1. Paper 2: Psychopathology SPECIFICATION: 1. DEFINITIONS OF ABNORMALITY 2. CLINICAL CHARACTERISITCS OF DISORDERS 3. EXPLAINING ABNORMALITY 4. TREATING ABNORMALITY

2. What is Psychopathology? The study of abnormal thoughts, behaviors, and feelings. “Psycho” refers to “mind.” –Derives from the Greek “Psyche” for “soul.” “Pathology” refers to “disease.”

3. INTRODUCTION TO ABNORMALITY Not a single definition to abnormality Szasz (1972) argued that there was no such thing as ‘abnormality’ – only problems with living Psychiatry seen as a tool to control ‘difficult behaviour’ and abnormal behaviour seen in some cases to be a sane reaction to an insane world. The legal system was seen to be used to control violent or antisocial behaviours The role of psychology in relation to people with psychological disorders: Drugs treatment can only be authorised by medically trained doctors and psychiatrists. A psychiatrist has completed medical training and is a specialist in psychopathology. They deal with severe conditions such as schizophrenia, depression, personality disorders. The GP may treat mild anxiety or depression through prescribing drugs. Psychologists will use psychological therapies. They have completed degrees in psychology and specialised in the study of psychological disorders. Not a single definition to abnormality Szasz (1972) argued that there was no such thing as ‘abnormality’ – only problems with living Psychiatry seen as a tool to control ‘difficult behaviour’ and abnormal behaviour seen in some cases to be a sane reaction to an insane world. The legal system was seen to be used to control violent or antisocial behaviours The role of psychology in relation to people with psychological disorders: Drugs treatment can only be authorised by medically trained doctors and psychiatrists. A psychiatrist has completed medical training and is a specialist in psychopathology. They deal with severe conditions such as schizophrenia, depression, personality disorders. The GP may treat mild anxiety or depression through prescribing drugs. Psychologists will use psychological therapies. They have completed degrees in psychology and specialised in the study of psychological disorders.

4. SPECIFICATION REQUIREMENT: Understand the three definitions of abnormality Describe fully: deviation from social norms, failure to function adequately and deviation from ideal mental health Know the limitations of each definition

5. DEFINTIONS OF ABNORMALITY LEARNING OBJECTIVES: DEFINTIONS OF ABNORMALITY  I KNOW WHAT IS MEANT BY THE DEFINITIONS: DSN, DIMH, FFA & S.I  I KNOW HOW EACH DEFINITION ATTEMPTS TO DEFINE ABNORMALITY.  I KNOW THEIR LIMITATIONS.  I KNOW WHAT IS MEANT BY THE DEFINITIONS: DSN, DIMH, FFA & S.I  I KNOW HOW EACH DEFINITION ATTEMPTS TO DEFINE ABNORMALITY.  I KNOW THEIR LIMITATIONS.

6. Deviation from social norms

8. DEVIATIONS OF SOCIAL NORMS EVALUATIONS

9. STRENGTH OF DEVIATION OF SOCIAL NORMS DOES distinguish between desirable and undesirable behaviour. Hence establishing social rules and order to help people live together Is probably the initial sign that something is wrong with an individual – it is obvious to outsiders

10. Deviation from Social Norms Social ‘norms’ change over time Acceptable to not acceptable – Drinking and driving – Smoking Not acceptable to acceptable – Homosexuality – Having children out of wedlock

11. Deviation from Social Norms The context and the degree of the behaviour have to be considered No clear distinction between what is an abnormal deviation from a social norm Context of behaviour: – Wearing a bathing suit on a beach would be considered normal – Wearing a bathing suit to do your weekly shopping would be considered abnormal [simplistic and odd conduct] Degree of behaviour: – Being rude would be considered deviant – But how rude does one have to become before such behaviour is considered pathological? The context and the degree of the behaviour have to be considered No clear distinction between what is an abnormal deviation from a social norm Context of behaviour: – Wearing a bathing suit on a beach would be considered normal – Wearing a bathing suit to do your weekly shopping would be considered abnormal [simplistic and odd conduct] Degree of behaviour: – Being rude would be considered deviant – But how rude does one have to become before such behaviour is considered pathological?

