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Longitudinal changes in neurometabolite concentrations in the dorsal anterior cingulate cortex after concentrated exposure therapy for obsessive-compulsive disorder. J Affect Disord 2022; 299:344-352. [PMID: 34920037 DOI: 10.1016/j.jad.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The dorsal anterior cingulate cortex (dACC) plays an important role in the pathophysiology of obsessive-compulsive disorder (OCD) due to its role in error processing, cognitive control and emotion regulation. OCD patients have shown altered concentrations in neurometabolites in the dACC, particularly Glx (glutamate+glutamine) and tNAA (N-acetylaspartate+N-acetyl-aspartyl-glutamate). We investigated the immediate and prolonged effects of exposure and response prevention (ERP) on these neurometabolites. METHODS Glx and tNAA concentrations were measured using magnetic resonance spectroscopy (1H-MRS) in 24 OCD patients and 23 healthy controls at baseline. Patients received concentrated ERP over four days. A subset was re-scanned after one week and three months. RESULTS No Glx and tNAA abnormalities were observed in OCD patients compared to healthy controls before treatment or over time. Patients with childhood or adult onset differed in the change over time in tNAA (F(2,40) = 7.24, ɳ2p= 0.27, p = 0.004): concentrations increased between one week after treatment and follow-up in the childhood onset group (t(39) = -2.43, d = -0.86, p = 0.020), whereas tNAA concentrations decreased between baseline and follow-up in patients with an adult onset (t(42) = 2.78, d = 1.07, p = 0.008). In OCD patients with versus without comorbid mood disorders, lower Glx concentrations were detected at baseline (t(38) = -2.28, d = -1.00, p = 0.028). Glx increased after one week of treatment within OCD patients with comorbid mood disorders (t(30) = -3.09, d = -1.21, p = 0.004). LIMITATIONS Our OCD sample size allowed the detection of moderate to large effect sizes only. CONCLUSION ERP induced changes in neurometabolites in OCD seem to be dependent on mood disorder comorbidity and disease stage rather than OCD itself.
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Rangaprakash D, Tadayonnejad R, Deshpande G, O'Neill J, Feusner JD. FMRI hemodynamic response function (HRF) as a novel marker of brain function: applications for understanding obsessive-compulsive disorder pathology and treatment response. Brain Imaging Behav 2021; 15:1622-1640. [PMID: 32761566 PMCID: PMC7865013 DOI: 10.1007/s11682-020-00358-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The hemodynamic response function (HRF) represents the transfer function linking neural activity with the functional MRI (fMRI) signal, modeling neurovascular coupling. Since HRF is influenced by non-neural factors, to date it has largely been considered as a confound or has been ignored in many analyses. However, underlying biophysics suggests that the HRF may contain meaningful correlates of neural activity, which might be unavailable through conventional fMRI metrics. Here, we estimated the HRF by performing deconvolution on resting-state fMRI data from a longitudinal sample of 25 healthy controls scanned twice and 44 adults with obsessive-compulsive disorder (OCD) before and after 4-weeks of intensive cognitive-behavioral therapy (CBT). HRF response height, time-to-peak and full-width at half-maximum (FWHM) in OCD were abnormal before treatment and normalized after treatment in regions including the caudate. Pre-treatment HRF predicted treatment outcome (OCD symptom reduction) with 86.4% accuracy, using machine learning. Pre-treatment HRF response height in the caudate head and time-to-peak in the caudate tail were top-predictors of treatment response. Time-to-peak in the caudate tail, a region not typically identified in OCD studies using conventional fMRI activation or connectivity measures, may carry novel importance. Additionally, pre-treatment response height in caudate head predicted post-treatment OCD severity (R = -0.48, P = 0.001), and was associated with treatment-related OCD severity changes (R = -0.44, P = 0.0028), underscoring its relevance. With HRF being a reliable marker sensitive to brain function, OCD pathology, and intervention-related changes, these results could guide future studies towards novel discoveries not possible through conventional fMRI approaches like standard BOLD activation or connectivity.
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Affiliation(s)
- D Rangaprakash
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, 90095, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School and Harvard-MIT Health Sciences and Technology, Cambridge, MA, 02129, USA
| | - Reza Tadayonnejad
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, 90095, USA
- Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, 91125, USA
| | - Gopikrishna Deshpande
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, 36849, USA
- Department of Psychological Sciences, Auburn University, Auburn, AL, 36849, USA
- Alabama Advanced Imaging Consortium, Auburn University and University of Alabama Birmingham, Auburn, AL, USA
- Center for Health Ecology and Equity Research, Auburn University, Auburn, AL, USA
- Center for Neuroscience, Auburn University, Auburn, AL, USA
- School of Psychology, Capital Normal University, Beijing, China
- Key Laboratory for Learning and Cognition, Capital Normal University, Beijing, China
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Joseph O'Neill
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Jamie D Feusner
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, 90095, USA.
