OCD
- Created by: Hannah Galvin
- Created on: 15-06-13 17:38
What is the DIMIV classification of OCD?
recurrent obsessions and compulsions, recognition that the compulsions are excessive, no other disorders present, interfere with everyday tasks
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what are obsessions?
these are things that create anxiety. They are intrusive and excessive and the impulses are seen as inappropriate. They are not only worries but everyday problems and are controllable and this creates anxiety, so the person tries to neutralise them.
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what are compulsions?
they aim to reduce anxiety and are repated behaviours that can be both psychical ad mental. They are either not linked realistically or are clearly excessive. Examples include washing hands and counting.
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what is reliability?
this is is whether the measuring instrument is consistent or not.
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what is inter-rater reliability?
whether two assessors give similar results.
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test re-test reliability?
whether items are consistent.
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what is Y-bocs test
introduced by Goodman, used to diagnose OCD and is a semi-structured interview which tests symptoms severity and monitors response to treatment.
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How was inter-rater reliability reliability tested?
Woody assessed 54 patients on Y-bocs and found good internal consistency.
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How was test-retest reliability tested?
Woody looked at Y-bocs over a reliability and found obsessions was .64, compulsions was .56 and there was an average of 48.5 days. They found this was lower than expected.
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an issue with testing OCD using Y-bocs tests?
participants may lack in understanding of severity and frequency of symptoms or may not understand questions (issue with self-report)
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what did scahill find?
children's Y-bocs test also had good inter-rater reliability?
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What did Baer find?
computerised version also had good reliability
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one positive of assessing OCD?
it is observable
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What did Kim find?
they tested test-retest reliability and found over a short time (2 weeks) that it was good. this may be more important as symptoms may change over time.
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What is validity?
the extent to which a diagnosis represents something real and unique. Also, whether something is measuring what it is intends to measure.
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what did Rosenfeld find?
patients with OCD had higher OCD scores than thse with anxiety disorders and normal controls. This shows it can distinguish between OCD
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What is one issue with Validity?
patients may be embarresed or think interview may make a deeper psychoanalysis and so may not produce honest answers.
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what did Anthony and Barlow suggest?
interviews may be better than questionnaires as they may be fearful of handling questionnaires.
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What did Brown suggest?
a compterised version may be better because there is no pressure from other s who may create negative fears
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what is one weakness of interviews for diagnosis?
clinical psychologists may be also better at distinguish between worries and obsessions better than a psychologist.
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how may the Y-bocs test be biased?
it may be culturally biased as they have come from a place of origin. For example india fear contamination of social class.
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what did Kobak find?
a computerised version meant less interview expectations
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What did Matsunga find?
OCD symptoms in Japan were similar to those in West so may be universal.
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what did Sternberg and Shuh find?
DSMIV was 95% accurate but ICD was only 46% accurate, possibly because of more detailed criteria and so less valid.
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what issue did Woody find with Y-bocs?
found it was difficult to discriminate between depression and OCD. Showing it is not good when advising treatments
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What did Nestdadt study when looking at genetic influence of OCD?
studied first degree relatives and looked at 80 OCD patients and 343 first degree relatives and then 73 and 300 controlled. They found that those with 1st degree relative were 5x more likely to have OCD at some point. Compared to general population.
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What did Billet find when looking at twin studies?
they did a meta-analysis of 14 studies on Mz and Dz twins and found if Mz twins have OCD their twin was more than twice as likely to have OCD at some point.
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what did Karaigiocgou find when looking at variations of genes?
Found alterations can reduce the production of COMT and this stops the action of dopamine. Collected data from 78 patients and 148 with none. They found variation of geen found in 50% of males, 10% of females and 16% in normal population.
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what did Jenicke find when looking at seratonin and OCD?
They found abnormal functioning of the brain could lead to abnormal levels of seratonin. They found antidepressants increase seratonin levels and reduce OCD symptoms.
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what did animal studies find around dopamine and OCD?
found dopamine levels when high are though to be linked to OCD. This was found in animal studies where they were given drugs to enhance dopamine and found them to be ritualistic.
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what did Szechtman find when looking at functioning of the brain and OCD?
the worry circuit (frontal cortex) if damaged causes worry. The caudate nucleus suppresses the worry signals from the orbifrontal cortex to the thalmes.
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What did Moritz argue about participants?
They did ont behave abnormally in cognitive tasks related to the OFC
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what research support is there for inheritance of OCD?
Carey and Gottesman found 87% concordance rating in MZ twins with OCD
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What concordance rating did McGiffin find for schizophrenia?