12. Deviation from Social Norms  Mental Illness is culturally relative  Behaviour only makes sense when viewed within the originating culture  Abnormality cannot be judged without reference to the standards of the culture where the behaivour arose  A diagnosis of mental illness may be different for the same person in two different cultures:  Cochrane [1977] found that Afro- Caribbean immigrants in the UK were more likely to be diagnosed as schizophrenics than whites. This high diagnosis for Afro-Caribbean’s is only found in the UK and not other countries

13. Evaluation Summary Social deviance cannot offer a complete definition of abnormality because social norms change over time Mental health professional would be able to classify anyone who transgressed a social norm as being mentally ill Mental illness would be defined in terms of the social moral and attitudes of the time and may be subject to abuse Social deviance cannot offer a complete definition of abnormality as both context and the degree of behaviour has to be considered If context is considered behaviour may be nothing more than harmless eccentricity When the degree of a behaviour is considered there is no clear line between what is an abnormal deviation

14. Evaluation  Social norms are influenced and defined by a culture and therefore behaviour only makes sense when viewed within the originating culture  Abnormality cannot be judged without reference to the standards of the culture where the behaivour arose  Therefore abnormal behaviour is culturally relative

15. STATISTICAL INFREQUENCY

16. Under this definition of abnormality, a person's trait, thinking or behaviour is classified as abnormal if it is rare or statistically unusual. With this definition it is necessary to be clear about how rare a trait or behaviour needs to be before we class it as abnormal SEE IQ graph For instance one may say that an individual who has an IQ below or above the average level of IQ in society is abnormal.

17. Evaluations However this definition obviously has limitations, it fails to recognize the desirability of the particular behaviour. Therefore cannot establish between desirable and undesirable behaviours. Going back to the example, someone who has an IQ level above the normal average wouldn't necessarily be seen as abnormal, rather on the contrary they would be highly regarded for their intelligence. Equally, there are some normal behaviours that are undesirable. For example, experiencing depression is relatively common, yet it is undesirable The cut off point is subjectively determined. In terms of ‘SI’ we need to decide to separate normality from abnormality. For example, the symptoms of depression – one is ‘difficultly sleeping’ – where is the cut off ? i.e. sleeping 80% less or few hours than population or than 90% population. STRENGTH: does help to establish a cut-off point for abnormality. Sets the criterion for defining abnormality and diagnosis.

18. Deviation from ideal mental health

20. Marie Jahoda (1958)  Abnormality can be diagnosed the same as physical ill health  Reviewed what others had written about mental health and proposes that the absence of the following criteria indicates abnormality or a mental disorder – Self attitude : having high self-esteem and a strong sense of identity – Personal growth and self-actualisation: the extent to which a person develops their full capabilities – Integration, such as being able to cope with stressful situations – Autonomy : being independent and self regulating – Having an accurate perception or reality – Master of the environment : Including the ability to love, function at work and interpersonal relations, adjust to new situations and solve problems

21. Evaluation Summary Who can achieve all this criteria? How many do we need to be lacking before one is judged as abnormal? Is mental health the same as physical health? Can it be diagnosed the same? This model is culturally relative, for instance the idea of self actualisation is relevant to individualistic cultures

22. Failure to function adequately

24. FAILURE TO FUNCTION ADEQUATELY (FFA) Individuals who cannot look after themselves or who are perceived to be irrational or out of control, are often viewed as dysfunctional

