Psychopathology

Deviation from Social Norms

Social norm - Explicit or implicit rules in society tell us acceptable behaviours, values, and beliefs. Set up by the social group and followed by those in the group.

Implicit social norm - Agreed as matter of convention e.g. queuing, not swearing around children.

Explicit social norm - Rules dictated by laws e.g. not taking drugs, being violent.

Social standards are also concerned with manners as well as serious moral issues, like what is acceptable in terms of sexual behaviour. 

Behaviours considered socially deviant include dramatically altering appearance, makeup/contacts to provoke or look shocking, taking illegal substances, wearing underwear in public, and extreme plastic surgery.

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Criticisms

(-) Social control. May outcast individuals who fail to obey to social rules. Szasz (1974) claimed mental illness was simple a way to exclude non-conformists from society.

(-) Social norms change over time. Homosexuality used to be considered abnormal, but attitudes towards behaviour have changed. Fact that social norms change over time affect our beliefs about abnormality as shows social norms are very subjective

(-) Socal norms may vary according to culture/subculture, so difficult to know when they've been broken. May be that person is breaking a social norm according to another culture but not according to their own

(+) Behaviour that's deviant isn't socially acceptable for rest of us. This way of defining abormality takes into account greater good of society and distinguishes between desirable and undesirable behaviour; feature that was absent from statistical frequency model. According to definition, abnormal behaviour is behaviour that damages others.

(+) Recognises role of context i.e. situational norms.  Some behviours may be normal in one context and abnormal in another. E.g. wearing bikini in office would be abnormal, but wearing one on beach would be perfectly normal. Therefore context in which behaviours occur must be consudered.

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Failure to Function Adequately

Abnormality judged in terms of not being able to cope with everyday living. Definition includes bizarre behaviour and/or behaviours that distress patient or others.

GAF (Global Assessment of Functioning) scale used to assess extent to which someone is functioning adequately. For individual to be code 10 using GAF scale, person would need to display recurring violence to themselves or others, persistent inability to maintain minimal personal hygiene, serious suicidal act with clear expectation of death.

Rosenhan and Seligman (1989) : 

Characteristics of abnormal behaviour related to 'failure to function adequately' include: Personal distress (loss of appetite, insomnia), observer discomfort (another's behaviour causes discomfort), unpredictability (inability to predict behaviour of others), and irrationality (irrational behaviour presented is difficult to understand).

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Criticisms

(-) May be considered subjective concept. All have different perception of what it means to function adequately, makes difficult to judge if someone is functioning adequately or not.

(-) Behaving indequately doesn't always indicate abnormal behaviour, certain factors (e.g. exam stress, death of loved one) temporarily impacts individual's functioning, not necessarily indicate abnormality. Context must always be considered.

(-) Cultural relativism. Terms vary between cultures. Cultural variations in what it means to maintain good personal hygiene. Individuals may be considered normal in one culture but abnormal somewhere else.

(+) Model of abnormality does recognise personal experience of patient

(+) Relatively easy to judge objectively, uses a checklist of common behaviours they would expect in someone deemed normal. Focuses on observable behaviour.

(+) GAF scale allows clinicians to judge degree of abnormality.

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Deviation from Ideal Mental Health

Jahoda (1958) said physical illness can be defined by looking at absence of signs of physical health and that we should apply same principles to diagnosing mental illness.

Six categories for Jahoda's theory of 'ideal mental health': personal autonomy (self reliant, independent), accurate perception of reality (seeing self and world realistically), resistance to stress (tolerate anxiety, good coping strategies), positive towards self (positive self concept and sense of identity, self confidence, self respect, self acceptance, high self esteem), self actualisation of potential (striving to fulfil potential, personal growth), and adapting/mastering environment (competent in all areas, flexible, accepting to change).