46%
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What did Rassmussen and Eirsen find?
OCD symptoms were in other disoders such as obsession in anorexia suggesting disorders was an outcome of one gene.
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What did Welch find about mice?
those lacking in SARAP3 gene compulsively groomed themselves.
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What did PET scans show?
OCD patients burned glucose in the OFC caudate nucleai loop than control, showing a correlation with severity.
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what does the evolutionary explanation suggest?
that the nature of obsessions is adapted
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What did Marks and Nesse suggest?
Three behaviours which lead to OCD including; grooming, concern for others and hoarding.
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what did Abed and Pauw suggest?
we have adapted a function in OCD which is an involentary risk scenario generataring system. This is a mental module that has evolved and involves imagining any potential risks, so that they can plan. OCD patients have an extremely sensitive one.
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what research support is there for the evolutionary explanation of OCD?
Buttolph said that this theory suggests that there is an increased risk of OCD at critical lift stages. This was supported when he found an increased risk of OCD during pregnancy.
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what further researcher support is there for the evolutionary explanation of OCD?
Abed and Pauw suggest is generates a lot of testable hypothesis.
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what did Osborne find?
OCD patients are less prone to risk taking because of IRSGS.
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what does the behavioural approach suggest about obsessions?
Mowrer suggested gaining of fears is a 2 step process. 1st- classical conditioning, a neutral stimulus is associated with anxiety. 2nd-operant conditioning, avoiding fear leads to positive outcome (negative reinforcement) so anxiety is maintained
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how did the behavioural suggest compulsions were learned?
learned because of association between anxiety, obsessions, and reducing anxiety. The behaviour is reinforced and maintained and they link what the perform to changing the fearful situation. It's an accidental association that's negatively reinforced
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what does the cognitive approach suggest about obsessions?
we all has intrusive thoughts but these can be ignored. OCD's cant do this, can be misinterpreted which leads to self-blame + expectation of terrible things. It cant be stopped and often comes with depression, stoppin them from distracting themselves
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what does the cognitive theory suggest about compulsions?
they neutralise anxiety to avoid concequences of intrusive thoughs. They are only temporary relief and anxiety wil build up again. It becomes harder to resist, like an addiction.
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what research support is there for Behavioural approach?
Tracey found OCD p's conditioned more rapidly to blinking when a bell rang after previously having air blown in eye.
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what research support is there for behavioural explanation of compulsions?
Rachman + Hodges asked p's to do a prompted activity and this would create an urge to repsond. They then did the compulsions but if delayed the anxiety persisted and then declined, showing it is a quick relief.
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what issues are there with research into behavioural appraoch?
ethical issues- they are not protected from harm/ non-clinical population used/ not a direct cause and effect
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what research is there for the cognitive approach to OCD?
Bouchard found they do have maladaptive thoughts as believe they can + should have control over the world/Pleva and Wade found students with OCD more likely to self-blame and intrusive thoughts/Clark found more intrusive thoughts than normal
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what issues are there with the cognitive approach?
gender issues- Lochner and Stein suggest OCD have different triggers in men and women e.g. males that have brain injury may be associated with OCD and tourrettes and females have OCD and trichotillomania during pregnancy + childbirth.
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what research support is there for neutralising anxiety?
Rachman and Hodgson show how compulsive acts neutralise anxiety.
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issue with cognitive approach?
ERP does not protect form harm?
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What are SSR'S do?
they are the preferred anti-depressants- reduce anxiety. Increases seratonin which regulates mood + anxiety. Work by blocking the re-uptake of seratonin at pre-synaptic membrane. This increases concentration at receptor sites on postsynaptic membrane
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What do trycilics do?
blocks the transporter mechanism that re-absorbs nor-adrenaline + seratonin in the pre-synaptic cell after its been fired, this results in more neurotransmitters in synapse. Prolongs activity and eases transmission to the next synapse.
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what do benzodiazepenes
Reduces anxiety by slowing activity of CNS by enhancing GABA. It locks onto GABA receptors on the outside of receiving neurons, opening channel that increases chloride ions- make it harder 4 neuron to stimulate by neurotrans- relaxing them
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what other drugs are there?
D-cycloserine is an anti biotic that appears to enhance the neurotransmission of GABA and reduce anxiety.
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what research support is there for SSRIS?
Soomro reviewed 17 studies into effectiveness of SSRS and found them to be more effective than placebos in reducing symptoms measured by y-bos up to 3 months.
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what research support is there for trycilics?