25. Failure to Function Adequately Rosenhan and Seligman [1989] propose seven major features that appear in abnormal behaviour as opposed to normal behaviour: – SUFFERING: Most abnormal individuals report that they are suffering – MALADPTIVENESS: Maladaptive behaviour that prevents an individual from achieving, from having fulfilling relationships, working effectively – UNCONVENTIONALITY: Demonstrating unconventional behaviour which is unusual and differs from the way in which you would expect people to behave in similar situations – LOSS OF CONTROL: You can usually predict what most people would do in a situation. Dysfunctional behaviour is unpredictable – IRRATIONAL: There is no reason why a person is behaving in a specific way – OBSERVER DISCOMFORT: Behaviour is governed by unspoken rules about how we should behave. When others break these we experience discomfort – VIOLATION OF MORAL STANDARDS: When moral standards are violated this behaviour may be judged as abnormal or dysfunctional

26. Evaluation Summary Who decides what is meant by ‘failure to function adequately’? [The individual or others?] Some dysfunctional behaviours maybe seen as adaptive and functional for the individual [Eating disorders and depression may lead to extra attention] Unusual behaviour may be a coping strategy for those who are experiencing a difficult period in their lives Ideas relating to ‘functioning adequately’ are culturally relative. You cannot use the standard of one culture to judge or measure the behaviour of another

27. SPEC CHECK: Describe the behavioural, emotional and cognitive characteristics of phobias Describe and evaluate the behavioural approach to explaining phobias including research support from Watson and Raynor Describe and evaluate the behavioural approach to treating phobias (systematic desensitisation and flooding) including research evidence for effectiveness (Gilroy)

28. What are phobias? Anxiety disorder Irrational fears that produce a conscious avoidance of the feared object or situation Different types of phobias i.e. social / specific

29. A01 Exam question Explanations Outline the emotional characteristics of phobias Emotional response of Fear Unpleasant state of high arousal Prevents sufferer relaxing and cannot experience positive emotion Can be long term Fear is immediate and extremely unpleasant response we experience when we encounter or think about the phobic stimulus Outline the behavioural characteristics of phobias Panic – crying, screaming, running away or Freezing (fainting), flight/fight Avoidance – effort to keep away from the phobic stimulus. Making it hard to go about daily life. E.g. public toilet fear (can’t go out) Endurance – in unavoidable situations (i.e. flying) continuous and extreme anxiety) Outline the cognitive characteristics of phobias Irrational thought processes Person knows that their fear is excessive Thinking resists rational arguments about the phobia

30. The behavioural approach to explaining phobias THE TWO-PROCESS MODEL Role of learning Mowrer (1947) Acquired through CC and continue because of OC

31. HOW DOES THE BEHAVIOURAL APPROACH EXPLAIN THE ONSET OF PHOBIAS? CLASSICAL CONDITIONINGOPERANT CONDITIONING This takes place when our behaviour is reinforced (rewarded) or punished Increases the frequency of a behaviour When we avoid a phobic stimulus we successfully escape the fear and anxiety that is rewarding and reinforces the avoidance behaviour and the phobia is maintained. http://youtu.be/Xt0ucxOrPQE  Associate something we initially do not fear (neutral stimulus with something that already triggers a fear response (UCS)  Watson and Rayner (1920) ‘little Albert’ created a phobia. Played with a white rat. Whenever rat presented made a loud noise  Noise UCS – creating UCR of fear, RAT was NS and became associated with fear. Rat became learned CS and produced a CR. Can be used to explain any fear

32. Rat (NS) – (no response) Loud noise (UCS) – fear response (UCR) Loud noise + white rat (UCS and NS) – Fear response (UCR) White rat (CR) – Fear response (CR)

33. EVALUATION OF THE BEHAVIOURAL APPROACH in explaining phobias. : Explains the role of CC in the development of phobias. Sue et al (1994) people with phobias do recall specific incidents when phobia appeared (e.g. panic attack when bitten by a dog) Ost (1987) not everyone who has phobia can recall a traumatic incidents (long forgotten) Reductionist – explains behaviour in simple learning principles and not all Develop a phobia Ignores cognitive and emotional contributions to the development of psychopathology i.e. irrational thinking Only explains all behaviour through learning experiences (nature) and has no role for any genetic contributions (nature) Seligman – we are biologically prepared to learn associations between stimuli – fear for survival.