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Criticisms

(-) Difficulty achieving all six criteria all the time. Self-actualisation difficult to achieve all the time. Some may be content in a supermarket even if they have potential to be a brain surgeon. Few are psychologically healthy and most of us therefore abnormal. Unclear how many criteria lacking to be classes as 'mentally ill'

(-) Resistance to stress. Some work more efficiently in moderately stressful situations

(-) Cultural relativism. Based on western ideals. Autonomy and self-actualisation not valued in collectivist cultures

(-) Subjective criteria. Vague and difficult to measure, relies on self-reports of patients, highly subjective and unreliable. Physical health easy to measure objectively. Undermines Jahoda's ideas of measuring mental health same as physical health

(+) Positive approach to judging mental health. Emphasises positives rather than failures, stresses positive approach to mental health problems by focusing on desirable characteristics rather than undesirable

(+) Takes holistic approach. Considers an individual as a whole person rather than just focusing on individual areas of behaviour

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Statistical Infrequency

Researchers and government agencies collect statistics to inform what is normal . 'Norm' is something that is regular or typical. If we can define what's most common or normal, we can also have idea what is not common. If you draw graph of most aspects of human behaviour, get a normal distribution graph. In normal distribution, most people (normal) are in central group clustered around mean, and fewer people (abnormal) are at either extreme.

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Statistical Infrequency Evaluation

(-) Not all abnormal behaviour is undesirable. Very few people have IQ over 150 but Einstein and Stephen Hawking aren't seen and undesirably smart. Some normal behaviours are undesirable like anxiety, smoking, drinking and violence. Provides method for measuring typical behaviours within population, but doesn't indicate which characteristics relate to abnormal behaviour

(-) Not all abnormal behaviours infrequent. Depression becoming increasingly common in Western world, research suggests 1/10 have serious depressive episode at least one in lifetime

(-) Difficult to decide where cut off point should be for defining abnormality. No agreed point on scale where behaviour classified as abnormal. Not clear how far behavioural should deviate from normal to be seen as abnormal

(-) Statistics can be misleading. Only possible to determine mental disorder statistics for those who recieved diagnosis. Do not reflect true-occurence  because many who suffer choose not to seek help. Many men don't speak out due to stereotypes and many from countries like India and China have stigmas which prevent them seeking help

(+) Objective and unbiaseed, collecting data about behaviour/characteristic, then cut off point arranged

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Characteristics of Phobias

DMS - Diagnostic and statistical manual of mental disorders
ICD - Classification of mental and behavioural disorders

Anxiety disorder involing uncontrollable, extreme, irrational and eduring fears, and anxiety levels that are out of proportion to risk. Three types of phobias: specific, social phobia, and agoraphobia.

Emotional - Persistent, excessive fear, produces high levels of anxiety due to presence/anticipation of phobia. Fear from exposure to phobic stimulus, produce immediate fear response (even panic attacks) due to presence of phobia

Behavioural - Avoidant/anxiety response, efforts made to avoid phobia. Stimulus to reduce chances of anxious response. Distruption of functioning (anxiety and avoidance response so extreme, severely interfere with normal day-to-day living and social , plus occupational functioning)

Cognitive - Recognition of anxiety exaggerated, person constantly aware that fear excessive or unreasonable

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Characteristics of Depression

DSM - V,

ICD - 10

Mood disorder, either unipolar or bipolar depression.

Emotional - Loss of enthusiasm (lessened concern/lack of pleasure in daily activities), contant depresses mood (overwhelming sadness/hopelessness), worthlessness (feelings of reduced worth, guilt, low self esteem).

Behavioural - Loss of energy (fatigue, lethargy, inactivity), social impairment (reduced social interaction), weight changes (increase/decrease in weight), sleep disturbance (constant insomnia/over sleeping), poor personal hygiene (reduced washing/clean clothes/etc).

Cognitive - Negative thoughts (negative self concept, world, expectations), reduced concentration (difficulty maintaining attention, slowed thinking, indecisiveness), constant thoughts of death/suicide.

