. Also, patients may find talking with the therapist during SD pleasant.  This is reflected in the low refusal and attrition (drop out) rates for SD compared to flooding. Therefore, SD can be viewed as a more beneficial therapy for phobias

What is flooding as a treatment of phobias? How long is it? What is extinction?

A behavioural therapy in which a person is exposed to an extreme form of a phobic stimulus, without a build up in a hierarchy, to reduce anxiety triggered by it.

Takes place over a small number of long therapy sessions (2-3hrs). Could even be 1 session

It stops phobic responses very quickly because there's no option of avoidance (anxiety calms eventually as realises phobic stimulus is harmless). Some achieve relaxation because they become exhausted by their own fear response.

This is called extinction through classical conditioning. A learned response is extinguished when the CS (snake) is encountered WITHOUT the UCS (being bitten). This results in the CS not producing the CR (fear).

Evaluation for flooding

• It’s cost effective and quicker than SD because it does not involve a hierarchy of stages that a patient needs to make their way through. Instead it throws the person straight into the phobic stimulus, thus saving a lot of time building up to it. It’s effective for those who stick with it. This means it’s also cost-effective because it lasts a shorter amount of time, so they may need to take less time off work for example. Choy et al found both SD and flooding to be effective, but flooding was more effective. However, Craske et al found SD and flooding were equally effective therapies for phobias. This shows that flooding is an effective and more convenient treatment for phobias amongst several options

• Traumatic experience for patients. The actual procedure is stressful and therefore not suitable for every patient. Such as children, who may not fully understand what’s happening and thus result in worsening the phobia. They also may not be able to give consent. Although patients fully consent, there’s a high dropout rate, which reduces its effectiveness. Therefore, individual differences in responding to flooding limit the effectiveness of the therapy in the treatment of phobias.

Explaining depression using the cognitive approach - Beck's cognitive theory of depression

He explained using this approach why some people are more vulnerable to depression than others. Simply, it’s a person's cognitions that create this vulnerability (the way they think). He suggested 3 parts to this cognitive vulnerability.  

1. Faulty information processing. When depressed, we ignore positive aspects and focus on negatives, we blow small problems out of proportion and think in black and white terms

2. Negative self schemas. The package of information we have about ourselves. We use schemas to interpret the world, so if we have negative self-schemas we interpret all information about ourselves in a negative way. Also affects how we interpret new info

3. Negative triad. This is three types of negative thinking that occur automatically, regardless of the reality of what is really happening. This means the person has a dysfunctional view of themselves. 

• Negative view of the world (no hope)

• Negative view of the future (hopelessness + enhance depression)

• Negative view of the self (enhance depression as of low self esteem)

Ellis’s ABC model in explaining depression using cognitive approach

Said that irrational beliefs make us overreact to events and we get depressed. Said that good mental health is the result of rational thinking and poor mental health results from irrational thoughts (illogical/unrealistic thoughts). He used the ABC model to explain how irrational thoughts affect our behaviour and emotional state.

• A- activating event. We get depressed when we experience negative events and these trigger irrational beliefs. Irrational thoughts triggered by events.

• B- beliefs. These events trigger irrational beliefs. E.g. perfectionism or utopianism

• C- consequences. When an event triggers irrational beliefs, there are emotional and behavioural consequences. E.g. if you believe you always have to succeed and then fail, this can trigger depression

Evaluation for Beck’s cognitivee theory

• Real life application of Beck’s research is that it has formed the basis of CBT as a treatment for depression. Beck’s theory suggested that irrational thoughts cause depression, so CBT was formed to directly address or challenge these thoughts and provide evidence against them. CBT also helps to target certain issues because Beck identified many issues could be a cause of depression (schema/negative triad/ faulty info processing). This gives us a more idiographic approach when using CBT as we can tailor it to  the person's needs. 

• A strength of Beck is that his research has positive impacts on the economy. Based on the explanation, we can make changes to the workplace that help reduce the risk of having characteristics that cause depression, like the negative triad. E.g. the workplace could try to include positive policies when appraising employees, which can reduce negative self schema and worrying about your position in work. This leads to less absenteeism which is more predictive for the economy. Therefore, these positive policies can reduce mental health issues in the workplace 

• The role of faulty information processing machine reductionist because it suggests people take information from the environment and process it in a negative way, which results in  faulty output of depression. This is machine reductionism because it reduces complex human behaviour to a simple mechanical process when in reality it is more complex. It treats the human mind like a computer: input → process → output.

Evaluation for Ellis’s ABC model

• Only a partial explanation for depression. There is no doubt that some cases of depression follow an activating event, and psychologists call this reactive depression, seeing it as a different kind of depression to that that arises without an obvious cause. This means that there are some cases of depression that are not triggered by an event and Ellis only explains the kind of depression that is caused by one. This means that his explanation only applies to some kinds of depression and is therefore only a partial explanation. It also doesn't explain all aspects of depression such as the anger, hallucinations or delusions that come with depression, so its a limited explanation.