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The effects of cognitive behavioral therapy on the whole brain structural connectome in unmedicated patients with obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2021; 104:110037. [PMID: 32682876 DOI: 10.1016/j.pnpbp.2020.110037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/09/2020] [Accepted: 07/12/2020] [Indexed: 02/06/2023]
Abstract
Cognitive behavioral therapy (CBT) is considered a first-line treatment for patients with obsessive-compulsive disorder (OCD), and it possesses advantages over pharmacological treatments in stronger tolerance to distress, lower rates of drop out and relapse, and no physical "side-effects". Previous studies have reported CBT-related alterations in focal brain regions and connections. However, the effects of CBT on whole-brain structural networks have not yet been elucidated. Here, we collected diffusion MRI data from 34 unmedicated OCD patients before and after 12 weeks of CBT. Fifty healthy controls (HCs) were also scanned twice at matched intervals. We constructed individual brain white matter connectome and performed a graph-theoretical network analysis to investigate the effects of CBT on whole-brain structural topology. We observed significant group-by-time interactions on the global network clustering coefficient and the nodal clustering of the left lingual gyrus, the left middle temporal gyrus, the left precuneus, and the left fusiform gyrus of 26 CBT responders in OCD patients. Further analysis revealed that these CBT responders showed prominently higher global and nodal clustering compared to HCs at baseline and reduced to normal levels after CBT. Such significant changes in the nodal clustering of the left lingual gyrus were also found in 8 CBT non-responders. The pre-to-post decreases in nodal clustering of the left lingual gyrus and the left fusiform gyrus positively correlated with the improvements in obsessive-compulsive symptoms in the CBT-responding patients. These findings indicated that the network segregation of the whole-brain white matter network in OCD patients was abnormally higher and might recover to normal after CBT, which provides mechanistic insights into the CBT response in OCD and potential imaging biomarkers for clinical practice.
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Batistuzzo MC, Sottili BA, Shavitt RG, Lopes AC, Cappi C, de Mathis MA, Pastorello B, Diniz JB, Silva RMF, Miguel EC, Hoexter MQ, Otaduy MC. Lower Ventromedial Prefrontal Cortex Glutamate Levels in Patients With Obsessive-Compulsive Disorder. Front Psychiatry 2021; 12:668304. [PMID: 34168581 PMCID: PMC8218991 DOI: 10.3389/fpsyt.2021.668304] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/23/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Recent studies using magnetic resonance spectroscopy (1H-MRS) indicate that patients with obsessive-compulsive disorder (OCD) present abnormal levels of glutamate (Glu) and gamma aminobutyric acid (GABA) in the frontal and striatal regions of the brain. These abnormalities could be related to the hyperactivation observed in cortico-striatal circuits of patients with OCD. However, most of the previous 1H-MRS studies were not capable of differentiating the signal from metabolites that overlap in the spectrum, such as Glu and glutamine (Gln), and referred to the detected signal as the composite measure-Glx (sum of Glu and Gln). In this study, we used a two-dimensional JPRESS 1H-MRS sequence that allows the discrimination of overlapping metabolites by observing the differences in J-coupling, leading to higher accuracy in the quantification of all metabolites. Our objective was to identify possible alterations in the neurometabolism of OCD, focusing on Glu and GABA, which are key neurotransmitters in the brain that could provide insights into the underlying neurochemistry of a putative excitatory/inhibitory imbalance. Secondary analysis was performed including metabolites such as Gln, creatine (Cr), N-acetylaspartate, glutathione, choline, lactate, and myo-inositol. Methods: Fifty-nine patients with OCD and 42 healthy controls (HCs) underwent 3T 1H-MRS in the ventromedial prefrontal cortex (vmPFC, 30 × 25 × 25 mm3). Metabolites were quantified using ProFit (version 2.0) and Cr as a reference. Furthermore, Glu/GABA and Glu/Gln ratios were calculated. Generalized linear models (GLMs) were conducted using each metabolite as a dependent variable and age, sex, and gray matter fraction (fGM) as confounding factors. GLM analysis was also used to test for associations between clinical symptoms and neurometabolites. Results: The GLM analysis indicated lower levels of Glu/Cr in patients with OCD (z = 2.540; p = 0.011). No other comparisons reached significant differences between groups for all the metabolites studied. No associations between metabolites and clinical symptoms were detected. Conclusions: The decreased Glu/Cr concentrations in the vmPFC of patients with OCD indicate a neurochemical imbalance in the excitatory neurotransmission that could be associated with the neurobiology of the disease and may be relevant for the pathophysiology of OCD.