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Characteristics of OCD

Anxiety disorder invloving obsessions and compulsions, affects 2% of population. Two main components: Obsessions (internal component - persistent, recurrent, instrusive, unpleasant thoughts) and compulsions (external component - repetitive, ritual behaviours, generally in response to obsessions to reduce anxiety).

Emotional - Obsessions and compulsions are source of extremely high levels of anxiety and distress (cannot be consciously controlled), experience feelings of embarrassment/shame as they're aware behaviour is excessive.

Behaviour - Compulsive behaviours (repeating behaviours/response  to obsessive thoughts e.g. washing, checking), unable to work efficiently, social impairment (limited ability to conduct meaningful interpersonal relationships).

Cognitive - Recurrent, persistent thoughts of intrusive nature, thoughts recognised as self generated , realisation of inappropraite (understanding thoughts/compulsions are inappropriate, but unable to consciously control).

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Two-Process Model

Orval Hobart Mowrer (1947) proposed two-process model to explain how phobias are learnt. First stage is classical conditioning, second stage is operant conditioning. 

Little Albert was 9 month old infant shown white rat (NS). Cried when hammer (US) struck against steel bar behind head (loud noise). Over 7 weeks, white rat (NS) presented immediately followed by hammer (UCS). Little Albert only saw rat (CS) and showed fear, phobia also generalised to other furry objects.

Maintenance of phobias - Positive reinforcement aspect (attention generated), increases likelyhood behaviour will happen again in future. Negative reinforcement aspect (avoidance response, escape reduces fear), increases likelyhood behaviour will occur again in future.

Di Gallo (1996) reported 20% in car accidents developed fear of cars (classical conditioning). Tendency to make avoidance responses (behavioural characteristic), maintenance of phobia explained by operant conditioning. Avoidance response negatively reinforcing and repeating behaviour, phobia resistant to extinction.

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Behaviour Approach to Explaining Phobias Evaluatio

(+) Led to treatments like systemtic desensitisation and flooding - conditioning techniques based on behaviourist priciples. Success suggests phobias are maladaptive behaviours aquired by learning and can be unlearnt by replacing with more adaptive behaviours (counter conditioning)

(+) Little Albert (Watson and Rayner, 1920) supports two-process models and idea that phobias are aquired through operant conditioning. However, only one subject and unethical as child could not consent.

(-) Diathesis-stress model. Suggests we inherit genetic vulnerability for mental disorders but disorder only manifests itself if triggered by environmental factors stress or other factors. Di Nardo (1988) said not everyone bitten by dog develops phobia. According to diathesis-stress model, dog bite would only lead to phobia in people with vulnerability

(-) Not everyone who has a phobia recalls a traumatic event that caused it. Ost (1987) suggested that traumatic events did happen but have since been forgotteen.

(-) Two-process model ignores cognitive factors. Cognitive approach would explain phobias by irrational thinking, attentional bias (phobias focus more on nxiety generating stimuli e.g. teeth of dog rather than other features)

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Systematic Desensitisation

Systematic desensitisation is behavioural therapy where people are gradually desensitised to feared object or situation. Done by gradual exposure from least to most feared sitution. Based on idea of counter-conditioning (teaching behaviour that's incompatible with fear response/reciprocal inhibition)

1. Patient taught muscle relaxation techniques

2. Therapist and patient construct hierarchy of anxiety provoking situations from least to most feared

3. Patient works through desensitisation/fear hierarchy involving in vitro (imagined exposure to phobia stimulus) and in vivo (actual exposure to phobic stimulus)

4. Can only progress onto next stage once mastered current stage

5. Patient successfully masters feared situation

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Systematic Desensitisation Evaluation

(+) Research shows effectiveness. McGrath et al. (1990) found 75% patients respond to SD. Supports validity of treatment.

(+) No side effects and no risk of addiction dependency. BZs highly addictive and can cause aggression and long term memory impairments.

(-) Symptom substitution may occur. Only deals with symptoms not root cause, risk symptoms may resurface in possibly another form e.g another phobia/fear develops in its place. However lack of evidence for symptom substitution.