• Another limitation of this is that it puts blame and responsibility on the person for their depression. It suggests that it is the irrational beliefs that cause depression, so blames the person and their beliefs for having depression, which could make their depression worse if they feel low self esteem and lack of motivation to get help if they feel it is down to them entirely. It also gives low confidence to get better if they feel the weight of responsibility is on them. So when giving someone CBT based on this explanation, it should avoid accusatory language

• A strength is that through the therapy, if you can identify an activating event, it gives a clearer direction for how the therapist should treat the patient because a cause has been identified. This makes it easier for the therapist to challenge the irrational beliefs because they have a starting point  for targeted REBT therapy. This is easier than the therapist attempting to find out what is wrong with the client

How is the cognitive approach used to treat depression

Through CBT using Beck’s Cognitive Theory, and CBT using Ellis’s REBT (rational emotive behaviour therapy)

What is CBT?

Cognitive Behavioural Therapy 

• Uses Beck's cognitive theory and/or Ellis ABC model 

• Identify where there might be irrational or negative thoughts

• Patient and therapist work Together to clarify the problems

• It Challenges these thoughts and puts more effective behaviours in place 

• Gives Homework

• Identify Goals and put a plan together to achieve them 

5-21 weekly sessions of 30-60 mins

How is CBT used through Beck’s Cognitive Theory?

CBT using Beck’s Cognitive Theory 

• Through this theory you identify automatic thoughts about the world, self and future, then these thoughts are challenged directly

• Set homework to record positive events e.g. when my child came and cuddled me. Completing assignments between sessions 

• So when the patient says those negative thoughts, the patient can prove them wrong by using this evidence proving reality 

• Must include unconditional positive regard from the therapist 

How is CBT used through Ellis’s REBT?

CBT using Ellis’s rational emotive behaviour therapy (REBT)

• REBT extends the ABC model to ABCDEF (d=dispute, e=effect, f=feelings)

• REBT identifies and disputes (challenges) irrational thoughts 

• And replaces them with more effective thoughts and new feelings 

• Disputing consists of empirical argument on whether there is evidence to support the negative belief, and then logical argument disputing whether the negative thought logically follows from the facts, and then pragmatic disputing asking how useful this belief is

What is behavioural activation?

encouraging a depressed patient to be more active and do enjoyable activities. It provides more evidence for irrational beliefs.

Evaluation for the cognitive approach to treat depression

• Research Support: March et al found that CBT is just as effective as drugs in treating depression in adolescents. He compared CBT alone with drugs alone, then together. In 327 adolescents after 36 weeks, 81% significantly improved with drugs, and 81% with CBT, and 86% with both. Shows that CBT is as effective as drugs, so a good case for CBT being the first choice  in treatment in the NHS. Ultimately, the combination of both is the best for treating depression

• A limitation of the cognitive approach to treating depression is that CBT may not be suitable for all individuals. CBT requires active engagement and cognitive effort, which can be difficult for severely depressed individuals who may lack motivation and concentration. In such cases, drug treatments may be necessary before CBT can be effectively implemented. Keller et al. found that recovery rates were highest (85%) when CBT was combined with drug therapy, compared to 55% for drug therapy alone and 52% for CBT alone. Additionally, CBT may overemphasise cognition, assuming that simply challenging negative thoughts is enough to improve well-being. However, in extreme situations, such as for individuals from war-torn areas, the focus on changing thought patterns may overlook real-life hardships, potentially minimising the impact of their external circumstances. A more holistic approach, incorporating both biological and social considerations, may be necessary for optimal treatment outcomes.

• Economic implications: If effective then reduces number on sick days, lowering absenteeism. Increasing productivity if more people with depression are able to work. But if the treatment is ineffective, people would be out of work, so then wouldn’t be paying taxes to the NHS. The CBT treatment is also expensive so the NHS should be diverting their money to other illnesses like cancer treatments

What are the 2 biological explanations to explaining OCD?

Genetic explanation

Neural explanation

What does the genetic explanation include? Brief outline

Suggests OCD is inherited and that people are predisposed to develop OCD a result of their genetic makeup. OCD tends to run in the family. Lewis found 37% of people have OCD if their parents do, and 21% if siblings do

Diathesis stress model

COMT and SERT gene

Candidate genes

Polygenic

Aetiologically heterogeneous

What is the diathesis stress model?

Diathesis-stress model: suggests certain genes make some people more likely to suffer OCD (genetic vulnerability) and some environmental stress like a stressful situation is needed to trigger the condition.

What are the 3 genes linked to the genetic explanation?