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Affiliation(s)
- Marcelo C Batistuzzo
- Department & Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.,Department of Methods and Techniques in Psychology, Pontifical Catholic University, São Paulo, Brazil
| | - Bruna A Sottili
- Laboratory of Magnetic Resonance (LIM44), Department and Institute of Radiology, University of São Paulo (InRad-FMUSP), São Paulo, Brazil
| | - Roseli G Shavitt
- Department & Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Antonio C Lopes
- Department & Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Carolina Cappi
- Department & Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Maria Alice de Mathis
- Department & Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Bruno Pastorello
- Laboratory of Magnetic Resonance (LIM44), Department and Institute of Radiology, University of São Paulo (InRad-FMUSP), São Paulo, Brazil
| | - Juliana B Diniz
- Department & Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Renata M F Silva
- Department & Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Euripedes C Miguel
- Department & Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Marcelo Q Hoexter
- Department & Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.,Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Maria C Otaduy
- Laboratory of Magnetic Resonance (LIM44), Department and Institute of Radiology, University of São Paulo (InRad-FMUSP), São Paulo, Brazil
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Biria M, Cantonas LM, Banca P. Magnetic Resonance Spectroscopy (MRS) and Positron Emission Tomography (PET) Imaging in Obsessive-Compulsive Disorder. Curr Top Behav Neurosci 2021; 49:231-268. [PMID: 33751502 DOI: 10.1007/7854_2020_201] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Obsessive-compulsive disorder (OCD) is characterised by structural and functional deficits in the cortico-striato-thalamic-cortical (CSTC) circuitry and abnormal neurochemical changes are thought to modulate these deficits. The hypothesis that an imbalanced concentration of the brain neurotransmitters, in particular glutamate (Glu) and gamma-amino-butyric acid (GABA), could impair the normal functioning of the CSTC, thus leading to OCD symptoms, has been tested in humans using magnetic resonance spectroscopy (MRS) and positron emission tomography (PET). This chapter summarises these neurochemical findings and represents an attempt to condense such scattered literature. We also discuss potential challenges in the field that may explain the inconsistent findings and suggest ways to overcome them. There is some convergent research from MRS pointing towards abnormalities in the brain concentration of neurometabolite markers of neuronal integrity, such as N-acetylaspartate (NAA) and choline (Cho). Lower NAA levels have been found in dorsal and rostral ACC of OCD patients (as compared to healthy volunteers), which increase after CBT and SSRI treatment, and higher Cho concentration has been reported in the thalamus of the OCD brain. However, findings for other neurometabolites are very inconsistent. Studies have reported abnormalities in the concentrations of creatine (Cr), GABA, glutamate (Glu), glutamine (Gln), Ins (myo-inositol), and serotonin (5-HT), but most of the results were not replicated. The question remains whether the NAA and Cho findings are genuinely the only neurochemical abnormalities in OCD or whether the lack of consistent findings for the other neurometabolites is caused by the lower magnetic field (1-3 Tesla (T)) used by the studies conducted so far, their small sample sizes or a lack of proper control for medication effects. To answer these questions and to further inform the biological underpinning of the symptoms and the cognitive problems at the basis of OCD we need better controlled studies using clear medicated vs unmedicated groups, larger sample sizes, stronger magnetic fields (e.g. at 7 T), and more consistency in the definition of the regions of interest.
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Affiliation(s)
- Marjan Biria
- Department of Psychology, University of Cambridge, Cambridge, UK.
| | | | - Paula Banca
- Department of Psychology, University of Cambridge, Cambridge, UK
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Vattimo EFQ, Barros VB, Requena G, Sato JR, Fatori D, Miguel EC, Shavitt RG, Hoexter MQ, Batistuzzo MC. Caudate volume differences among treatment responders, non-responders and controls in children with obsessive-compulsive disorder. Eur Child Adolesc Psychiatry 2019; 28:1607-1617. [PMID: 30972581 DOI: 10.1007/s00787-019-01320-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 03/18/2019] [Indexed: 12/22/2022]
Abstract
Treatment response in obsessive-compulsive disorder (OCD) is heterogeneous and the neurobiological underpinnings of such variability are unknown. To investigate this issue, we looked for differences in brain structures possibly associated with treatment response in children with OCD. 29 children with OCD (7-17 years) and 28 age-matched controls underwent structural magnetic resonance imaging. Patients then received treatment with fluoxetine or group cognitive-behavioral therapy during 14 weeks, and were classified as treatment responders or non-responders. The caudate nucleus, thalamus and orbitofrontal cortex were selected a priori, according to previous evidence of their association with OCD and its treatment. Gray matter (GM) volume comparisons between responders, non-responders and controls were performed, controlling for total GM volume. 17 patients were classified as responders. Differences among responders, non-responders and controls were found in both caudate nuclei (both p-values = 0.041), but after Bonferroni correction for multiple comparisons, these findings were non-significant. However, after excluding the effect of an outlier, findings were significant for the right caudate (p = 0.004). Pairwise comparisons showed larger caudate GM volume in responders versus non-responders and controls, bilaterally. The right caudate accounted for 20.2% of the variance in Y-BOCS changes after treatment in a linear regression model, with a positive correlation (p = 0.016). We present a possible neural substrate for treatment response in pediatric OCD, which is in line with previous evidence regarding the caudate nucleus. Considering the limitations, further research is needed to replicate this finding and elucidate the heterogeneity of treatment response in children with OCD (National Clinical Trials Registration Number: NCT01148316).
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Affiliation(s)
- Edoardo F Q Vattimo
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos 785, Sao Paulo, SP, 01060-970, Brazil.
