Overactive performance monitoring in obsessive-compulsive disorder is independent of symptom expression

Are errors more aversive in an uncertain world? Testing the influence of uncertainty on the error-related negativity in a randomized controlled trial

Overactive error monitoring-as measured by the error-related negativity (ERN)-is a candidate transdiagnostic risk marker for internalizing psychopathology. Previous research reported associations of the ERN and individual differences in intolerance of uncertainty (IU). These findings imply associations between the subconstructs of IU (prospective and inhibitory IU) and the ERN, which we sought to replicate and extend by testing for causal influences that might elucidate specific mechanisms underlying this association. To test associations of uncertainty and the ERN, a preregistered, randomized-controlled design was employed. After measuring the baseline ERN of N = 120 university students, a subsample was randomly assigned to two groups: While an intervention group (n = 30) performed an unsolvable probabilistic "learning" task intended to induce state uncertainty, a passive control group (n = 30) rested. Subsequently, the ERN was assessed again. Self-reported uncertainty was assessed before and after the intervention. To further increase the statistical power of the replication attempt, we performed a correlation analysis (non-preregistered) by including data from two additional samples collected at different study sites. This analysis comprised psychophysiological data from a total of N = 355 participants. Cross-sectionally, no effects of IU on the ERN emerged. Regarding the state uncertainty induction, the intervention group displayed increased self-reported uncertainty after the intervention, but no evidence emerged for ERN alterations attributable to the intervention. The link between individual differences in IU and the ERN might be smaller and less robust than previous findings suggest, reflecting the understudied character of this association. The absence of evidence for mechanistic changes in the ERN due to a successful induction of state uncertainty further questions a link between IU and the ERN. In line with previous studies that linked increased ERN to anxiety, independent of current clinical status, the ERN seems unaffected by short-term changes such as symptom provocations in non-clinical populations.

Flanker task parameters are related to the strength of association between the ERN and anxiety: a meta-analysis

The error-related negativity (ERN)-an index of error monitoring-is associated with anxiety symptomatology. Although recent work suggests associations between the ERN and anxiety are relatively modest, little attention has been paid to how variation in task parameters may influence the strength of ERN-anxiety associations. To close this gap, the current meta-analysis assesses the possible influence of task parameter variation in the Flanker task-the most commonly used task to elicit the ERN-on observed ERN-anxiety associations. Here, we leveraged an existing open database of published/unpublished ERN-anxiety effect sizes, supplementing this database by further coding for variation in stimulus type (letter vs. arrow), response type (one-handed vs. two-handed), and block-level feedback (with vs. without). We then performed meta-regression analyses to assess whether variation in these Flanker task parameters moderated the effect size of ERN-anxiety associations. No evidence for an effect of stimulus type was identified. However, both response type and block-level feedback significantly moderated the magnitude of ERN-anxiety associations. Specifically, studies employing either a two-handed (vs. one-handed) task, or those with (vs. without) block-level feedback exhibited more than a two-fold increase in the estimated ERN-anxiety effect size. Thus, accounting for common variation in task parameters may at least partially explain apparent inconsistencies in the literature regarding the magnitude of ERN-anxiety associations. At a practical level, these data can inform the design of studies seeking to maximize ERN-anxiety associations. At a theoretical level, the results also inform testable hypotheses regarding the exact nature of the association between the ERN and anxiety.

Neural Network Dynamics and Brain Oscillations Underlying Aberrant Inhibitory Control in Internet Addiction

Previous studies have reported a role of alterations in the brain's inhibitory control mechanism in addiction. Mounting evidence from neuroimaging studies indicates that its key components can be evaluated with brain oscillations and connectivity during inhibitory control. In this study, we developed an internet-related stop-signal task with electroencephalography (EEG) signal recorded to investigate inhibitory control. Healthy controls and participants with Internet addiction were recruited to participate in the internet-related stop-signal task with 19-channel EEG signal recording, and the corresponding event-related potentials and spectral perturbations were analyzed. Brain effective connections were also evaluated using direct directed transfer function. The results showed that, relative to the healthy controls, participants with Internet addiction had increased Stop-P3 during inhibitory control, suggesting that they have an altered neural mechanism in impulsive control. Furthermore, participants with Internet addiction showed increased low-frequency synchronization and decreased alpha and beta desynchronization in the middle and right frontal regions compared to healthy controls. Aberrant brain effective connectivity was also observed, with increased occipital-parietal and intra-occipital connections, as well as decreased frontal-paracentral connection in participants with Internet addiction. These results suggest that physiological signals are essential in future implementations of cognitive assessment of Internet addiction to further investigate the underlying mechanisms and effective biomarkers.

Obsessive-compulsive disorder (OCD) is associated with increased engagement of frontal brain regions across multiple event-related potentials

BACKGROUND

Obsessive-compulsive disorder (OCD) is a psychiatric condition leading to significant distress and poor quality of life. Successful treatment of OCD is restricted by the limited knowledge about its pathophysiology. This study aimed to investigate the pathophysiology of OCD using electroencephalographic (EEG) event-related potentials (ERPs), elicited from multiple tasks to characterise disorder-related differences in underlying brain activity across multiple neural processes.

METHODS

ERP data were obtained from 25 OCD patients and 27 age- and sex-matched healthy controls (HCs) by recording EEG during flanker and go/nogo tasks. Error-related negativity (ERN) was elicited by the flanker task, while N200 and P300 were generated using the go/nogo task. Primary comparisons of the neural response amplitudes and the topographical distribution of neural activity were conducted using scalp field differences across all time points and electrodes.

RESULTS

Compared to HCs, the OCD group showed altered ERP distributions. Contrasting with the previous literature on ERN and N200 topographies in OCD where fronto-central negative voltages were reported, we detected positive voltages. Additionally, the P300 was found to be less negative in the frontal regions. None of these ERP findings were associated with OCD symptom severity.

CONCLUSIONS

These results indicate that individuals with OCD show altered frontal neural activity across multiple executive function-related processes, supporting the frontal dysfunction theory of OCD. Furthermore, due to the lack of association between altered ERPs and OCD symptom severity, they may be considered potential candidate endophenotypes for OCD.

Cortical glutamate and GABA are related to compulsive behaviour in individuals with obsessive compulsive disorder and healthy controls

There has been little analysis of neurochemical correlates of compulsive behaviour to illuminate its underlying neural mechanisms. We use 7-Tesla proton magnetic resonance spectroscopy (¹H-MRS) to assess the balance of excitatory and inhibitory neurotransmission by measuring glutamate and GABA levels in anterior cingulate cortex (ACC) and supplementary motor area (SMA) of healthy volunteers and participants with Obsessive-Compulsive Disorder (OCD). Within the SMA, trait and clinical measures of compulsive behaviour are related to glutamate levels, whereas a behavioural index of habitual control correlates with the glutamate:GABA ratio. Participants with OCD also show the latter relationship in the ACC while exhibiting elevated glutamate and lower GABA levels in that region. This study highlights SMA mechanisms of habitual control relevant to compulsive behaviour, common to the healthy sub-clinical and OCD populations. The results also demonstrate additional involvement of anterior cingulate in the balance between goal-directed and habitual responding in OCD.