Genes make up chromosomes and consist of DNA which codes the physical and psychological features of an organism - transmitted/inherited from parent to offspring

2 genes linked to OCD. COMT gene (produces an enzyme to regulate dopamine, causing higher levels, resulting in OCD). SERT gene (affects transport of seretonin, causing lower levels, causing OCD)

Candidate genes create vulnerability for OCD. Specific genes are likely to be involved in vulnerability

What does polygenic mean in OCD, and what is aetiologically heterogeneous

OCD is polygenic meaning it's caused by several genes, not just 1. Taylor found up to 230 genetic variations may be involved in OCD 

Aetiologically heterogeneous - the origin of OCD has different causes. One group of genes may cause OCD in one person, but another group of genes may cause it in another person. Different types of OCD may be due to different genetic variations, e.g. hoarding disorder and religious obsession

Outline the neural explanation for OCD

The regions in our brain, structures such as neurons and the neurotransmitters involved in sending messages through the nervous system.

The faults in our nervous system that cause OCD, these faults can be neurotransmitters (serotonin and dopamine) and brain parts

What are neurotransmitters and what do they do? How do they contribute to OCD?

Chemical messengers pass info between neurons and make the brain function effectively.

The 2 neurotransmitters are dopamine and serotonin

• Low levels of serotonin = OCD (mood related info transmission) Antidepressants that increase serotonin reduces OCD

• High levels of dopamine = OCD (movement related info transmission) Drugs taken that increase dopamine (movements) found OCD in people. Found higher dopamine caused more OCD

What is the basal ganglia?

• Basal ganglia: distributes serotonin, so if damaged/disconnected, can cause OCD. And controls emotional and cognitive functions. It coordinates movement

• If the basal ganglia, orbitofrontal cortex, frontal lobes, and the parahippocampal gyrus is damaged, it brings about OCD

What is the caudate nucleus and orbitofrontal cortex (OFC)?

The caudate nucleus suppresses minor worries signals,  it alters the thalamus, which sends signals back to the orbitofrontal cortex, creating a worry circuit in the brain. It causes a circuit between the basal ganglia and the OFC, circulating the worry 

The orbitofrontal cortex converts sensory information into thoughts and actions

Damage to these cause OCD

Evaluation for GENETIC explanations for OCD

• Twin studies suggest genetic influence on OCD. Nestadt et al found 68% of monozygotic twins shared OCD, compared to only 31% of dizygotic twins. So because more MZ twins share 100% of genotype, and have higher concordance rates of DZ twins for OCD, who only share 50% of genotype. This must mean OCD has a genetic basis as the twins who share more genotype share more OCD. There are also problems with twin studies as even MZ twins have different phenotype and environments from each other, so it is hard to test genetics without testing some influence of their environment. Small amount of MZ twins available so small sample

• (GE) Environmental risk factors: biological determinism Weakness as Cromer at al found over half of OCD patients had a traumatic event in their life, and OCD was more severe in those with a trauma. So OCD involves both genes and environment, so cannot solely rely on genetic explanation as doesn’t consider influence of environment. DSM may be a kore valid explanation (environmental trigger needed). Demonstrates env aspect. But it touches on the nurture aspect slightly (DSM), but mainly looks at genes/nature. So they may have the candidate genes for OCD but only when they are put in a stressful situation do they cause OCD. So may be biologically reductionist

• 🙂 Animal studies. Difficult to find candidate genes (genetic variations) that are possible causes of OCD. But there is evidence from animal studies. Ahmari (2016) used mice to study the brain circuits and genes that might cause OCD-like behaviours. Used optogenetics, which allows her to control their brain cells in real-time using light. She inserted light-sensitive proteins into certain brain cells of the mice. When the mice were exposed to light, she could turn specific brain circuits on or off.Once Ahmari activated these brain circuits, the mice started repetitive behaviours (like grooming themselves over and over again) similar to how humans have repetitive behaviours of turning light switches on/off. By studying this in mice, she could see how changes in the brain led to these repetitive behaviors. Also genes: she used genetic tools to alter specific genes in mice —> deliberate changes to certain genes to see if those changes affected the mice’s repetitive behaviours (genetic basis of OCD). This has generalisability issues of course.