| | | | - Guaraci Requena
- Department of Statistics, Institute of Mathematics and Statistics, USP, Sao Paulo, Brazil
| | - João R Sato
- Center of Mathematics, Computing, and Cognition, Universidade Federal do ABC, Santo Andre, Brazil
| | - Daniel Fatori
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos 785, Sao Paulo, SP, 01060-970, Brazil
| | - Euripedes C Miguel
- National Institute for Developmental Psychiatry for Children and Adolescents (INPD), Sao Paulo, Brazil
| | - Roseli G Shavitt
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos 785, Sao Paulo, SP, 01060-970, Brazil
| | - Marcelo Q Hoexter
- National Institute for Developmental Psychiatry for Children and Adolescents (INPD), Sao Paulo, Brazil
| | - Marcelo C Batistuzzo
- National Institute for Developmental Psychiatry for Children and Adolescents (INPD), Sao Paulo, Brazil
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Parmar A, Sharan P, Khandelwal SK, Agarwal K, Sharma U, Jagannathan NR. Brain neurochemistry in unmedicated obsessive-compulsive disorder patients and effects of 12-week escitalopram treatment: 1 H-magnetic resonance spectroscopy study. Psychiatry Clin Neurosci 2019; 73:386-393. [PMID: 30973183 DOI: 10.1111/pcn.12850] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 03/07/2019] [Accepted: 03/29/2019] [Indexed: 11/25/2022]
Abstract
AIM The purpose of this study was to examine treatment-related neurochemical changes in 28 unmedicated obsessive-compulsive disorder (OCD) patients using 1 H-magnetic resonance spectroscopy (1 H-MRS). METHODS We included subjects diagnosed with OCD (n = 28), each with a total duration of illness of less than 5 years, as a study group and age- and sex-matched healthy controls (n = 26). The inclusion criteria for the OCD group were right-handed individuals aged 18 years or older who had not been on any specific treatment for OCD for the last at least 8 weeks and who had no other psychiatric comorbidity. A pre-post and case-control design was employed in which OCD patients underwent 1 H-MRS at baseline and 12 weeks after treatment with escitalopram (n = 21). Clinical assessment was carried out using a semi-structured pro forma Yale-Brown Obsessive Compulsive Scale and the World Health Organization Disability Assessment Scale 2.0 before and after treatment. Volume-localized 1 H-MRS was carried out with a 3-Tesla Philips MR scanner. RESULTS Our data suggested higher levels of myoinositol (mI), total choline (tCho), and glutamate+glutamine (Glx) in the medial thalamus at pre-assessment in OCD subjects as compared to healthy controls and a significant reduction in tCho and Glx after treatment in OCD subjects. The mI levels in the caudate nucleus and Glx levels in the anterior cingulate cortex were significantly correlated with disease severity on the Yale-Brown Obsessive Compulsive Scale. CONCLUSION Our study supports the hypothesis of a hyper-glutaminergic state (as suggested by increased Glx levels) and neurodegeneration (as suggested by increased tCho and mI in the thalamus) in cortico-striato-thalamocortical circuitry in OCD patients as suggested by previous studies using MRS as well as other functional imaging studies.
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Affiliation(s)
- Arpit Parmar
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | | | - Khushbu Agarwal
- Department of NMR and MRI Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Uma Sharma
- Department of NMR and MRI Facility, All India Institute of Medical Sciences, New Delhi, India
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Abstract
INTRODUCTION Predictive neuroimaging markers of treatment response are increasingly sought in order to inform the treatment of major depressive and anxiety disorders. We review the existing literature regarding candidate predictive neuroimaging markers of psychotherapy response and assess their potential clinical utility. METHODS We searched Embase, PsycINFO, and PubMed up to October 2014 for studies correlating pretreatment neuroimaging parameters with psychotherapy response in major depressive and anxiety disorders. Our search yielded 40 eligible studies. RESULTS The anterior cingulate cortex, amygdala, and anterior insula emerged as potential markers in major depressive disorder and some anxiety disorders. Results across studies displayed a large degree of variability, however, and to date the findings have not been systematically validated in independent clinical cohorts and have not been shown capable of distinguishing between medication and psychotherapy responders. Also limited is the examination of how neuroimaging compares or might add to other prognostic clinical variables. CONCLUSION While the extant data suggest avenues of further investigation, we are still far from being able to use these markers clinically. Future studies need to focus on longitudinal testing of potential markers, determining their prescriptive value and examining how they might be integrated with clinical factors.
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A critical review of PANDAS research in the context of obsessive compulsive disorder. HEALTH PSYCHOLOGY REPORT 2018. [DOI: 10.5114/hpr.2018.70356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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ZHANG Z, FAN Q, BAI Y, WANG Z, ZHANG H, XIAO Z. Brain Gamma-Aminobutyric Acid (GABA) Concentration of the Prefrontal Lobe in Unmedicated Patients with Obsessive-Compulsive Disorder: A Research of Magnetic Resonance Spectroscopy. SHANGHAI ARCHIVES OF PSYCHIATRY 2016; 28:263-270. [PMID: 28638200 PMCID: PMC5434282 DOI: 10.11919/j.issn.1002-0829.216043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND In recent years, a large number of neuroimaging studies found that the Cortico-Striato- Thalamo-Cortical circuit (CSTC), including the prefrontal lobe, a significant part of CSTC, has disturbance metabolically in patients with Obsessive-Compulsive Disorder (OCD). AIM Explore the correlation between the neuro-metabolic features and clinical characteristics of OCD patients using magnetic resonance spectroscopy technology. METHODS 88 patients with OCD who were not received medication and outpatient treatment for 8 weeks and 76 health controls were enrolled, there was no significant difference in gender, age or education level between the two groups. SIEMENS 3.0T MRI scanner was used to measure the spectral wave of Orbito Frontal Cortex (OFC) and Anterior Cingulate Cortex (ACC) of participants, setting mega-press sequences. Meanwhile, the concentrations of gamma-aminobutyric acid (GABA), glutamine/glutamate complex (Glx) and N-Acetyl Aspartate (NAA) were measured relative to concentration of water, on the ACC and OFC of participants, for statistical analysis via LC model version 6.3 software. The concentration of metabolic substances of the OCD group compared to the healthy control group was analyzed using two sample t-test. The correlation between substance concentration and scores on the scales, including Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Anxiety scale (HAMA) and Hamilton Depression scale (HAMD) was carried out using the Pearson correlation method. RESULTS Compared with healthy controls, the GABA/W and NAA/W concentration in individuals with OCD are significantly decreased (p=0.031, t=2.193, p=0.002, t=3.223). Also, the concentration of GABA/W had a trend of decrease in the ACC. The GABA/W of the OFC had a negative correlation with Y-BOCS-O, Y-BOCS-C and Y-BOCS-T scores (p=0.037, r=0.221; p=0.007, r=0.283; p=0.014, r=0.259). CONCLUSIONS These results support that GABA concentration in the OFC area of patients with OCD is significantly decreased and the concentration in the ACC has a trend of decreasing. All of these indicate that there is a relationship between the GABA concentration and the psychopathology of OCD.