Abnormally Enhanced Midfrontal Theta Activity During Response Monitoring in Youths With Obsessive-Compulsive Disorder

BACKGROUND

Response monitoring, as reflected in electroencephalogram recordings after commission of errors, has been consistently shown to be abnormally enhanced in individuals with obsessive-compulsive disorder (OCD). This has traditionally been quantified as error-related negativity (ERN) and may reflect abnormal neurophysiological mechanisms underlying OCD. However, the ERN reflects the increase in phase-locked activities, particularly in the theta-band (4-8 Hz), and does not reflect non-phase-locked activities. To more broadly investigate midfrontal theta activity in a brain region that is essential for complex cognition, this study investigated theta abnormalities during response monitoring in participants with OCD to acheive a better understanding of the mechanism underlying the ERN.

METHODS

Electroencephalogram data were recorded from 99 participants with pediatric OCD and 99 sex- and age-matched healthy control participants while they completed the arrow flanker task. Effects of group (OCD, healthy control) and response type (error, correct) on postresponse theta total power and intertrial phase coherence (ITPC) were examined using mixed analysis of covariance and Bayesian analyses controlling for sex and accuracy.

RESULTS

Theta total power was larger on error than on correct trials and larger in OCD than healthy control participants, but there was no effect of response type between groups. Theta ITPC was larger on error than correct trials, but there was no group difference or response type difference between the groups. Correlations of theta total power and ITPC with clinical measures were overall small.

CONCLUSIONS

Abnormally enhanced midfrontal theta total power, but not ITPC, may reflect ineffective heightened response monitoring or compensatory activity in pediatric OCD.

Functional connectivity abnormalities of brain networks in obsessive–compulsive disorder: a systematic review

Obsessive-compulsive disorder (OCD) is characterized by cognitive abnormalities encompassing several executive processes. Neuroimaging studies highlight functional abnormalities of executive fronto-parietal network (FPN) and default-mode network (DMN) in OCD patients, as well as of the prefrontal cortex (PFC) more specifically. We aim at assessing the presence of functional connectivity (FC) abnormalities of intrinsic brain networks and PFC in OCD, possibly underlying specific computational impairments and clinical manifestations. A systematic review of resting-state fMRI studies investigating FC was conducted in unmedicated OCD patients by querying three scientific databases (PubMed, Scopus, PsycInfo) up to July 2022 (search terms: “obsessive–compulsive disorder” AND “resting state” AND “fMRI” AND “function* *connect*” AND “task-positive” OR “executive” OR “central executive” OR “executive control” OR “executive-control” OR “cognitive control” OR “attenti*” OR “dorsal attention” OR “ventral attention” OR “frontoparietal” OR “fronto-parietal” OR “default mode” AND “network*” OR “system*”). Collectively, 20 studies were included. A predominantly reduced FC of DMN – often related to increased symptom severity – emerged. Additionally, intra-network FC of FPN was predominantly increased and often positively related to clinical scores. Concerning PFC, a predominant hyper-connectivity of right-sided prefrontal links emerged. Finally, FC of lateral prefrontal areas correlated with specific symptom dimensions. Several sources of heterogeneity in methodology might have affected results in unpredictable ways and were discussed. Such findings might represent endophenotypes of OCD manifestations, possibly reflecting computational impairments and difficulties in engaging in self-referential processes or in disengaging from cognitive control and monitoring processes.

Neural indices of performance monitoring are associated with daily emotional functioning in youth with anxiety disorders: An ERP and EMA study

Excessive monitoring of one's performance is a characteristic of anxiety disorders that has been linked to alterations in implicit emotion regulation (ER), including elevations in neural measures of performance monitoring (i.e., error- and correct-related negativity; ERN and CRN). Elevations in ERN and CRN amplitudes have been reported consistently in anxiety disorders, suggesting that an overactive performance monitoring system is linked to ER difficulties in anxiety. Yet, the relevance of these lab-based neural measures for day-to-day emotional functioning remains poorly understood. This study examined the degree to which ERN and CRN amplitudes are associated with measures of daily ER difficulties in youth with anxiety disorders. Youth (N = 100, Mage = 11.14, SDage = 1.46) completed a computerized flanker task assessing the ERN and CRN. They then completed a 5-day ecological momentary assessment (EMA) protocol assessing their daily ER (i.e., intensity of momentary and peak negative affect, intensity of worry, reliance on maladaptive ER strategies). Results showed that more negative mean CRN amplitudes were associated with higher levels of negative emotional reactivity and more intense worries. There were no significant associations between ERN amplitude and EMA measures. Furthermore, elevations in CRN were linked to more frequent use of maladaptive ER strategies (i.e., rumination, physiological reactivity, avoidance). Together, results indicate that among youth with anxiety, individual differences in CRN, but not ERN, amplitudes are related to daily ER difficulties. Findings highlight the clinical utility of a lab-based neural measure of ER, suggesting that the CRN, rather than the ERN, reflects individual ER differences in the context of daily life among youth with pediatric anxiety disorders. As such, the CRN might serve as an important dimensional index of a treatment target that can be tracked with a validated, multi-method measure.

Post-error slowing in anxiety and obsessive-compulsive disorders

Altered brain response to errors in anxiety and obsessive-compulsive disorders (OCD) suggests cognitive control abnormalities across both types of illness, but behavioral metrics of cognitive control function have yet to be compared in patients selected from these different diagnostic categories. Thus, we examined post-error slowing (PES), a behavioral adjustment that typically occurs after a mistake, in children and adolescents with and without a primary anxiety disorder (N = 103 anxiety and N = 28 healthy controls) and adolescents and adults with and without OCD (N = 118 OCD and N = 60 healthy controls) using a go/no-go task. Primary analyses tested for differences in PES between diagnostic groups (anxiety, OCD, healthy), controlling for age, overall reaction time, and overall accuracy. Results indicated that patients with anxiety disorders exhibited more post-error slowing than both patients with OCD and healthy volunteers. In contrast, participants with OCD did not differ from healthy volunteers in post-error slowing. In subgroup analyses restricted to adolescent participants (ages 13-17 years), more post-error slowing was observed in the anxiety disorders group compared with either the OCD or healthy groups. These data suggest that excessive post-error slowing, an index of behavioral adjustment following errors, may uniquely characterize patients with anxiety disorders relative to healthy individuals and those with OCD.

Neural Correlates of Executive Functioning in Anorexia Nervosa and Obsessive-Compulsive Disorder

Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) are commonly reported to co-occur and present with overlapping symptomatology. Executive functioning difficulties have been implicated in both mental health conditions. However, studies directly comparing these functions in AN and OCD are extremely limited. This review provides a synthesis of behavioral and neuroimaging research examining executive functioning in AN and OCD to bridge this gap in knowledge. We outline the similarities and differences in behavioral and neuroimaging findings between AN and OCD, focusing on set shifting, working memory, response inhibition, and response monitoring. This review aims to facilitate understanding of transdiagnostic correlates of executive functioning and highlights important considerations for future research. We also discuss the importance of examining both behavioral and neural markers when studying transdiagnostic correlates of executive functions.