Koran found they were often regarded as more effective than SSRI'S but also had more side effects
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what did Zohar and Judge find?
SSRI'S where comparable in effective to trycilics and placebos.
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what issues are there with studies into these?
Koran arued more studies were no longer than 3-4 months so little long term data exisits/Meina suggests it doesn't take into account that they often relapse.
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what contradictory evidence is there?
Koran concluded aftera review of treatments that although drugs are effective, other treatments should be considered first because they are ont long lasting and have side effects
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What did Shwartz find?
other treatments are just as effective for example ERP shows reduced anxiety in caudate nucleus as did anti-depressants.
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what ethical issues are there of the use of drugs?
pp's go through unnessesary side effects/ most do not know if they have placebos or not/fundamental requirement is that if an effective treatment exists they should be used as control.
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what does capsulotomy or cingulotomy involve?
removal of the capsule and the cingulum respectively. the Capsule is part of the limbic system involved in emotion and anxiety.
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what is deep brian stimulation?
Involves putting wires on target areas of the brain which are connected to a battery and the chest. It interrupts target circuits in brain.
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what is TMS?
avoids distruction of brain tissue. Electromagnetic coil is placed above scalp near forehead. This creates electric currents that stimulate the frontal cortex associated with OCD.
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what Research support is there for psychosurgery?
Doughety found 44% of 44 pps previously unresponsive to behavioural treatments were at least partially improved after cingulotomy.
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what furhter research support is there for psychosurgery?
Jung supported this and found similar rates in a sample of 17 patients and no long term adverse effects.
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what research support is there for TMS?
Greenberg treated 1200 patients on two frontal sites stimulated for 8 hours and made a reduction in compulsive urges up to 8 hours.
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what issues are there?
sachdev and hay suggested a reduction of symptoms may be due to educing motivation and energy levels and Rodriquez and Martin found when patients were given TMS or sham TMS there was no measurable difference. Suggesting a placebo affect
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What ethical issues are there?
there are irreversible effects and cannot be justified e.g. Mary Zimmerman (Carey)
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What does ERP involve?
P's unlearn behaviours that have been conditions and re-conditioning. Involves exposure to feared stimulus, and responce prevention which involves stopped them from conducting acts. Typically lasts 13-20 weeks and used in new situations.
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what research support for ERP?
Albucher found between 6-90% of adults improved considerably and found ERP improved when there was added discussion of feared functions and dysfunctional beliefs.
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what further research support was there?
Foa and Kozack found ERP alone just as effective as ERP with drugs. Both did equally well in 2 year follow up
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what did Wilhelm find?
d-cycloserine improved effectiveness
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What did Greist find that contradicted ERP?
found BET steps was more effective.
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What did Gershuny find that contradicted ERP?
found it not to be as effective or helpful for those who were depressed or had certain types of OCD eg hoarding. as it involved effort.
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what ethical issues are there of ERP?
there is unnecessary distress
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How does CT treat obsessions?
therapists question their obsessionsand how they interoperate them. Beliefs are challeneged and re-interpreated so that they are no longer seen as anxiety provocking activity.
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how does CT treat compulsions?
questions the value of their behaviours and their beliefs are challenged and confronted as false.
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what are thought records?
helps consider the dysfunctional beliefs about obsessions and compulsions and takes a daily record of intrusive thoughs and what they thought, how they felt, what they did, and any responses. This is then discuses and unrealistic beliefs challenged
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what research support is there for CT?
Bond and Dryden found people who have irrational beliefs are more dysfunctional than those who have rational ones.
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What did Alloy and Abrahmon suggest?
OCD thoughts may be counterproductive but realisitic, for example depressed people have more accurate estimates of a disaster.
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what further support was found for CT?
Willhelm found significant improvements in 15 patients who used CT alone for 14 weeks
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who contradicted Wilhelm and why?
Ellis believed sometimes people were not putting in their reviewed beliefs into action.
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what issues are there with CT?
it is not suitable for all. It involves considerable effort e.g. Ellis explained lack of successs, some do not want direct advise and instead they want to share worried without cognitive effort.
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what ethical issues are there with CT?
placebo is used and is unethical to withhold effective treatment.
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Other cards in this set
Card 2
Front
what are obsessions?
Back
these are things that create anxiety. They are intrusive and excessive and the impulses are seen as inappropriate. They are not only worries but everyday problems and are controllable and this creates anxiety, so the person tries to neutralise them.
Card 3
Front
what are compulsions?
Back
Card 4
Front
what is reliability?
Back
Card 5
Front
what is inter-rater reliability?
Back
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