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Affiliation(s)
| | | | | | | | | | - Zeping XIAO
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ortiz AE, Gassó P, Mas S, Falcon C, Bargalló N, Lafuente A, Lázaro L. Association between genetic variants of serotonergic and glutamatergic pathways and the concentration of neurometabolites of the anterior cingulate cortex in paediatric patients with obsessive-compulsive disorder. World J Biol Psychiatry 2016; 17:394-404. [PMID: 26505676 DOI: 10.3109/15622975.2015.1111524] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The present study aimed to assess the relationship between variability in genes related to the pathophysiology of obsessive-compulsive disorder (OCD) and the concentration of different neurometabolites in the anterior cingulate cortex (ACC). METHODS We concomitantly assessed neurometabolite concentrations using 3-T (1)H-MRS and 262 single nucleotide polymorphism (SNPs) in 35 genes in 41 paediatric OCD patients. RESULTS There were significant associations, after Bonferroni correction, between the concentration of inositol, glutamate and glutamine, and total choline and five polymorphisms located in genes related to serotonin and glutamate (i.e., the vesicular monoamine transporter 1 gene, SLC18A1 [rs6586896]; the serotonin receptor 1B gene, HTR1B [rs6296 and rs6298]; and the glutamate receptor, ionotropic, AMPA1 gene, GRIA1 [rs707176 and rs2963944]). CONCLUSIONS The association observed between these polymorphisms and the neurometabolite concentrations could indicate the presence of a biological interaction between the serotonin and the glutamate pathways that could be involved in the pathophysiology of OCD. More studies with this methodology could increase our understanding of the aetiology and pathophysiology of OCD in children.
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Affiliation(s)
- Ana E Ortiz
- a Department of Child and Adolescent Psychiatry and Psychology , Institute of Neurosciences, Hospital Clínic , Barcelona , Spain
| | - Patricia Gassó
- b Department Anatomic Pathology, Pharmacology and Microbiology , University of Barcelona, Barcelona , Spain ;,f Institut D'investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) , Barcelona , Spain
| | - Sergi Mas
- b Department Anatomic Pathology, Pharmacology and Microbiology , University of Barcelona, Barcelona , Spain ;,f Institut D'investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) , Barcelona , Spain ;,g Centro De Investigación Biomédica En Red De Salud Mental (CIBERSAM) , Spain
| | | | - Nuria Bargalló
- c Magnetic Resonance Image Core Facility. IDIBAPS (Institut D'investigacions Biomèdiques August Pi I Sunyer) , Barcelona , Spain ;,d Image Diagnostic Center, Hospital Clínic , Barcelona , Spain ;,g Centro De Investigación Biomédica En Red De Salud Mental (CIBERSAM) , Spain
| | - Amalia Lafuente
- b Department Anatomic Pathology, Pharmacology and Microbiology , University of Barcelona, Barcelona , Spain ;,f Institut D'investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) , Barcelona , Spain ;,g Centro De Investigación Biomédica En Red De Salud Mental (CIBERSAM) , Spain
| | - Luisa Lázaro
- a Department of Child and Adolescent Psychiatry and Psychology , Institute of Neurosciences, Hospital Clínic , Barcelona , Spain ;,e Department Psychiatry and Clinical Psychobiology , University of Barcelona , Barcelona , Spain ;,f Institut D'investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) , Barcelona , Spain ;,g Centro De Investigación Biomédica En Red De Salud Mental (CIBERSAM) , Spain
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Gillan CM, Robbins TW, Sahakian BJ, van den Heuvel OA, van Wingen G. The role of habit in compulsivity. Eur Neuropsychopharmacol 2016; 26:828-40. [PMID: 26774661 PMCID: PMC4894125 DOI: 10.1016/j.euroneuro.2015.12.033] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 12/17/2015] [Accepted: 12/20/2015] [Indexed: 11/22/2022]
Abstract
Compulsivity has been recently characterized as a manifestation of an imbalance between the brain׳s goal-directed and habit-learning systems. Habits are perhaps the most fundamental building block of animal learning, and it is therefore unsurprising that there are multiple ways in which the development and execution of habits can be promoted/discouraged. Delineating these neurocognitive routes may be critical to understanding if and how habits contribute to the many faces of compulsivity observed across a range of psychiatric disorders. In this review, we distinguish the contribution of excessive stimulus-response habit learning from that of deficient goal-directed control over action and response inhibition, and discuss the role of stress and anxiety as likely contributors to the transition from goal-directed action to habit. To this end, behavioural, pharmacological, neurobiological and clinical evidence are synthesised and a hypothesis is formulated to capture how habits fit into a model of compulsivity as a trans-diagnostic psychiatric trait.