34. SYSTEMATIC DESENSITISATION: PHOBIAS: Therapist trains client in deep relaxation techniques. Relaxation is alternative response to feared situation. Aim is to replace fear response with relaxation Therapist asks client to visualise least feared situation while performing deep relaxation procedure Once client feels comfortable at that level. They are asked to imagine the next situation in the hierarchy – the same procedure is repeated Over series of sessions, clients will cope with every level of hierarchy. They can stop and restart at a lower level. Eventually, cope with most of the feared situations at the top of the hierarchy An alternative to visualising fearful situations is to use real life examples e.g. Pictures, life-like models, real thing!

35. 1. Anxiety hierachy Therapist asks client to list situations from least to most fearful Lowest = seeing picture Highest = holding a spider lowest highest

36. 2. relaxation Therapist asks client to visualise least feared situation while performing deep relaxation procedure (breathing,images)

37. 3. exposure Once client feels comfortable at that level. They are asked to imagine the next situation in the hierarchy – the same procedure is repeated

38. 4 Over series of sessions, clients will cope with every level of hierarchy. They can stop and restart at a lower level. Eventually, cope with most of the feared situations at the top of the hierarchy

39. 5 An alternative to visualising fearful situations is to use real life examples e.g. Pictures, life-like models, real thing!

40. Evaluations of Systematic desensitisation APPROPRIATENESS: Behaviour therapies quick and require less effort than psychotherapy. Treatment may not be possible for groups of people with severe learning difficulties EFFECTIVENESS: SD is successful for range of anxiety disorders. McGrath et al (1998) 75% of patients respond to SD. Also supported by Gilroy 42 patients / three 45 min sessions of SD for arachnaphobia, found after 3 months and 33 months = less fearful hence helpful in reducing anxiety in spider phobia Capafons et al (1998) reported that when used with aerophobics those who had undergone SD reported lower levels of fear and lower physiological signs of fear during a flight simulation Problems with SD is that it may appear to resolve problems but simply eliminating or suppressing symptoms may lead to symptom substitution (other symptoms appearing) Langevin (1983) claims no evidence to support this objection

41. Knowledge and understanding: Outline (without using your notes) how systematic desensitisation is used to treat psychological disorders Outline two strengths and two limitations of using SD to treat psychological disorder Apply SD to ‘Jo’s fear of dogs’ - How could SD help Jo with her fear of dogs?

42. FLOODING A01 Exposure to phobic stimulus but without gradual build up in an anxiety hierarchy Immediate exposure to a very frightening situation E.g having a spider crawling on you Learns that the stimulus is harmless No longer produces the conditioned fear response Ethical issues - full informed consent A03 Cost effective : compared to cognitive therapies it is highly effective and quicker than alternatives Less effective for some types of phobias: not useful for social phobia because it has cognitive aspects (unpleasant thoughts rather than anxiety response Treatment is traumatic for patients:

43. Knowledge and understanding: 1. outline how phobias are treated by flooding (6 marks) 2. Explain one advantage of flooding as compared to systematic desensitisation 3. Describe and evaluate the behavioural approach to the treatment of phobias (12 marks)

44. SPEC CHECK: Describe the behavioural, emotional and cognitive characteristics of Depression Describe and evaluate the cognitive approach to explaining depression including Beck and Ellis models Describe and evaluate the cognitive approach to treating depression (Cognitive-Behavioural therapy) including research evidence for effectiveness