Evaluation for NEURAL explanations for OCD

☹ Environmental risk factors: biological determinism Weakness as Cromer at al found over half of OCD patients had a traumatic event in their life, and OCD was more severe in those with a trauma. So OCD involves both biological factors and environment, so cannot solely rely on neural explanation as doesn’t consider influence of environment. DSM may be a more valid explanation (environmental trigger needed). Demonstrates env aspect. So they may have the candidate genes for OCD but only when they are put in a stressful situation do they cause OCD. So may be biologically reductionist

🙂 Neuroimaging evidence. Several neuroimaging studies have shown using PET scans hyperactivity in the OFC and the caudate nucleus in ppl with OCD whilst scanning brain at rest when symptoms are activated. However only correlational, researchers cannot be sure if the hyperactivity in these areas is the cause of OCD, or a consequence of having OCD. Therefore, the neural explanation may not fully explain the causes of OCD, as it is unclear whether brain differences are a cause or a result of the disorder

🙂 Animal studies. Difficult to find candidate genes (genetic variations) that are possible causes of OCD. But there is evidence from animal studies. Ahmari (2016) used mice to study the brain circuits and genes that might cause OCD-like behaviours. Used optogenetics, which allows her to control their brain cells in real-time using light. She inserted light-sensitive proteins into certain brain cells of the mice. When the mice were exposed to light, she could turn specific brain circuits on or off.Once Ahmari activated these brain circuits, the mice started repetitive behaviours (like grooming themselves over and over again) similar to how humans have repetitive behaviours of turning light switches on/off. By studying this in mice, she could see how changes in the brain led to these repetitive behaviors. Also genes: she used genetic tools to alter specific genes in mice —> deliberate changes to certain genes to see if those changes affected the mice’s repetitive behaviours (genetic basis of OCD). This has generalisability issues of course.

What are the treatments for OCD?

Drug therapy like SSRIs

Combining SSRIs with other treatments

Alternatives to SSRIs

Anti-anxiety drugs

What are SSRIs?

• OCD drug treatment - type of antidepressant

• The presynaptic neurons release serotonin and it travels across a synapse. It chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron, and then it is reabsorbed by the presynaptic neuron where it’s broken down and re-used. 

• SSRIs prevent the reabsorption and breakdown of serotonin

• This increases serotonin levels in the synapse which continues to stimulate the postsynaptic neuron 

• This increases serotonin activity in the brain, helping improve mood and reduce anxiety

• This compensates what is wrong with the serotonin system in OCD 

• E.g. prozac (fluoxetine) takes 3-4 months to have an effect. Doses vary but 20mg is typical 

Combining SSRIs with other treatments

• Drugs are usually alongside CBT to treat OCD

• The drugs reduce emotional symptoms like anxiety or depression which means people with OCD can engage more effectively with CBT 

• Some people can benefit from CBT alone better 

• Other drugs can be prescribed alongside SSRIs

Alternatives to SSRIs

• If ineffective after 3-4 months, the dose can be increased up to 60mg a day or it can be combined with other drugs 

• Tricyclics (older type of antidepressant) are used such as clomipramine. This has the same effect as SSRIs on the serotonin system, they block the reabsorption of serotonin and noradrenaline so more is left in the synapse. It has more side effects than SSRIs, which is why it’s kept as a reserve for those who don’t respond to SSRIs

• SNRIs (serotonin noradrenaline reuptake inhibitors) - different class of antidepressants for people who don’t respond to SSRIs. They also increase levels of serotonin, as well as another neurotransmitter called noradrenaline

• This is because some drugs work well for some and not work for others, so there are alternatives

Anti-anxiety drugs

• Benzodiazepines (BZs) drug to reduce anxiety

• Slow down the central nervous system (CNS) by enhancing the activity of the NT GABA 

• GABA has a general quietening effect on many of the neurons in the brain.

• When GABA locks onto receptor channels are opened to increase the flow of chlorine ions into the neuron.

• Chlorine ions make it harder for the neuron to be stimulated by other NT’s, thus slowing down its activity.

• So they reduce anxiety from the obsessive thoughts

Evaluation for treating OCD

• Economic implications: they not only improve patients’ quality of life but also lessen the strain on healthcare services and the economy. If individuals can manage their symptoms effectively with medication, fewer resources are needed for long-term psychological interventions, and the overall cost to the NHS or private healthcare providers is reduced. However, it is important to acknowledge that drug treatments are not always a long-term solution, as they do not address the underlying cognitive or behavioural causes of OCD. This means that while they may initially reduce costs, some individuals may require additional therapy in the future.

• Drugs are more preferable than CBT. There is little effort required in taking drugs which makes it easy, simple, and non-disruptive - especially compared to CBT which takes time, motivation and commitment, and can be more costly. Drugs are much cheaper than other treatments and saves the NHSs money. Also, patients can benefit from talking to a GP about the symptoms and treatments, which takes place when prescribing drugs to them. It requires little monitoring 

• Side effects. Common ones are headaches, nausea and insomnia.

  • Tricyclics: hallucinations + irregular heartbeats

  • BZs: aggression + addiction

  • Therefore should only be used for a limited amount of time. These side effects can have damaging effects to people's everyday life and change relationships with other people, causing changes to their lives. Side effects can diminish the effectiveness of the treatment, as patients often stop taking the medication if the side effects get really bad