(-) In vitro requires vivid imagination. In vivo techniques more effective and long lasting, some lack ability to imagine feared situation and might still experience fear response when confronted by fear. However, not always practical using in vivo e.g. fear of flying.

(-) Time consuming, therapies like flooding involve immediate exposure to phobia which is quicker alternative.

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Flooding and Flooding Evaluation

Flooding is alternative to systematic desensitisation where instead of step-by-step approach, patients go straight to top of hierarchy and imagine or have direct contact with most feared scenarios. Based on idea that patients cannot make usual avoidance responses and learnt that their anxiety will peak but then subside as there is not enough energy to sustain it.

(+) Effectiveness treatment equal to systematic desensitisation and relatively quick compared to systematic desensitisation and cognitive behavioural therapy.

(-) Individual differences. Highly traumatic, unethical, psychologically harmful, patients may quit during treatment which reduces effectiveness.

(-) Not suitable if patient not healthy, extreme anxiety levels can be stressful on body e.g. increase heart attack risk.

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Cognitive Approach to Explaining Depression

Beck (1987) believed people became depressed because world is seen through negative schemas. Negative schemas dominate thinking, leading to negative view of worls and triggered whenever individuals are in situations that are similar to those in which negative schemas were learnt. Proposed these negative chemas developed during childhood and adolescence when authority figures place unrealistic demands on individual and are highly critical of them, therefore leads them to expect to fail (based on past experience).

Selective abstraction - Conclusions drawn from isolated detail of event without considering full context.

Overgeneralisation - Sweeping conclusions drawn on basis of single event.

Beck's negative triad - Pessimistic and irrational view of three key elements: negative views about world, negative views about self, negative views about future.

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Ellis' ABC Model

Ellis (1962) believes irrational thinking leads to psychological disturbance, mainly due to fact that individuals fall into cycle of irrational thinking, which prevents individual from behaving in adaptive (rational) way. 

A - Activating event (something happens in the environment around you).

B - Belief (you hold a belief about event or situation).

C - Consequence (you have emotional response to your belief).

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Criticisms

(+) Therapeutic success. Lessened by challenging irrational thoughts suggests thoughts had role in depression in first place. CBT found to be best treatment for depression, especially combined with drug therapy. CBT identifies irrational thoughts/beliefs and restructures into adaptive/rational thinking. Therefore cognitive approach has practical applications in therapy.

(+) Research support. Hammen and Krantz (1976) found depressed participants made more errors in logic when interpretting written material than non-depressed participants. Supports idea that depressed people have faulty thinking. 

(-) Cause and effect. Link between negative thoughts and depression does not mean negative thoughts cause depression. May be that depressed individuals develop negative way of thinking as consequence of depression i.e. negative thoughts are a symptom of depression. Therefore, undermines validity of Beck and Ellis and suggests there may be other causes.

(-) Doesn't ackowledge current situtional factors. Blames the client, suggesting they are responsible for disorder. Certain environments may continue to produce and reinforce irrational thoughts and maladaptive behaviours. Therefore treatment which overlooks factors wouldn't be effective.

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Cognitive Behavioural Therapy (CBT)

Thought that thoughts interact with and influence emotions and behaviour. If thoughts are persistently negative and irrational, can lead to abnormal behaviour. CBT encourages individuals to examine beliefs and expectations preventing happiess and replace thoughts with positive, adaptive pattern of thinking. Therapists and clients work to bring about realistic and rational beliefs that are worked into their thinking.

Cognitive element - Therapist encourages client to become aware of faulty beliefs that contribute to depression. Can involve direct questioning.

Behavioural element - Therapist and client decide how client's beliefs can be reality tested through experimentation. Recognise consequences of faulty congnition of their behaviour.