45. Depression Mood affective disorder DSM-5 identifies MDD (major depressive disorder which is sever but short-term) and PDD (Persistent depressive disorder, long term and recurring DSM-IV Criteria for Major Depressive Disorder (MDD) Depressed mood or a loss of interest or pleasure in daily activities for more than two weeks. Mood represents a change from the person's baseline. Impaired function: social, occupational, educational. Specific symptoms, at least 5 of these 9, present nearly every day: 1. Depressed mood or irritable most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). 2. Decreased interest or pleasure in most activities, most of each day 3. Significant weight change (5%) or change in appetite 4. Change in sleep: Insomnia or hypersomnia 5. Change in activity: Psychomotor agitation or retardation 6. Fatigue or loss of energy 7. Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt 8. Concentration: diminished ability to think or concentrate, or more indecisiveness 9. Suicidality: Thoughts of death or suicide, or has suicide plan loss of interest/pleasure What is the difference between everyday feeling down and depression?

46. Characteristics of depression descriptions BEHAVIOURAL  Low levels of energy, lethargic (withdrawn from work, social life ) in extreme cases they can’t get out of bed  Psychomotor agitation – struggle to relax (pace up and down)  Disruption to sleep (insomnia or hypersomnia)  Appetite increase or decrease – effecting weight.  Verbal aggression (ending a r’ship or job) or physical aggression (self-harm, suicide) COGNITIVE  Poor levels of concentration (unable to stick with a task)  Pay more attention to negative aspects of a situation and ignore positives  Tend to recall unhappy events rather than happy ones EMOTIONAL  Lowered mood (worthless, empty)  Anger (at self or others) may lead to self-harming  Self-esteem is low (self-loathing)

47. THE COGNITIVE APPROACH TO EXPLAINING DEPRESSION BECK’S COGNITIVE THEORY OF DEPRESSION: Beck suggested it is cognitions that create vulnerability (way they think) Faulty information processing Negative self-schemas The negative triad (world, future, self) Ao3 Supporting evidence Practical applications in CBT Doesn’t explain all aspects of depression ELLIS ‘S ABC MODEL: Ellis proposed that it is irrational thoughts (thoughts that interfere with us being happy) A (activating events) B (beliefs) C (consequences) Ao3 Partial explanation Practical application in CBT Doesn’t explain all aspects of depression P 148- 149

48. https://youtu.be/9c_Bv_FBE-c https://youtu.be/9c_Bv_FBE-c CBT The cognitive approach to dealing with depression CBT – cognitive behavioural therapy 1.assessment: patient and CBT therapist work together to clarify the patient’s problems 2.Jointly identify goals for the therapy and create a plan on how to achieve them 3.Identify negative or irrational thoughts 4.Some CBT use either Beck or Ellis therapy or combine both. CBT: BECK’S COGNTIIVE THERAPY Identify automatic thoughts about the world, self and future (negative triad) Once identified, thoughts are challenged Aim to help patients to test the reality of their negative beliefs Set homework such as record when they enjoyed an event or when someone was nice to them. This is called ‘patient as scientist’, investigating the reality of negative thoughts in the way scientist would. Use the evidence to refute future negative comments (i.e. no one has ever been nice to me) CBT: ELLIS’S RATIONAL EMOTIVE BEHAVIOUR THERAPY (REBT) Uses the ABCDE model (activating events, beliefs, consequences, dispute, effect) Aim is to identify and challenge irrational thoughts and to change the irrational belief to break the link with negative events and depression Disputing may involve looking at evidence and logical arguments following from facts Evaluation March et al (2007) compared effects of CBT with antidepressants and a combination of the two in adolescents with depression. After 36 weeks 81% CBT group were equally improved as the antidepressant group (81%) and combined (86%). This shows that CBT is just as effective as medication, helpful alongside medication and there is a good argument for making it first choice treatment in the NHS. Severe cases of depression may cause patient to be de-motivated and not being able to engage with CBT. May not pay attention (would be effective with medication) but shows that CBT alone wouldn’t be used as a sole treatment Found that the quality of the relationship determines successful therapy rather than the type of therapy Ignores patients past as it only deals with present and future. Could be childhood experiences causing the depression and this may cause frustration in not being able to discuss early experiences.

