9990 · 1.5.3
Treatment and management of obsessive-compulsive disorder flashcards
Revision flashcards for Cambridge 9990 Treatment and management of obsessive-compulsive disorder (syllabus 1.5.3). Flip, recall, then mark a real past-paper question.
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What is ERP?
**Exposure and Response Prevention** — deliberate exposure to obsession trigger while **preventing** compulsive ritual; anxiety habituates without reinforcement.
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CBT for OCD?
Challenges **inflated responsibility** and thought-action fusion; behavioural experiments during ERP — Salkovskis's cognitive-behavioural model.
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SSRIs for OCD?
Higher doses often needed vs depression; fluoxetine, fluvoxamine, sertraline — NICE recommends CBT first, SSRI if moderate-severe.
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Combined treatment?
CBT/ERP + SSRI more effective than either alone for moderate-severe OCD — addresses cognitive and biological components.
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Deep brain stimulation?
Surgical electrodes for **treatment-resistant** severe OCD — last resort; ethical concerns about irreversibility.
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ERP ethics?
Deliberate distress during exposure requires **informed consent**; must be structured and supported — short-term anxiety for long-term gain.
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What is the 'response prevention' component of ERP?
It involves the patient deliberately refraining from performing their compulsive rituals or avoidance behaviours when exposed to a feared stimulus or obsessive thought. This helps them learn that their anxiety will naturally decrease (habituation) without the need for the compulsion.
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How does CBT for OCD differ from just ERP?
CBT incorporates a cognitive component to challenge the dysfunctional beliefs underlying obsessions (e.g., thought-action fusion, inflated responsibility). ERP is the behavioural component, but CBT adds cognitive restructuring to directly address the 'O' in OCD, not just the 'C'.
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Explain the mechanism of action for SSRIs in treating OCD.
SSRIs block the reuptake of the neurotransmitter serotonin from the synaptic cleft into the presynaptic neuron. This increases the concentration and availability of serotonin in the synapse, allowing it to stimulate the postsynaptic neuron more effectively, which is thought to correct the serotonergic dysfunction implicated in OCD.
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What is a major limitation of using only SSRIs to treat OCD?
A high relapse rate. Many patients experience a return of their symptoms once they stop taking the medication, as the underlying cognitive and behavioural patterns have not been addressed. This is a key reason for recommending combined treatment with CBT.
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What is 'habituation' in the context of ERP?
Habituation is the psychological process where a person's emotional and physiological response to a repeated or prolonged stimulus decreases over time. In ERP, through repeated exposure to a feared object or thought without performing a compulsion, the associated anxiety naturally subsides.