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Types of CBT

REBT (Ellis, 1962) - Focuses on encouraging patients to challenge or dispute any self-defeating beliefs, replacing then with effective, rational beliefs. Logical disputing (self-defeating beliefs don't follow logically from information available). Empirical disputing (self-defeting beliefs may not be consistent with reality).Pragmatic disputing (emphasises lack of usefulness of self-defeating beliefs)

Beck's cognitive therapy - Mainly used to treat people with depression, encouraging clients to monitor situations where they make negative assumptions.

Meichenbum's stress inoculation therapy (SIT) - Type of CBT used to manage stress.

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Criticisms

(+) Research evidence. Embling (2002) studied 38 clients, 19 treated with CBT and 19 added to list as control group. 12 sessions of CBT from procedures by Beck et al (1979). Results confirm CBT is effective treatment.

(+) David et al (2008), 170 patients suffering major depressive disorder randomly assignment: 14 weeks of REBT, 14 weeks of CT and 14 weeks of SSRIs (fluoxetine). Patients treated with14 weeks REBT better outcomes than those treated with fluoxetine. Suggests REBT is better long-term treatment than drug therapy.

(-) May not be effective for everyone. Less suitable for people who lack commitment and motivation to engage fully, people with high levels of irrational beliefs which are rigid and resistant to change, realistic stressors (irrational environments) in person's life that therapy can't resolve, difficulty concentrating, and difficulty talking about feelings. Individual differences affect receptivity towards CBT.

(+) Cost and time effective. Provides self-sufficient and life long coping strategies that individual can continue to use long after completing course. More cost effective than drug treatments, medication must continue even after improvements or relapse may occur.

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Biological Approach to Explaining OCD

One explanation for mental disorders like OCD is that they may be inherited. 

COMT gene - A variation of COMT gene found to be more common in OCD patients. The variation gene produces lower activity of COMT gene and higher levels of dopamine, which has also been linked to OCD.

SERT gene - SERT gene affects transport of serotonin, variation of this gene may be possessed by those with OCD creates lower levels of serotonin which is also linked to OCD.

Diathesis-stress model - Gene may provide genetic predisposition for OCD but may need to be triggered by another factor/environment/stressor, which is why some people may posses variations of SERT and COMT gene but never develop OCD.

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Key Study

Grootheest et al. (2005)

Meta analysed results from multiple studies on OCD in twins. 70 years of twin studies (over 10,000 twin pairs in 24 studies) where MZ twins were compared to DZ twins. In children, OCD symptoms have genetic influences from 45-65%. In adults, OCD symptoms have genetic influence from 27-47%. Suggests and indicates genetic component to OCD. Heritability OCD greater in children than adults. However, majority of studies not performed in large enough numbers or under methodical/objective conditions.

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Neural Explanations

Dopamine levels abnormally high in people with OCD. Animal research shows that in drugs that increase dopamine, animal displays stereotyped movements that resemble compulsive behaviours found in patients with OCD. PET scans show low serotonin activity in people with OCD. Drugs that increase serotonin found to reduce symptoms of OCD.

Several ares in frontal lobes thought to be abnormal in people with OCD. The caudate nucleus (in basal ganglia) normally supresses signals from orbitofrontal cortex (OFC). OFC sends signals to thalamus about things that are worrying e.g. potential germ hazard. When caudate nucleus is damaged, it fails to supress minor worry signals and thalamus is alerted, which sends signals back to OFC accting as a worry circuit.

Supported by PET scans of patients with OCD, while symptoms were active. Scans showed heightened activity in OFC. Research also shows link between functioning of these areas and serotonin levels, suggesting abnormal levels of serotonin might cause these areas to malfunction. Dopamine also linked to this system as it's main neurotransmitter of basal ganglia. High levels of dopamine appear to lead to overactivity in this area, supporting idea of lack of suppression of signals from the OFC.

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Evidence for Neural Explanation

Evidence for role of serotonin in OCD comes from Hu (2006). Serotonin activity compared in 169 OCD patients and 253 non-sufferers. Found serotonin levels lower in those with OCD. Supports biological explanation that low levels of serotonin may implicated in OCD.