Error-Related Brain Activity in Patients With Obsessive-Compulsive Disorder and Unaffected First-Degree Relatives: Evidence for Protective Patterns

Background

Indicators of increased error monitoring are associated with obsessive-compulsive disorder (OCD), as shown in electroencephalography and functional magnetic resonance imaging studies. As most studies used strictly controlled samples (excluding comorbidity and medication), it remains open whether these findings extend to naturalistic settings. Thus, we assessed error-related brain activity in a large, naturalistic OCD sample. We also explored which activity patterns might qualify as vulnerability endophenotypes or protective factors for the disorder. To this aim, a sample of unaffected first-degree relatives of patients with OCD was also included.

Methods

Participants (84 patients with OCD, 99 healthy control participants, and 37 unaffected first-degree relatives of patients with OCD) completed a flanker task while blood oxygen level–dependent responses were measured with functional magnetic resonance imaging. Aberrant error-related brain activity in patients and relatives was identified.

Results

Patients with OCD showed increased error-related activity in the supplementary motor area and within the default mode network, specifically in the precuneus and postcentral gyrus. Unaffected first-degree relatives showed increased error-related activity in the bilateral inferior frontal gyrus.

Conclusions

Increased supplementary motor area and default mode network activity in patients with OCD replicates previous studies and might indicate excessive error signals and increased self-referential error processing. Increased activity of the inferior frontal gyrus in relatives may reflect increased inhibition. Impaired response inhibition in OCD has been demonstrated in several studies and might contribute to impairments in suppressing compulsive actions. Thus, increased inferior frontal gyrus activity in the unaffected relatives of patients with OCD may have contributed to protection from symptom development.

A systematic review and meta-analysis of altered electrophysiological markers of performance monitoring in Obsessive-Compulsive Disorder (OCD), Gilles de la Tourette Syndrome (GTS), Attention-Deficit/Hyperactivity disorder (ADHD) and Autism

Altered performance monitoring is implicated in obsessive-compulsive disorder (OCD), Gilles de la Tourette syndrome (GTS), attention-deficit/hyperactivity disorder (ADHD) and autism. We conducted a systematic review and meta-analysis of electrophysiological correlates of performance monitoring (error-related negativity, ERN; error positivity, Pe; feedback-related negativity, FRN; feedback-P3) in individuals with OCD, GTS, ADHD or autism compared to control participants, or associations between correlates and symptoms/traits of these conditions. Meta-analyses on 97 studies (5890 participants) showed increased ERN in OCD (Hedge's g = 0.54[CIs:0.44,0.65]) and GTS (g = 0.99[CIs:0.05,1.93]). OCD also showed increased Pe (g = 0.51[CIs:0.21,0.81]) and FRN (g = 0.50[CIs:0.26,0.73]). ADHD and autism showed reduced ERN (ADHD: g=-0.47[CIs:-0.67,-0.26]; autism: g=-0.61[CIs:-1.10,-0.13]). ADHD also showed reduced Pe (g=-0.50[CIs:-0.69,-0.32]). These findings suggest overlap in electrophysiological markers of performance monitoring alterations in four common neurodevelopmental conditions, with increased amplitudes of the markers in OCD and GTS and decreased amplitudes in ADHD and autism. Implications of these findings in terms of shared and distinct performance monitoring alterations across these neurodevelopmental conditions are discussed. PROSPERO pre-registration code: CRD42019134612.

EEG correlates of attentional control in anxiety disorders: A systematic review of error-related negativity and correct-response negativity findings

BACKGROUND

Anxiety disorders are highly prevalent and cause substantial personal, social and economic burden. Altered attentional control has been shown to be present across anxiety disorders and is associated with specific changes in brain activity which can be recorded by electroencephalogram (EEG). These include changes in the EEG markers of error-related negativity (ERN) and correct-response negativity (CRN), both believed to reflect response monitoring and attentional control pathophysiology in anxiety. The aim of this review was to systematically assess the research on ERN and CRN in attentional control in individuals with clinical anxiety and healthy controls, across emotional and non-emotional attentional control.

METHODS

A comprehensive literature search was conducted for studies published prior to October 22^nd, 2020. Details of the protocol for this systematic review were registered on PROSPERO (CRD42019144885).

RESULTS

66 studies had their data extracted. All 66 studies measured ERN, with 85% finding significantly increased ERN amplitudes associated with clinical anxiety. Only 44 of the extracted studies analysed CRN and only ~20% of these found significant changes in CRN amplitude associated with individuals with clinical anxiety.

LIMITATIONS

There were several anxiety disorders that had either limited literature (i.e. specific phobia, separation anxiety disorder or agoraphobia) or nil literature (i.e. selective mutism) available. No extracted studies included samples of older adults (i.e. aged 60+ years), and only six extracted studies included measures of emotional attentional control.

CONCLUSIONS

Findings indicate the promising utility of ERN of attentional control as a robust, transdiagnostic trait marker of clinical anxiety.

Deep Brain Stimulation Reduces Conflict-Related Theta and Error-Related Negativity in Patients With Obsessive-Compulsive Disorder

OBJECTIVES

Obsessive-compulsive disorder (OCD) is a psychiatric disorder with alterations of cortico-striato-thalamo-cortical loops and impaired performance monitoring. Electrophysiological markers such as conflict-related medial frontal theta (MFT) and error-related negativity (ERN) may be altered by clinically effective deep brain stimulation (DBS) of the anterior limb of the internal capsule and nucleus accumbens (ALIC/NAc). We hypothesized that ALIC/NAc DBS modulates electrophysiological performance monitoring markers.

MATERIALS AND METHODS

Fifteen patients (six male) with otherwise treatment-refractory OCD receiving ALIC/NAc DBS performed a flanker task with EEG recordings at three sessions: presurgery, and at follow-up with DBS on and off. We examined MFT, ERN, and task performance. Furthermore, we investigated interrelations with clinical efficacy and the explored the influence of the location of individual stimulation volumes on EEG modulations.

RESULTS

MFT and ERN were significantly attenuated by DBS with differences most pronounced between presurgery and DBS-on states. Also, we observed reaction time slowing for erroneous responses during DBS-off. Larger presurgery ERN amplitudes were associated with decreased clinical efficacy. Exploratory anatomical analyses suggested that stimulation volumes encompassing the NAc were associated with MFT modulation, whereas ALIC stimulation was associated with modulation of the ERN and clinical efficacy.

CONCLUSION

ALIC/NAc DBS diminished MFT and ERN, demonstrating modulation of the medial frontal performance monitoring system in OCD. Furthermore, our findings encourage further studies to explore the ERN as a potential predictor for clinical efficacy.