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Affiliation(s)
- Claire M Gillan
- Department of Psychology, New York University, 6 Washington Place, New York, NY 10003, USA; Department of Psychology, University of Cambridge, Cambridge, United Kingdom; Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom.
| | - Trevor W Robbins
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom; Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
| | - Barbara J Sahakian
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Odile A van den Heuvel
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; Department of Anatomy & Neurosciences, VU University Medical Center, Amsterdam, The Netherlands; The OCD Team, Haukeland University Hospital, Bergen, Norway
| | - Guido van Wingen
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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van den Heuvel OA, van Wingen G, Soriano-Mas C, Alonso P, Chamberlain SR, Nakamae T, Denys D, Goudriaan AE, Veltman DJ. Brain circuitry of compulsivity. Eur Neuropsychopharmacol 2016; 26:810-27. [PMID: 26711687 DOI: 10.1016/j.euroneuro.2015.12.005] [Citation(s) in RCA: 205] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 08/28/2015] [Accepted: 12/01/2015] [Indexed: 01/27/2023]
Abstract
Compulsivity is associated with alterations in the structure and the function of parallel and interacting brain circuits involved in emotional processing (involving both the reward and the fear circuits), cognitive control, and motor functioning. These brain circuits develop during the pre-natal period and early childhood under strong genetic and environmental influences. In this review we bring together literature on cognitive, emotional, and behavioral processes in compulsivity, based mainly on studies in patients with obsessive-compulsive disorder and addiction. Disease symptoms normally change over time. Goal-directed behaviors, in response to reward or anxiety, often become more habitual over time. During the course of compulsive disorders the mental processes and repetitive behaviors themselves contribute to the neuroplastic changes in the involved circuits, mainly in case of chronicity. On the other hand, successful treatment is able to normalize altered circuit functioning or to induce compensatory mechanisms. We conclude that insight in the neurobiological characteristics of the individual symptom profile and disease course, including the potential targets for neuroplasticity is an unmet need to advance the field.
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Affiliation(s)
- Odile A van den Heuvel
- Department of Psychiatry, VU University Medical Center (VUmc), Amsterdam, The Netherlands; Department of Anatomy & Neurosciences, VUmc, Amsterdam, The Netherlands; The Obsessive-Compulsive Disorder Team, Haukeland University Hospital, Bergen, Norway.
| | - Guido van Wingen
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Carles Soriano-Mas
- OCD Clinical and Research Unit, Department of Psychiatry, Bellvitge University Hospital; Bellvitge Biomedical Research Institute (IDIBELL), and CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Barcelona, Spain; Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Spain
| | - Pino Alonso
- OCD Clinical and Research Unit, Department of Psychiatry, Bellvitge University Hospital; Bellvitge Biomedical Research Institute (IDIBELL), and CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Barcelona, Spain; Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain
| | - Samuel R Chamberlain
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Cambridge and Peterborough NHS Foundation Trust (CPFT), Cambridge, United Kingdom
| | - Takashi Nakamae
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anna E Goudriaan
- Academic Medical Center, Department of Psychiatry, Amsterdam Institute for Addiction Research, University of Amsterdam, Amsterdam, The Netherlands; Arkin Mental Health and Jellinek Addiction Treatment, Amsterdam, The Netherlands
| | - Dick J Veltman
- Department of Psychiatry, VU University Medical Center (VUmc), Amsterdam, The Netherlands
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14
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Howells FM, Baldwin DS, Kingdon DG. Can cognitive behaviour therapy beneficially influence arousal mechanisms in psychosis? Hum Psychopharmacol 2016; 31:64-9. [PMID: 26270489 DOI: 10.1002/hup.2499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 07/02/2015] [Accepted: 07/04/2015] [Indexed: 11/07/2022]
Abstract
Cognitive behavioural therapy for psychosis (CBTp) is an approved adjunct therapy for patients with psychotic disorders; however, we do not fully understand the neurobiological effects that this therapy may exert. Arousal, as measured by electroencephalography (EEG), provides a useful electrophysiological marker for assessing psychotic disorders. EEG studies may therefore serve as a useful measure for assessing the underlying effects of CBTp in psychotic disorders.