Further evidence for neural explanations of OCD comes from Saxene and Rauche (2000). Reviewed studies of OCD that used PET, fMRI, and MRI neuro-imaging techniques to find consistent evidence of association between orbital frontal cortex and OCD symptoms. Suggests specific areas and mechanisms of brain (specifically OFC) involved in disorder.

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Criticism

(-) Not a 100% concordance rate. Possible other causes of OCD (e.g. environmental) because if genetic factors alone, there would be 100% concordance rate. Even OCD in family, may be learnt as well as possible inheritance, difficult to detangle genes from environment. Suggests environmental component to OCD

(+) Meta analysis support (Grootheest, 2005)

(-) Cause and effect. Can't be sure biological factors identified causing OCD as may be effect of OCD e.g. OCD reduces serotonin levels. Issues of cause and effect reduces validity

(+) SSRIs which increase serotonin alleviate symptoms. Suggests low levels of serotonin linked to OCD.

(-) Not all OCD patients respond to drugs that increase serotonin. It may be case that there are many types of OCD, each with slightly different biological causes

Cognitive explanation - People with OCD have faulty, persistent thought processes focusing on anxiety-inducing stimuli like assessing rick of infection from environment much higher than in reality.

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Biological Approach to Treating OCD

Given that OCD is linked to abnormal levels of neurotransmitters, there are drugs designed to address this

Antidepressants (SSRIs) - Increase availability of serotonin in brain. Released into synapse from neuron, targets receptor cells on receiving neuron. After, message sent to next neuron, released back into synapse, reabsorbed by presynaptic neuron. Work by preventing reabsorbtion, so greater levels of serotonin in synapse.

Anti-anxiety drugs (Benzodiazepines/BZs) - Slows activity of CNS (mainly brain) by increasing activity of neurotransmitter (GABA). Quietening effect on brain. Reacting with special GABA receptor sites on receiving neurons causes channel in receptors to open to increase flow of chloride ions into neuron. Chloride ions more difficult for neuron to be stimulated by other neurotransmitter. Reduction in activity makes individual more relaxed.

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Biological Approach to Treating OCD Evaluation

(+) Can be very effective at reducing symptoms of OCD like reducing obsessive thoughts and compulsive behaviour to a level that someone can lead a more normal lifestyle

(+) Soomro et al (2008) reviewed 17 studies into use of SSRIs on OCD patients vs placebo treatment on over 3,000 OCD patients. Found SSRIs more effective than placebo at reducing symptoms up to 3 months after treatment. Suggests symptoms improved as result of medication elevating serotonin levels.

(-) Drug therapy not a cure, only relieves symptoms to allow individuls to live normal life. Patients relapse within few weeks when medication stopped. Suggests drugs don't deal with root cause of disorder and so not a good, long lasting treatment. Best treatment is drugs and psychological treatment.

(-) Patients may have side effects. SSRIs - nausea, insomnia, headaches, low libido, loss of appetite. BZs - aggression, impaired memory, risk of addiction, only prescribed for max of 4 weeks.  Side effects are severe and outweight benefits of drugs

(+) Require little effort and time, relatively cheap in comparison to CBT. Patients using CBT expected to attend several sessions with therapist, discuss thoughts , complete 'homework' assignment outside therapy

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Psychosurgery

Psychosurgery involves destroying specific parts of brain tissue to disrupt the cortico-straital circuit by use of radio-frequency waves. Has an effect of orbital frontal cortex, thalamus and caudate nucleus. Destroying this tissue often associated with reduction of OCD symptoms.

(-) Risky strategy. Invasive treatment causes irreversible destruction to brain tissue. Side effects include seizures and increased risk of suicide.

(+) Deep brain stimulation is new technology that may help to deal with this issue. Involves no destruction of tissue, although wires are permanent. Wires placed in target areas of brain and attached to battery. When battery or pulse generator switched on, interrupts target brain circuits in brain, reducing symptoms.

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