Identification of biomarkers that predict response to subthalamic nucleus deep brain stimulation in resistant obsessive-compulsive disorder: protocol for an open-label follow-up study

INTRODUCTION

Deep brain stimulation (DBS) of bilateral anteromedial subthalamic nucleus (amSTN) has been found to be helpful in a subset of patients with severe, chronic and treatment-refractory obsessive-compulsive disorder (OCD). Biomarkers may aid in patient selection and optimisation of this invasive treatment. In this trial, we intend to evaluate neurocognitive function related to STN and related biosignatures as potential biomarkers for STN DBS in OCD.

METHODS AND ANALYSIS

Twenty-four subjects with treatment-refractory OCD will undergo open-label STN DBS. Structural/functional imaging, electrophysiological recording and neurocognitive assessment would be performed at baseline. The subjects would undergo a structured clinical assessment for 12 months postsurgery. A group of 24 healthy volunteers and 24 subjects with treatment-refractory OCD who receive treatment as usual would be recruited for comparison of biomarkers and treatment response, respectively. Baseline biomarkers would be evaluated as predictors of clinical response. Neuroadaptive changes would be studied through a reassessment of neurocognitive functioning, imaging and electrophysiological activity post DBS.

ETHICS AND DISSEMINATION

The protocol has been approved by the National Institute of Mental Health and Neurosciences Ethics Committee. The study findings will be disseminated through peer-reviewed scientific journals and scientific meetings.

Controlling parenting and perfectionism is associated with an increased error-related negativity (ERN) in young adults

A substantial amount of research focuses on the error-related negativity (ERN)—a negative deflection in the event-related potential waveform that occurs when individuals commit errors on lab-based tasks. The ERN has been link to concurrent and prospective risk for psychopathology and is thought to index sensitivity or reactivity to errors. The ERN can be potentiated in the lab with punishment and has been shown to be increased among offspring of harsh or controlling parents. A separate line of work has demonstrated that the ERN is increased among individuals high in perfectionism. In the current study, we integrate these separate lines of work by examining parenting styles, perfectionism and the ERN in a sample of young adults. Results suggest that the ERN is increased among offspring of controlling parents (both maternal and paternal). Additionally, the ERN is increased among individuals who report being high in perfectionism—specifically, the concerns over mistake and the personal standard perfectionism subscales of the Frost Multidimensional Perfectionism Scale. Moreover, results supported a mediation model wherein the indirect pathway from controlling parenting style to perfectionism (personal standard subscale) was mediated by the ERN—for paternal parenting.

The Error-Related Negativity Predicts Self-Control Failures in Daily Life

Adaptive behavior critically depends on performance monitoring (PM), the ability to monitor action outcomes and the need to adapt behavior. PM-related brain activity has been linked to guiding decisions about whether action adaptation is warranted. The present study examined whether PM-related brain activity in a flanker task, as measured by electroencephalography (EEG), was associated with adaptive behavior in daily life. Specifically, we were interested in the employment of self-control, operationalized as self-control failures (SCFs), and measured using ecological momentary assessment. Analyses were conducted using an adaptive elastic net regression to predict SCFs from EEG in a sample of 131 participants. The model was fit using within-subject averaged response-locked EEG activity at each electrode and time point within an epoch surrounding the response. We found that higher amplitudes of the error-related negativity (ERN) were related to fewer SCFs. This suggests that lower error-related activity may relate to lower recruitment of interventive self-control in daily life. Altered cognitive control processes, like PM, have been proposed as underlying mechanisms for various mental disorders. Understanding how alterations in PM relate to regulatory control might therefore aid in delineating how these alterations contribute to different psychopathologies.

Neurocognitive Endophenotypes of OCD

In this chapter, I address the concept of endophenotypes for obsessive-compulsive disorder (OCD). Endophenotypes are objective and heritable quantitative traits hypothesized to be more biologically tractable than distal clinical phenotypes. This approach has been adopted to gain a better understanding of psychiatric conditions in general. It is theorized that endophenotypes will particularly assist in clarifying both the diagnostic status and aetiological origins of complex neuropsychiatric conditions such as OCD. At the cognitive level, separable constructs of relevance for OCD have been identified. The prevailing model for OCD assumes the development of abnormalities within fronto-striatal neural circuits leading to impairment of executive functions and their neuropsychological subcomponents. Here, I address whether this model can guide towards the identification of endophenotypes for this condition and discuss possible implications.

A dimensional investigation of error-related negativity (ERN) and self-reported psychiatric symptoms

Alterations in error processing are implicated in a range of DSM-defined psychiatric disorders. For instance, obsessive-compulsive disorder (OCD) and generalised anxiety disorder show enhanced electrophysiological responses to errors-i.e. error-related negativity (ERN)-while others like schizophrenia have an attenuated ERN. However, as diagnostic categories in psychiatry are heterogeneous and also highly intercorrelated, the precise mapping of ERN enhancements/impairments is unclear. To address this, we recorded electroencephalograms (EEG) from 196 participants who performed the Flanker task and collected scores on 9 questionnaires assessing psychiatric symptoms to test if a dimensional framework could reveal specific transdiagnostic clinical manifestations of error processing dysfunctions. Contrary to our hypothesis, we found non-significant associations between ERN amplitude and symptom severity of OCD, trait anxiety, depression, social anxiety, impulsivity, eating disorders, alcohol addiction, schizotypy and apathy. A transdiagnostic approach did nothing to improve signal; there were non-significant associations between all three transdiagnostic dimensions (anxious-depression, compulsive behaviour and intrusive thought, and social withdrawal) and ERN magnitude. In these same individuals, we replicated a previously published transdiagnostic association between goal-directed learning and compulsive behaviour and intrusive thought. Possible explanations discussed are (i) that associations between the ERN and psychopathology might be smaller than previously assumed, (ii) that these associations might depend on a greater level of symptom severity than other transdiagnostic cognitive biomarkers, or (iii) that task parameters, such as the ratio of compatible to incompatible trials, might be crucial for ensuring the sensitivity of the ERN to clinical phenomena.

Do Individuals With Obsessive-Compulsive Disorder and Obsessive-Compulsive Personality Disorder Share Similar Neural Mechanisms of Decision-Making Under Ambiguous Circumstances?

Impaired decision-making is well documented in obsessive-compulsive disorder (OCD) and a range of electrophysiological and functional neuroimaging measures have begun to reveal the pathological mechanisms that underlie the decision-making process. Obsessive-compulsive personality disorder (OCPD) has core symptoms that often overlap with OCD, but similarities between these disorders at the behavioral and neurological levels are often unclear, including whether OCPD exhibits similar decision-making deficits and shared neurological dysfunction. To address these issues, we examined 24 cases of OCD, 19 cases of OCPD, and 26 matched normal control (NC) subjects during the revised Iowa Gambling Task (IGT) using event-related potentials (ERPs). The net IGT scores were lower for OCD subjects than for OCPD or NC subjects, thus indicating that OCD subjects chose more disadvantageous options and were "short-sighted" with regards to information. The feedback-related negativity (FRN) waveform (lose-win) was larger in both OCD and OCPD subjects, which suggested that obstacles exist in the feedback process. Consequently, these subjects might share similar neural mechanisms under ambiguous decision-making circumstances. Furthermore, IGT net scores were significantly and negatively correlated with Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale (HAMD) scales. This implies that more severe obsessive-compulsive symptoms inspired more negative emotions that led to worse decision-making ability. Therefore, although similar neural mechanisms might exist, this led to different behaviors in which OCPD is associated with better behavioral performance compared to OCD patients.