50. Jessica is a 28 year-old married female. She has a very demanding, high stress job as a second year medical resident in a large hospital. Jessica has always been a high achiever. She graduated with top honors in both college and medical school. She has very high standards for herself and can be very self-critical when she fails to meet them. Lately, she has struggled with significant feelings of worthlessness and shame due to her inability to perform as well as she always has in the past. For the past few weeks Jessica has felt unusually fatigued and found it increasingly difficult to concentrate at work. Her co-workers have noticed that she is often irritable and withdrawn, which is quite different from her typically upbeat and friendly disposition. She has called in sick on several occasions, which is completely unlike her. On those days she stays in bed all day, watching TV or sleeping. At home, Jessica’s husband has noticed changes as well. She’s shown little interest in talking to him and has had difficulties falling asleep at night. Her insomnia has been keeping him awake as she tosses and turns for an hour or two after they go to bed. He’s overheard her having frequent tearful phone conversations with her closest friend, which have him worried. When he tries to get her to open up about what’s bothering her, she pushes him away with an abrupt “everything’s fine”. Although she hasn’t ever considered suicide, Jessica has found herself increasingly dissatisfied with her life. She’s been having frequent thoughts of wishing she was dead. She gets frustrated with herself because she feels like she has every reason to be happy, yet can’t seem to shake the sense of doom and gloom that has been clouding each day as of late. Jessica is a 28 year-old married female. She has a very demanding, high stress job as a second year medical resident in a large hospital. Jessica has always been a high achiever. She graduated with top honors in both college and medical school. She has very high standards for herself and can be very self-critical when she fails to meet them. Lately, she has struggled with significant feelings of worthlessness and shame due to her inability to perform as well as she always has in the past. For the past few weeks Jessica has felt unusually fatigued and found it increasingly difficult to concentrate at work. Her co-workers have noticed that she is often irritable and withdrawn, which is quite different from her typically upbeat and friendly disposition. She has called in sick on several occasions, which is completely unlike her. On those days she stays in bed all day, watching TV or sleeping. At home, Jessica’s husband has noticed changes as well. She’s shown little interest in talking to him and has had difficulties falling asleep at night. Her insomnia has been keeping him awake as she tosses and turns for an hour or two after they go to bed. He’s overheard her having frequent tearful phone conversations with her closest friend, which have him worried. When he tries to get her to open up about what’s bothering her, she pushes him away with an abrupt “everything’s fine”. Although she hasn’t ever considered suicide, Jessica has found herself increasingly dissatisfied with her life. She’s been having frequent thoughts of wishing she was dead. She gets frustrated with herself because she feels like she has every reason to be happy, yet can’t seem to shake the sense of doom and gloom that has been clouding each day as of late. 1.Explain how CBT is used in the treatment of depression (4 marks) 2. explain how challenge irrational thoughts can work as a treatment of depression (3 marks) 3. Give one criticism of CBT as treatment of dep 4. D and E the Cognitive approach to treating depression 1.Explain how CBT is used in the treatment of depression (4 marks) 2. explain how challenge irrational thoughts can work as a treatment of depression (3 marks) 3. Give one criticism of CBT as treatment of dep 4. D and E the Cognitive approach to treating depression Apply CBT to the case study.

51. SPEC CHECK: Describe the behavioural, emotional and cognitive characteristics of Obsessive compulsive disorder Describe and evaluate the biological approach to explaining Describe and evaluate the biological approach to treating OCD(drug therapy) including research evidence for effectiveness

