The natural history of obsessive-compulsive disorder

Localization of cerebral functional deficits in patients with obsessive-compulsive disorder: a resting-state fMRI study

BACKGROUND

Abnormality of orbitofronto-striatal circuits was postulated in obsessive-compulsive disorder (OCD). The aim of this study is to test the abnormality hypothesis of orbitofronto-striatal circuits and explore whether there are any other dysfunctional brain regions in OCD using a resting-state functional magnetic resonance imaging (fMRI), and further investigate the relationship between the whole-brain voxel-based spontaneous neuronal activity of patients with OCD and clinical characteristics.

METHODS

23 patients with OCD and 23 age- and gender-matched normal controls were examined using resting-state fMRI, and amplitude of low-frequency fluctuation (ALFF) approach was used to analyze fMRI data.

RESULTS

Compared with normal controls, patients with OCD presented increased ALFF in the bilateral orbitofrontal cortex (OFC), anterior cingulate cortex (ACC) as well as decreased ALFF in the bilateral cerebellum and parietal cortex (P<0.01, corrected). Additionally, the ALFF values in bilateral OFC were positively correlated with total Y-BOCS scores (P<0.005, uncorrected).

CONCLUSION

Our findings added an expanding literature to the abnormality hypothesis of orbitofronto-striatal circuits and showed the changed spontaneous neuronal activity of the parietal cortex and cerebellum may also play an important role in the pathophysiology in patients with OCD.

The adequacy of pharmacotherapy in outpatients with obsessive-compulsive disorder

Pharmacotherapy and behavioural treatment are the main treatment options for patients with obsessive-compulsive disorder (OCD). Nevertheless, studies on the appropriateness of these treatments are scarce. We aimed to assess the adequacy of treatment in general, and pharmacotherapy in particular, in patients with OCD. Three hundred and thirteen outpatients with OCD were interviewed on admission at the University Medical Center (UMC) Utrecht, The Netherlands. Patients were evaluated for demographic and clinical characteristics. Current treatment was assessed on admission and treatment history was appraised retrospectively. On admission, only one-half of the patients took appropriate medication, of which 7.6% were prescribed maximal effective doses, 11.8% mean effective doses, 15% minimal effective doses and 19.4% ineffective doses. Approximately 35% of patients were prescribed no drugs and 16% inappropriate drugs. Although the majority of the patients had been treated on average three times prior to their current treatment, 24% had never received a serotonin reuptake inhibitor (SRI) or behaviour therapy. For approximately 50% of the total sample, the maximal effective dose of SRIs had never been taken during the course of treatment history. A large proportion of patients with OCD fail to receive adequate treatment. Many patients were prescribed SRIs at doses below those recommended for the guidelines.

Obsessive-Compulsive Disorder and Tourette's Syndrome

Obsessive-compulsive behavior (OCB) or full-blown obsessive-compulsive disorder (OCD) afflict more than 50% of patients with Tourette's syndrome (TS) and often are more debilitating than the tic disorder itself. Medications for OCD, including selective serotonin reuptake inhibitors (SSRIs), help patients with TS and OCD, particularly in combination with low-dose antipsychotic drugs, but seldom eliminate OCD entirely. Behavioral therapies are more effective as medications for the treatment of OCD. A combination of cognitive behavioral therapy and medication is the treatment of choice for most patients with TS and OCD.