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Affiliation(s)
- Fleur M Howells
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - David S Baldwin
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry, University of Southampton, Southampton, UK
| | - David G Kingdon
- Department of Psychiatry, University of Southampton, Southampton, UK
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15
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Göttlich M, Krämer UM, Kordon A, Hohagen F, Zurowski B. Resting-state connectivity of the amygdala predicts response to cognitive behavioral therapy in obsessive compulsive disorder. Biol Psychol 2015; 111:100-9. [PMID: 26388257 DOI: 10.1016/j.biopsycho.2015.09.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 08/31/2015] [Accepted: 09/14/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a psychiatric disorder which is characterized by recurrent intrusive thoughts (obsessions) and ritualized, repetitive behaviors or mental acts (compulsions). The gold standard for the treatment of OCD is cognitive behavioral therapy (CBT) with exposure and response prevention. This is the first study exploring the predictive value of resting-state functional connectivity for the outcome of CBT. METHODS We assessed whole-brain resting-state functional connectivity in a group of 17 un-medicated OCD inpatients prior to CBT compared to 19 healthy controls using functional magnetic resonance imaging. The graph theoretical metric degree centrality served as indicator for altered voxel-wise whole-brain functional connectivity. The relative change in the Yale-Brown Obsessive Compulsive Scale (YBOCS) score was used to evaluate treatment outcome. RESULTS The degree centrality of the right basolateral nuclei group of the amygdala was positively correlated with the response to subsequent CBT. OCD patients showed a lower degree centrality of the superficial amygdala (bilateral). CONCLUSIONS Our results suggest that two different sub-regions of the amygdala and their respective neural networks are affected in OCD: the superficial amygdala and networks related to evaluation of reinforcers and risk anticipation and the basolateral amygdala which is implicated in fear processing. The diminished CBT response in patients showing a lower degree centrality of the basolateral amygdala reflects a deficient fear circuit in these patients which may impact fear extinction as a core mechanism of exposure-based CBT.
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Affiliation(s)
- Martin Göttlich
- Department of Neurology, University of Lübeck, Lübeck, Germany.
| | - Ulrike M Krämer
- Department of Neurology, University of Lübeck, Lübeck, Germany; Institute for Psychology II, University of Lübeck, Lübeck, Germany
| | - Andreas Kordon
- Department of Psychiatry, University of Lübeck, Lübeck, Germany
| | - Fritz Hohagen
- Department of Psychiatry, University of Lübeck, Lübeck, Germany
| | - Bartosz Zurowski
- Department of Psychiatry, University of Lübeck, Lübeck, Germany; University of Hamburg, Institute for Systems Neuroscience, Germany
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16
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van Der Schaaf ME, Schmits IC, Roerink M, Geurts DEM, Toni I, Roelofs K, De Lange FP, Nater UM, van der Meer JWM, Knoop H. Investigating neural mechanisms of change of cognitive behavioural therapy for chronic fatigue syndrome: a randomized controlled trial. BMC Psychiatry 2015; 15:144. [PMID: 26138726 PMCID: PMC4489043 DOI: 10.1186/s12888-015-0515-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic fatigue syndrome (CFS) is characterized by profound and disabling fatigue with no known somatic explanation. Cognitive behavioral therapy (CBT) has proven to be a successful intervention leading to a reduction in fatigue and disability. Based on previous neuroimaging findings, it has been suggested that central neural mechanisms may underlie CFS symptoms and play a role in the change brought on by CBT. In this randomized controlled trial we aim to further investigate the neural mechanisms that underlie fatigue in CFS and their change by CBT. METHODS/DESIGN We will conduct a randomized controlled trial in which we collect anatomical and functional magnetic resonance imaging (MRI) measures from female CFS patients before and after CBT (N = 60) or waiting list (N = 30) and compare these with measures from age and education matched healthy controls (N = 30). By including a large treatment group we will also be able to compare patients that benefit from CBT with those that do not. In addition, to further investigate the role of endocrine and immune biomarkers in CFS, we will determine cortisol and cytokine concentrations in blood, hair and/or saliva. DISCUSSION This project creates an unique opportunity to enhance our understanding of CFS symptoms and its change by CBT in terms of neuroanatomical, neurofunctional, endocrinological and immunological mechanisms and can help to further improve future treatments strategies. TRIAL REGISTRATION Dutch Trial Register #15852. Registered 9 December 2013 ( http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4311 ).
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Affiliation(s)
- Marieke E van Der Schaaf
- Radboud University Medical Center, Expert Centre for Chronic Fatigue, Nijmegen, The Netherlands. .,Donders Institute for Brain, Cognition, and Behaviour, Centre for Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands. .,Donders Institute, Centre for neuroimaging, Kapittelweg 29, P.O. Box 9101, NL-6500 HB, Nijmegen, The Netherlands.
| | - Iris C Schmits
- Radboud University Medical Center, Expert Centre for Chronic Fatigue, Nijmegen, The Netherlands.
| | - Megan Roerink
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Dirk EM Geurts
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ivan Toni
- Donders Institute for Brain, Cognition, and Behaviour, Centre for Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands.
| | - Karin Roelofs
- Behavioral Science Institute (BSI), Radboud University Nijmegen, Nijmegen, The Netherlands.
| | - Floris P De Lange
- Donders Institute for Brain, Cognition, and Behaviour, Centre for Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands.
| | - Urs M Nater
- Department of Psychology, University of Marburg, Marburg, Germany.
| | - Jos WM van der Meer
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Knoop
- Radboud University Medical Center, Expert Centre for Chronic Fatigue, Nijmegen, The Netherlands.