52. DSM-5 has created a new chapter for a cluster of disorders that involve obsessional thoughts and/or compulsive behaviors. These include obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), hoarding disorder, trichotillomania (hair-pulling disorder), and excoriation (skin-picking) disorder. http://www.nhs.uk/conditions/obsessive- compulsive-disorder/Pages/Diagnosis.aspx Obsessive compulsive disorder (OCD) is a mental health condition where a person has obsessive thoughts and compulsive activity. An obsession is an unwanted and unpleasant thought, image or urge that repeatedly enters a person's mind, causing feelings of anxiety, disgust or unease. A compulsion is a repetitive behaviour or mental act that someone feels they need to carry out to try to temporarily relieve the unpleasant feelings brought on by the obsessive thought. For example, someone with a fear of their house being burgled may feel they need to check all the windows and doors are locked several times before they can leave the house. OCD symptoms can range from mild to severe. Some people with OCD may spend an hour or so a day engaged in obsessive-compulsive thinking and behaviour, but for others the condition can completely take over their life. Compulsion (behaviour) = something you do Obsession (cognition) = takes place in your mind https://youtu.be/THE4ZQR1oW4

53. Clinical characteristics of OCD CLINICAL CHARACTERISITCSDESCRIPTIONS BEHAVIOURAL COMPULSIVE BEHAVIOURS: REPETITIVE: e.g. hand washing, tidying Compulsions reduce anxiety – irrational fear (repeating behaviour helps manage anxiety AVOIDANCE: keep away from situations that trigger it, i.e.. Keeping away from germs, hence avoiding everyday situations like emptying bins., interfere with normal life EMOTIONAL Unpleasant emotions (anxiety and distress) Depression (lack of enjoyment) compulsions bring temporary relief Irrational guilt, disgust COGNTIVE Obsessive thoughts – recur over again, (i.e.. Being contaminated by dirt, door unlocked get hurt) Coping strategies: praying - but can be distracting Excessive anxiety – aware that there are not rational, catastrophic thoughts

54. Case study Mr Fizz obsesses about everything being perfect. He likes things to be in order. Recently he brought some sweets for his children but had to separate the sweets in to colour categories and put each colour in a different bowl. He had to count them each 3 times over ensuring there were 10 sweets in each bowl for each colour. Mr Fizz gets anxious if he hasn’t counted them 3 times over He feels guilty if they are not in bowls as he wants to ensure that his two children get an equal amount of each colour sweet. He believes if he doesn’t colour categories or count them then bad things will happen to his family and he can’t risk anything happening to them. He is worried so he prays every morning but has to say the prayer 3 times over – often making him late for work. Apply the clinical characteristics of OCD

55. Biological approach to explaining OCD explanat ion A01evaluations genetic Outline how Lewis’ study shows genetic vulnerability of OCD Which gene creates vulnerability for OCD? (explain referring to serotonin and 5HT1-D beta) Explain what is meant by OCD is polygenic Find out about the ‘COMT’ gene (use device) Good supporting evidence Too many candidate genes Environmental risk factors neural Explain the role of serotonin Outline decision –making systems Supporting evidence Unclear what neural mechanisms are involved Can’t assume neural mechanisms cause OCD Research the following information about OCD P152-153 text book

56. Ao1: Biological approach to treating OCD  Drug therapy aims to increase or decrease levels of neurotransmitters in the brain to increase or slow down their activity  SSRIs  Antidepressant called SSRI  Work on the serotonin (low in OCD) system in the brain  Serotonin is released by certain neurons in the brain  It is released by the presynaptic neuron and travels across a synapse  Serotonin is released into a synapse from one nerve (neuron)  It targets receptor cells on the receiving neuron at receptor sites  It is re-absorbed by neuron sending the message  In order to increase levels of serotonin at the synapse and increase stimulation to the receiving neuron, this re-absorption is inhibited.  TYPES OF SSRIs – Fluxoetine (can take up to 3-4 months to have impact)  OTHER TREATMENTS - Drugs used along side CBT  If not effective, SSRI dose can be increased (i.e. 20mg up to 60mg)  Other types of antidepressants which effect serotonin – TRICYCLICS (e.g. clomipramine) SNRIs –increase serotonin and noradrenaline DRUG THERAPY