A transdiagnostic perspective of constructs underlying obsessive-compulsive and related disorders: An international Delphi consensus study

BACKGROUND

The Research Domain Criteria seeks to bridge knowledge from neuroscience with clinical practice by promoting research into valid neurocognitive phenotypes and dimensions, irrespective of symptoms and diagnoses as currently conceptualized. While the Research Domain Criteria offers a vision of future research and practice, its 39 functional constructs need refinement to better target new phenotyping efforts. This study aimed to determine which Research Domain Criteria constructs are most relevant to understanding obsessive-compulsive and related disorders, based on a consensus between experts in the field of obsessive-compulsive and related disorders.

METHODS

Based on a modified Delphi method, 46 experts were recruited from Australia, Africa, Asia, Europe and the Americas. Over three rounds, experts had the opportunity to review their opinion in light of feedback from the previous round, which included how their response compared to other experts and a summary of comments given.

RESULTS

Thirty-four experts completed round one, of whom 28 (82%) completed round two and 24 (71%) completed round three. At the final round, four constructs were endorsed by ⩾75% of experts as 'primary constructs' and therefore central to understanding obsessive-compulsive and related disorders. Of these constructs, one came from the Positive Valence System (Habit), two from the Cognitive Control System (Response Selection/Inhibition and Performance Monitoring) and the final construct was an additional item suggested by experts (Compulsivity).

CONCLUSION

This study identified four Research Domain Criteria constructs that, according to experts, cut across different obsessive-compulsive and related disorders. These constructs represent key areas for future investigation, and may have potential implications for clinical practice in terms of diagnostic processes and therapeutic management of obsessive-compulsive and related disorders.

The error-related negativity (ERN) moderates the association between interpersonal stress and anxiety symptoms six months later

Anxiety disorders are often preceded by interpersonal stress; however, most individuals who experience stress do not develop anxiety, making it difficult to predict who is most susceptible to stress. One proposed trans-diagnostic neural risk marker for anxiety is the error-related negativity (ERN), a negative deflection in the event-related potential waveform occurring within 100 ms of error commission. The present study sought to investigate whether interpersonal stress experienced over the course of a year interacts with ERN magnitude to prospectively predict anxiety symptoms. A sample of 57 emerging adults performed an arrow flanker task to elicit the ERN at the start of the academic school year (time one). Toward the end of the academic year (time two), participants reported on past-year interpersonal stress and anxiety symptoms. Stress interacted with ERN magnitude to predict anxiety symptoms, whereby, for individuals with an enhanced ERN at time one, greater interpersonal stress over the course of a year was significantly associated with increased anxiety symptoms at time two, even controlling for anxiety symptoms at time one. These findings suggest that enhanced performance monitoring may render individuals more susceptible to the adverse effects of interpersonal stress, thereby increasing risk for heightened anxiety.

The erring brain: Error-related negativity as an endophenotype for OCD-A review and meta-analysis

Obsessive-compulsive disorder (OCD) is a complex and heterogeneous disorder that is associated with high personal and societal costs. Feelings of doubt, worry, and repetitive behavior, key symptoms of OCD, have been linked to hyperactive error signals in the brain. The error-related negativity (ERN) represents a validated marker of error processing in the ERP. Increased ERN amplitudes in OCD have been reported very robustly over the last 20 years. This article integrates results from 38 studies analyzing the ERN in OCD, using a quantitative meta-analysis. Meta-regressions were used to examine potential moderators such as task type, symptom severity, age, and sample size. The meta-analysis reveals a robust increase of ERN in OCD patients compared to healthy participants in response-conflict tasks (SMD -0.55) that is not modulated by symptom severity and age. No increase in ERN in OCD was observed in tasks that do not induce response conflict (SMD -0.10). In addition to the meta-analysis, the current article reviews evidence supporting that increased ERN amplitudes in OCD fulfill central criteria for an endophenotype. Further, the specificity of increased ERN amplitudes for OCD and its suitability as a potential transdiagnostic endophenotype is discussed. Finally, the clinical utility and clinical applications are examined. Overall, the evidence that increased ERN amplitudes represent a promising endophenotype indicating vulnerability for OCD is compelling. Furthermore, alterations in ERN are not limited to OCD and may constitute a transdiagnostic endophenotype. Altered neural error signals might serve as a diagnostic or predictive marker and represent a promising target for interventions.

Shared Response Inhibition Deficits but Distinct Error Processing Capacities Between Schizophrenia and Obsessive-Compulsive Disorder Patients Revealed by Event-Related Potentials and Oscillations During a Stop Signal Task

Background: Schizophrenia (SCH) patients are at high risk for obsessive-compulsive syndrome, which can lead to difficulty in differential diagnosis between SCH and obsessive-compulsive disorder (OCD). It would be of great clinical value to identify objective markers for these diseases based on behavioral or neurological manifestations. Deficient response inhibition has been reported in both SCH and OCD; however, it is unclear if common or distinct neural abnormalities underlie this impairment. Methods: To address this question, we compared Stop signal task performance and associated event-related potentials (ERPs) and event-related oscillation (ERO) among 24 SCH patients, 25 OCD patients, and 27 healthy controls (HCs). Results: In successful Stop trials, both SCH and OCD patients showed prolonged Stop signal response time, reduced ERP-P3 component amplitude, and weaker theta-band synchronization compared to HCs, while there were no significant differences between patient groups. In unsuccessful Stop trials, however, SCH patients demonstrated significantly lower P3 amplitudes and weaker theta-band activity than OCD patients. In addition, Stop accuracy rate in SCH patients was negatively correlated with Positive subscale score of the Positive and Negative Syndrome Scale. Conclusions: These results provide evidence that impaired response inhibition in SCH and OCD arises from common underlying neural processing abnormalities. However, the lower P3 amplitude and weaker theta-band activity in SCH patients in unsuccessful Stop trials suggest distinct neural activity patterns related to error processing. These differences in ERPs and ERO may provide clues to unique neurological abnormalities in SCH and provide objective measures for differential diagnosis.

Altered Functional Connectivity of Alpha Rhythm in Obsessive-Compulsive Disorder During Rest

Obsessive-compulsive disorder (OCD) is a common inheritable psychiatric disorder characteristic of repetitive thinking, imagination (obsession), and stereotyped behaviors (compulsive). To explore whether there is an alteration of brain functional connectivity (BFC) in patients with OCD during rest, electroencephalogram (EEG) data of healthy controls (HCs) and patients with OCD were collected during rest in both eyes-closed and eyes-open states. Synchronization likelihood and graph theory were applied to construct and analyze brain functional networks of patients with OCD and HCs. Patients with OCD showed abnormal graph-theoretic parameters and impaired small world features in the alpha and beta bands. In addition, the topological analysis consistently showed that the long-range BFC of alpha rhythm was significantly reduced in the bilateral posterior areas in patients with OCD in comparison with HCs, while the BFC in the beta rhythm was significantly increased only in the eyes-open state. The findings suggest that the BFC of patients with OCD show abnormal small-world features and altered topological structure during rest, mainly in alpha and beta bands, which may provide a new insight for the diagnosis and treatment of OCD.

