Psychology In The News | New Options for OCD

Obsessive-compulsive disorder (OCD) is a complex and often misunderstood condition affecting 1-3% of people worldwide. Recent research has shed new light on its underlying mechanisms, involving a complex interplay of genetics, brain networks, the immune system, and even gut bacteria.

OCD is characterised by intrusive thoughts (obsessions) and repetitive behaviours (compulsions) that significantly impact daily life, typically beginning in adolescence or early adulthood. Obsessions are unwanted ideas, images, or impulses that dominate people's thoughts and defy efforts to control them. They often involve themes of danger or harm, such as excessive fears about contamination or extreme concern with order and symmetry. Compulsions can manifest as excessive washing, lock checking, or superstitious behaviours like touching an object a specific number of times to prevent perceived harm.

Studies have identified specific brain circuits involved in OCD, particularly the frontostriatal loops connecting the cortex and striatum. These loops regulate goal-directed behaviour, habits, and the balance between them. In OCD, there is poor inhibitory control between these systems, leading to difficulty disengaging from habitual behaviours and contributing to compulsive actions.

The immune system's involvement in OCD is also becoming clearer, with conditions like PANS and PANDAS (in which children can suddenly develop OCD symptoms in response to infection) demonstrating a link between immune reactions and the sudden onset of OCD symptoms. In PANS/PANDAS the immune reaction appears to cause inflammation of an area of the brain called the basal ganglia (which the striatum is part of).

Current primary treatments include cognitive-behavioural therapy (CBT), particularly exposure and response prevention, and selective serotonin reuptake inhibitors (SSRIs). However, about a third of patients don't respond to these treatments, driving the search for new approaches. Promising new treatment areas include ketamine, which may increase the neuroplasticity of the brain and therefore make patients more receptive to CBT by ‘loosening’ their thinking. However, researchers are keen to caution the use of such an addictive drug which can cause many side effects as a sole treatment for OCD. Similarly, psilocybin (the active ingredient in magic mushrooms) is also being used in clinical trials to treat OCD in the UK and the US. Psilocybin is converted into a molecule that boosts serotonin levels (like an SSRI) and helps an individual’s thought processes become ‘unstuck’.

Non-invasive brain stimulation techniques, such as transcranial magnetic stimulation (TMS), also show promise in altering patterns of brain activity associated with OCD. TMS works by using electrodes to alter the activity in an individual’s brain circuitry. These methods offer potential alternatives to more invasive procedures like deep brain stimulation for treatment-resistant cases.

Emerging research also suggests a connection between gut microbiota and OCD. A study showed that transplanting gut microbes from humans with OCD into mice led to OCD-like behaviours in the animals, opening potential avenues for treatment through dietary interventions or manipulation of gut bacteria.

These advancements in understanding OCD mechanisms and developing new treatments offer hope for more effective management of this challenging condition in the future. As researchers continue to unravel the complexities of OCD, individuals affected by the disorder may look forward to a broader range of treatment options and improved quality of life.

ANSWER THE FOLLOWING QUESTIONS

1. Distinguish between an obsession and a compulsion
2. Identify an example of an obsession and a compulsion mentioned in the text.
3. How does this recent research suggest the immune system might be involved?
4. Which treatments are recommended for patients with OCD currently?
5. Outline two promising new treatment approaches for OCD mentioned in the article.

CHALLENGE: Research what dietary changes an individual with OCD may be advised to make in the future, as this research area develops

Reference: Rethinking OCD. New Scientist. Issue 14th September 2024 https://www.newscientist.com/a... (accessed 18.9.24)