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Naaijen J, Lythgoe DJ, Amiri H, Buitelaar JK, Glennon JC. Fronto-striatal glutamatergic compounds in compulsive and impulsive syndromes: A review of magnetic resonance spectroscopy studies. Neurosci Biobehav Rev 2015; 52:74-88. [DOI: 10.1016/j.neubiorev.2015.02.009] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 12/20/2014] [Accepted: 02/13/2015] [Indexed: 11/29/2022]
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Huyser C, van den Heuvel OA, Wolters L, de Haan E, Lindauer R, Veltman DJ. A longitudinal VBM study in paediatric obsessive-compulsive disorder at 2-year follow-up after cognitive behavioural therapy. World J Biol Psychiatry 2014; 15:443-52. [PMID: 24125065 DOI: 10.3109/15622975.2013.819122] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To identify neurodevelopmental differences in regional brain volume between medication-free paediatric obsessive-compulsive disorder (OCD) patients and controls at 2-year follow-up after cognitive behavioural therapy. METHODS We assessed 17 medication-free paediatric OCD patients (mean age 13.8 years; SD = 2.8; range 8.2-19.0) and 20 controls, matched on age and gender, with T1-weighted MR scans in a repeated measures design at three time points with intervals of 6 months and 2 years. Voxel based morphometry (VBM) was used to test whole brain voxel-wise for the effects of diagnosis and time on regional grey matter (GM) and white matter volumes. RESULTS GM volume of the orbitofrontal cortex showed a group × time interaction effect, driven by an increase of GM volume over the whole time period in OCD patients and a decrease in controls. When splitting the groups in two age groups (8-12 and 13-19 years) this interaction effect was only seen in the youngest age group. CONCLUSIONS Neuroimaging findings in paediatric OCD after 6 months of CBT in the GM volume of the orbital frontal cortex are still present at 2-year follow-up.
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Affiliation(s)
- Chaim Huyser
- Department of Child and Adolescent Psychiatry, University of Amsterdam, AMC , Amsterdam , The Netherlands
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Abstract
OBJECTIVE This article reviews neuroimaging studies that inform psychotherapy research. An introduction to neuroimaging methods is provided as background for the increasingly sophisticated breadth of methods and findings appearing in psychotherapy research. METHOD We compiled and assessed a comprehensive list of neuroimaging studies of psychotherapy outcome, along with selected examples of other types of studies that also are relevant to psychotherapy research. We emphasized magnetic resonance imaging (MRI) since it is the dominant neuroimaging modality in psychological research. RESULTS We summarize findings from neuroimaging studies of psychotherapy outcome, including treatment for depression, obsessive compulsive disorder (OCD), and schizophrenia. CONCLUSIONS The increasing use of neuroimaging methods in the study of psychotherapy continues to refine our understanding of both outcome and process. We suggest possible directions for future neuroimaging studies in psychotherapy research.
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Affiliation(s)
- Carol P Weingarten
- a Department of Psychiatry and Behavioral Sciences , Duke University , Durham , NC , USA
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Effects of intensive cognitive-behavioral therapy on cingulate neurochemistry in obsessive-compulsive disorder. J Psychiatr Res 2013; 47:494-504. [PMID: 23290560 PMCID: PMC3672238 DOI: 10.1016/j.jpsychires.2012.11.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 10/31/2012] [Accepted: 11/16/2012] [Indexed: 11/23/2022]
Abstract
The neurophysiological bases of cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) are incompletely understood. Previous studies, though sparse, implicate metabolic changes in pregenual anterior cingulate cortex (pACC) and anterior middle cingulate cortex (aMCC) as neural correlates of response to CBT. The goal of this pilot study was to determine the relationship between levels of the neurochemically interlinked metabolites glutamate + glutamine (Glx) and N-acetyl-aspartate + N-acetyl-aspartyl-glutamate (tNAA) in pACC and aMCC to pretreatment OCD diagnostic status and OCD response to CBT. Proton magnetic resonance spectroscopic imaging ((1)H MRSI) was acquired from pACC and aMCC in 10 OCD patients at baseline, 8 of whom had a repeat scan after 4 weeks of intensive CBT. pACC was also scanned (baseline only) in 8 age-matched healthy controls. OCD symptoms improved markedly in 8/8 patients after CBT. In right pACC, tNAA was significantly lower in OCD patients than controls at baseline and then increased significantly after CBT. Baseline tNAA also correlated with post-CBT change in OCD symptom severity. In left aMCC, Glx decreased significantly after intensive CBT. These findings add to evidence implicating the pACC and aMCC as loci of the metabolic effects of CBT in OCD, particularly effects on glutamatergic and N-acetyl compounds. Moreover, these metabolic responses occurred after just 4 weeks of intensive CBT, compared to 3 months for standard weekly CBT. Baseline levels of tNAA in the pACC may be associated with response to CBT for OCD. Lateralization of metabolite effects of CBT, previously observed in subcortical nuclei and white matter, may also occur in cingulate cortex. Tentative mechanisms for these effects are discussed. Comorbid depressive symptoms in OCD patients may have contributed to metabolite effects, although baseline and post-CBT change in depression ratings varied with choline-compounds and myo-inositol rather than Glx or tNAA.
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Schmitt A, Falkai P. Schizophrenia: from risk genes to outcome and comorbidity. Eur Arch Psychiatry Clin Neurosci 2012; 262:547-8. [PMID: 22923189 DOI: 10.1007/s00406-012-0358-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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