Electrophysiology of obsessive compulsive disorder: A systematic review of the electroencephalographic literature

Obsessive-compulsive disorder (OCD) is a chronic disease that causes significant decline in the quality of life of those affected. Due to our limited understanding of the underlying pathophysiology of OCD, successful treatment remains elusive. Although many have studied the pathophysiology of OCD through electroencephalography (EEG), limited attempts have been made to synthesize and interpret their findings. To bridge this gap, we conducted a comprehensive literature review using Medline/PubMed and considered the 65 most relevant studies published before June 2018. The findings are categorised into quantitative EEG, sleep related EEG and event related potentials (ERPs). Increased frontal asymmetry, frontal slowing and an enhancement in the ERP known as error related negativity (ERN) were consistent findings in OCD. However, sleep EEG and other ERP (P3 and N2) findings were inconsistent. Additionally, we analysed the usefulness of ERN as a potential candidate endophenotype. We hypothesize that dysfunctional frontal circuitry and overactive performance monitoring are the major underlying impairments in OCD. Additionally, we conceptualized that defective fronto-striato-thalamic circuitry causing poor cerebral functional connectivity gives rise to the OCD behavioural manifestations. Finally, we have discussed transcranial magnetic stimulation and EEG (TMS-EEG) applications in future research to further our knowledge of the underlying pathophysiology of OCD.

The development of the error-related negativity in large sample of adolescent females: Associations with anxiety symptoms

Anxiety is the most common form of psychopathology and tends to begin early in the course of development. Given this, there is great interest in identifying developmental changes in neural systems that may delineate healthy versus anxious trajectories. A substantial amount of work has focused on the error-related negativity as a neural marker of anxiety. The ERN is a negative deflection in the event-related potential that occurs when individuals make mistakes and is increased in anxious individuals. A separate body of work has focused on normative developmental changes in the ERN - demonstrating an age-related increase in the ERN that occurs across childhood and adolescence. In the current study, we examine the ERN in relation to specific phenotypic expressions of anxiety during a core risk period in a sample of females (N = 220) ranging from 8 to 14 years old. Results from the current study suggest that error-related brain activity is related to both parent and child report of social anxiety symptoms, even when controlling for all other symptom scales. Additionally, mediation models suggest that the normative developmental increase observed in the ERN is partially mediated by increases in social anxiety symptoms. The current results are novel insofar as they identify a specific phenotypic expression of anxiety that underlies developmental increases in this neural biomarker.

Brief training in mindfulness may normalize a blunted error-related negativity in chronically depressed patients

The error-related negativity (ERN), an evoked-potential that arises in response to the commission of errors, is an important early indicator of self-regulatory capacities. In this study we investigated whether brief mindfulness training can reverse ERN deficits in chronically depressed patients. The ERN was assessed in a sustained attention task. Chronically depressed patients (n = 59) showed significantly blunted expression of the ERN in frontocentral and frontal regions, relative to healthy controls (n = 18). Following two weeks of training, the patients (n = 24) in the mindfulness condition showed a significantly increased ERN magnitude in the frontal region, but there were no significant changes in patients who had received a resting control (n = 22). The findings suggest that brief training in mindfulness may help normalize aberrations in the ERN in chronically depressed patients, providing preliminary evidence for the responsiveness of this parameter to mental training.

Enhanced error related negativity amplitude in medication-naïve, comorbidity-free obsessive compulsive disorder

Error monitoring and response inhibition is a key cognitive deficit in obsessive-compulsive disorder (OCD). Frontal midline regions such as the cingulate cortex and pre-supplementary motor area are considered critical brain substrates of this deficit. Electrophysiological equivalent of the above dysfunction is a fronto-central event related potential (ERP) which occurs after an error called the error related negativity (ERN). In this study, we sought to compare the ERN parameters between medication-naïve, comorbidity-free subjects with OCD and healthy controls (HC). Age, sex and handedness matched subjects with medication-naïve, comorbidity-free OCD (N = 16) and Healthy Controls (N = 17) performed a modified version of the flanker task while EEG was acquired for ERN. EEG signals were recorded from the electrodes FCz and Cz. Clinical severity of OCD was assessed using the Yale Brown Obsessive Compulsive Scale. The subjects with OCD had significantly greater ERN amplitude at Cz and FCz. There were no significant correlations between ERN measures and illness severity measures. Overactive performance monitoring as evidenced by enhanced ERN amplitude could be considered as a biomarker for OCD.

Symptom dimensions in obsessive-compulsive disorder as predictors of neurobiology and treatment response

Purpose of review

Specific symptom dimensions of obsessive-compulsive disorder (OCD) have been suggested as an approach to reduce the heterogeneity of obsessive-compulsive disorder, predict treatment outcome, and relate to brain structure and function. Here, we review studies addressing these issues.

Recent findings

The contamination and symmetry/ordering dimensions have not been reliably associated with treatment outcome. Some studies found that greater severity of sexual/aggressive/religious symptoms predicted a worse outcome after cognitive behavioral therapy (CBT) and a better outcome after serotonin reuptake inhibitors (SRIs). Contamination symptoms have been related to increased amygdala and insula activation in a few studies, while sexual/aggressive/religious symptoms have also been related to more pronounced alterations in the function and structure of the amygdala. Increased pre-treatment limbic responsiveness has been related to better outcomes of CBT, but most imaging studies show important limitations and replication in large-scale studies is needed. We review possible reasons for the strong limbic involvement of the amygdala in patients with more sexual/aggressive/religious symptoms, in relation to their sensitivity to CBT.

Summary

Symptom dimensions may predict treatment outcome, and patients with sexual/religious/aggressive symptoms are at a greater risk of not starting or delaying treatment. This is likely partly due to more shame and perceived immorality which is also related to stronger amygdala response. Competently delivered CBT is likely to help these patients improve to the same degree as patients with other symptoms.

Response inhibition and error-monitoring processes in individuals with obsessive-compulsive disorder

Response inhibition (RI) has been putatively linked to the symptoms of OCD. Despite the enticing link between RI and OCD, there are points in the relationship that require clarification. We examined the RI-OCD relationship taking into account a) the potentially differential pattern of RI-OCD relationship between obsessions and compulsions, and b) the potentially confounding effect of negative affect, particularly in regards to depression. Additionally, we investigated how error-monitoring processes in the inhibitory context account for OCD symptoms. Results showed that the RI-OCD relationship is robust in regards to compulsion symptoms, but not for obsessions, even when controlling for negative affect. Additionally, while individuals with OCD display behavioral slow-down following commission errors on the stop-signal task, slow-down following successful inhibition is significantly related to compulsion symptoms. Findings suggest that future studies investigating RI in OCD should take into account heterogeneous clinical presentations in OCD, as well as incorporate error-monitoring variables to better understand RI processes in OCD.

Error-related brain activity and internalizing disorder symptom dimensions in depression and anxiety

BACKGROUND

Research suggests that enhanced neural reactivity to errors, measured via the error-related negativity (ERN), is relatively unique to internalizing psychopathologies (IPs) and symptom clusters characterized by excessive worry and apprehension. However, no prior study has tested the association between the ERN and IP symptom dimensions in a heterogeneous, clinically representative patient population. The current study was designed to address this gap in the literature and clarify the role of the ERN in an adult IP treatment-seeking patient sample.

METHOD

Eighty-five participants completed a well-validated flanker task known to robustly elicit the ERN and a battery of questionnaires assessing a range of IP symptoms. All participants had at least one IP diagnosis and over 75% had co-occurring IPs. A principal components analysis (PCA) was performed on the questionnaire data indicating two distinct factors that characterized the IP sample: affective distress/misery and fear-based anxiety.

RESULTS

Analyses indicated that within this sample, an enhanced ERN, but not CRN, was associated with greater fear-based anxiety symptoms but had no relation with distress/misery symptoms.

CONCLUSIONS

Together, these findings indicate that an enhanced ERN may not be specific to worry/apprehension and may extend to the IP fear dimension. The results also converge with a broader literature suggesting that fear-based psychopathology is characterized by an exaggerated reactivity to threat and this objective, psychophysiological response tendency may distinguish fear disorders from distress.

Modulation of error monitoring in obsessive-compulsive disorder by individually tailored symptom provocation

BACKGROUND

The enhanced error monitoring in patients with obsessive-compulsive disorder (OCD), typically measured with the error-related negativity (ERN), has been found to be temporally stable and independent of symptom expression. Here, we examined whether the error monitoring in patients with OCD could be experimentally modulated by individually tailored symptom provocation.

METHOD

Twenty patients with OCD and 20 healthy controls performed a flanker task in which OCD-relevant or neutral pictures were presented prior to a flanker stimulus. An individualized stimulus set consisting of the most provoking images in terms of OCD symptoms was selected for each patient with OCD. Response-locked event-related potentials were recorded and used to examine the error-related brain activity.

RESULTS

Patients with OCD showed larger ERN amplitudes than did control subjects in both the OCD-symptom provocation and neutral conditions. Additionally, while patients with OCD exhibited a significant increase in the ERN under the OCD-symptom provocation condition when compared with the neutral condition, control subjects showed no variation in the ERN between the conditions.

CONCLUSIONS

Our results strengthen earlier findings of hyperactive error monitoring in OCD, as indexed by higher ERN amplitudes in patients with OCD than in controls. Importantly, we showed that the patients' overactive error-signals were experimentally enhanced by individually tailored OCD-symptom triggers, thus suggesting convincing evidence between OCD-symptoms and ERN. Such findings imply that therapeutic interventions should target affective regulation in order to alleviate the perceived threatening value of OCD triggers.

The inner world of overactive monitoring: neural markers of interoception in obsessive-compulsive disorder

BACKGROUND

Obsessive-compulsive disorder (OCD) patients typically overmonitor their own behavior, as shown by symptoms of excessive doubt and checking. Although this is well established for the patients' relationship with external stimuli in the environment, no study has explored their monitoring of internal body signals, a process known to be affected in anxiety-related syndromes. Here, we explored this issue through a cardiac interoception task that measures sensing of heartbeats. Our aim was to explore key behavioral and electrophysiological aspects of internal-cue monitoring in OCD, while examining their potential distinctiveness in this condition.

METHOD

We administered a heartbeat detection (HBD) task (with related interoceptive confidence and awareness measures) to three matched groups (OCD patients, panic disorder patients, healthy controls) and recorded ongoing modulations of two task-relevant electrophysiological markers: the heart evoked potential (HEP) and the motor potential (MP).

RESULTS

Behaviorally, OCD patients outperformed controls and panic patients in the HBD task. Moreover, they exhibited greater amplitude modulation of both the HEP and the MP during cardiac interoception. However, they evinced poorer confidence and awareness of their interoceptive skills.

CONCLUSIONS

Convergent behavioral and electrophysiological data showed that overactive monitoring in OCD extends to the sensing of internal bodily signals. Moreover, this pattern discriminated OCD from panic patients, suggesting a condition-distinctive alteration. Our results highlight the potential of exploring interoceptive processes in the OCD spectrum to better characterize the population's cognitive profile. Finally, these findings may lay new bridges between somatic theories of emotion and cognitive models of OCD.

Conflict monitoring and adaptation as reflected by N2 amplitude in obsessive-compulsive disorder

BACKGROUND

Feelings of doubt and perseverative behaviours are key symptoms of obsessive-compulsive disorder (OCD) and have been linked to hyperactive error and conflict signals in the brain. While enhanced neural correlates of error monitoring have been robustly shown, far less is known about conflict processing and adaptation in OCD.

METHOD

We examined event-related potentials during conflict processing in 70 patients with OCD and 70 matched healthy comparison participants, focusing on the stimulus-locked N2 elicited in a flanker task. Conflict adaptation was evaluated by analysing sequential adjustments in N2 and behaviour, i.e. current conflict effects as a function of preceding conflict.

RESULTS

Patients with OCD showed enhanced N2 amplitudes compared with healthy controls. Further, patients showed stronger conflict adaptation effects on reaction times and N2 amplitude. Thus, the effect of previous compatibility was larger in patients than in healthy participants as indicated by greater N2 adjustments in change trials (i.e. iC, cI). As a result of stronger conflict adaptation in patients, N2 amplitudes were comparable between groups in incompatible trials following incompatible trials.

CONCLUSIONS

Larger N2 amplitudes and greater conflict adaptation in OCD point to enhanced conflict monitoring leading to increased recruitment of cognitive control in patients. This was most pronounced in change trials and was associated with stronger conflict adjustment in N2 and behaviour. Thus, hyperactive conflict monitoring in OCD may be beneficial in situations that require a high amount of control to resolve conflict, but may also reflect an effortful process that is linked to distress and symptoms of OCD.

Biological markers for anxiety disorders, OCD and PTSD: A consensus statement. Part II: Neurochemistry, neurophysiology and neurocognition

OBJECTIVE

Biomarkers are defined as anatomical, biochemical or physiological traits that are specific to certain disorders or syndromes. The objective of this paper is to summarise the current knowledge of biomarkers for anxiety disorders, obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD).

METHODS

Findings in biomarker research were reviewed by a task force of international experts in the field, consisting of members of the World Federation of Societies for Biological Psychiatry Task Force on Biological Markers and of the European College of Neuropsychopharmacology Anxiety Disorders Research Network.

RESULTS

The present article (Part II) summarises findings on potential biomarkers in neurochemistry (neurotransmitters such as serotonin, norepinephrine, dopamine or GABA, neuropeptides such as cholecystokinin, neurokinins, atrial natriuretic peptide, or oxytocin, the HPA axis, neurotrophic factors such as NGF and BDNF, immunology and CO2 hypersensitivity), neurophysiology (EEG, heart rate variability) and neurocognition. The accompanying paper (Part I) focuses on neuroimaging and genetics.

CONCLUSIONS

Although at present, none of the putative biomarkers is sufficient and specific as a diagnostic tool, an abundance of high quality research has accumulated that should improve our understanding of the neurobiological causes of anxiety disorders, OCD and PTSD.

Presupplementary Motor Area Contributes to Altered Error Monitoring in Obsessive-Compulsive Disorder

BACKGROUND

Hyperactive performance monitoring, as measured by the error-related negativity (ERN) in the event-related potential, is a reliable finding in obsessive-compulsive disorder (OCD) research and may be an endophenotype of the disorder. Imaging studies revealed inconsistent results as to which brain regions are involved in altered performance monitoring in OCD. We investigated performance monitoring in OCD with simultaneous recording of electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) signals to determine the neural source of the enhanced ERN.

METHODS

Concurrent EEG and fMRI data were collected from 20 patients with OCD and 22 healthy control subjects during a flanker task. Independent component analysis was used separately on EEG and fMRI to segment the data functionally and focus on processes of interest. The ERN, hemodynamic responses following errors, and intraindividual correlation of the ERN and blood oxygen level-dependent activity were compared between groups.

RESULTS

Patients with OCD showed significantly increased ERN amplitudes. Blood oxygen level-dependent activity in midcingulate cortex was not significantly different between groups. Increased activation of the right amygdala and the subgenual anterior cingulate cortex following errors was observed in patients with OCD. Increased intraindividual correlation of the ERN and activity of the presupplementary motor area was found in patients with OCD compared with healthy controls.

CONCLUSIONS

Higher error-related activity was found in the amygdala and subgenual anterior cingulate cortex, suggesting a stronger affective response toward errors in patients with OCD. Additionally, increased correlation of the ERN and presupplementary motor area may indicate stronger recruitment of proactive control in OCD.

Withdrawn/Depressed Behaviors and Error-Related Brain Activity in Youth With Obsessive-Compulsive Disorder

OBJECTIVE

The pathophysiology of obsessive-compulsive disorder (OCD) involves increased activity in corticostriatal circuits connecting the anterior cingulate cortex with other brain regions. The error-related negativity (ERN) is a negative deflection in the event-related potential after an incorrect response that is believed to reflect anterior cingulate cortex activity. This study examined the relation of the ERN to OCD symptom dimensions and other childhood symptom dimensions.

METHOD

The ERN, correct response negativity, and accuracy were measured during a flanker task to assess performance monitoring in 80 youth with a lifetime diagnosis of OCD and 80 matched healthy comparison participants ranging from 8 to 18 years old. The relation of the ERN to OCD symptom dimension scores and Child Behavior Checklist Syndrome Scale scores was examined in multiple linear regression analyses.

RESULTS

Accuracy was significantly decreased and ERN amplitude was significantly increased in patients compared with controls. ERN amplitude in patients was significantly correlated with accuracy, but not with OCD symptom dimensions, severity, comorbidity, or treatment. In a multiple linear regression analysis using age, accuracy, OCD, and Child Behavior Checklist Syndrome Scale scores as predictors of ERN amplitude, the ERN had significant associations only with Withdrawn/Depressed Scale scores and accuracy.

CONCLUSION

An enlarged ERN is a neural correlate of pediatric OCD that is independent of OCD symptom expression and severity. The finding of lower accuracy in pediatric cases requires replication. The relation between an enhanced ERN and withdrawn/depressed behaviors warrants further research in youth with OCD and other internalizing disorders.

Cognitive Dysfunction in Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a mental disorder featuring obsessions (intrusive thoughts) and compulsions (repetitive behaviors performed in the context of rigid rituals). There is strong evidence for a neurobiological basis of this disorder, involving limbic cortical regions and related basal ganglion areas. However, more research is needed to lift the veil on the precise nature of that involvement and the way it drives the clinical expression of OCD. Altered cognitive functions may underlie the symptoms and thus draw a link between the clinical expression of the disorder and its neurobiological etiology. Our extensive review demonstrates that OCD patients do present a broad range of neuropsychological dysfunctions across all cognitive domains (memory, attention, flexibility, inhibition, verbal fluency, planning, decision-making), but some methodological issues temper this observation. Thus, future research should have a more integrative approach to cognitive functioning, gathering contributions of both experimental psychology and more fundamental neurosciences.

Contextualizing individual differences in error monitoring: Links with impulsivity, negative affect, and conscientiousness

The error-related negativity (ERN) is a neural measure of error processing that has been implicated as a neurobehavioral trait and has transdiagnostic links with psychopathology. Few studies, however, have contextualized this traitlike component with regard to dimensions of personality that, as intermediate constructs, may aid in contextualizing links with psychopathology. Accordingly, the aim of this study was to examine the interrelationships between error monitoring and dimensions of personality within a large adult sample (N = 208). Building on previous research, we found that the ERN relates to a combination of negative affect, impulsivity, and conscientiousness. At low levels of conscientiousness, negative urgency (i.e., impulsivity in the context of negative affect) predicted an increased ERN; at high levels of conscientiousness, the effect of negative urgency was not significant. This relationship was driven specifically by the conscientiousness facets of competence, order, and deliberation. Links between personality measures and error positivity amplitude were weaker and nonsignificant. Post-error slowing was also related to conscientiousness, as well as a different facet of impulsivity: lack of perseverance. These findings suggest that, in the general population, error processing is modulated by the joint combination of negative affect, impulsivity, and conscientiousness (i.e., the profile across traits), perhaps more so than any one dimension alone. This work may inform future research concerning aberrant error processing in clinical populations.

Error-related brain activity dissociates hoarding disorder from obsessive-compulsive disorder

BACKGROUND

Obsessive-compulsive disorder (OCD) is associated with an abnormally large error-related negativity (ERN), an electrophysiological measure of error monitoring in response to performance errors, but it is unclear if hoarding disorder (HD) also shows this abnormality. This study aimed to determine whether the neurophysiological mechanisms underlying error monitoring are similarly compromised in HD and OCD.

METHOD

We used a visual flanker task to assess ERN in response to performance errors in 14 individuals with HD, 27 with OCD, 10 with HD+OCD, and 45 healthy controls (HC). Age-corrected performance and ERN amplitudes were examined using analyses of variance and planned pairwise group comparisons.

RESULTS

A main effect of hoarding on ERN (p = 0.031) was observed, indicating ERN amplitudes were attenuated in HD relative to non-HD subjects. A group × age interaction effect on ERN was also evident. In HD-positive subjects, ERN amplitude deficits were significantly greater in younger individuals (r = -0.479, p = 0.018), whereas there were no significant ERN changes with increasing age in OCD and HC participants.

CONCLUSIONS

The reduced ERN in HD relative to OCD and HC provides evidence that HD is neurobiologically distinct from OCD, and suggests that deficient error monitoring may be a core pathophysiological feature of HD. This effect was particularly prominent in younger HD participants, further suggesting that deficient error monitoring manifests most strongly early in the illness course and/or in individuals with a relatively early illness onset.