Specificity of performance monitoring changes in obsessive-compulsive disorder

Advancing Obsessive-Compulsive Disorder Research: Insights from Transgenic Animal Models and Innovative Therapies

Obsessive-compulsive disorder (OCD) is a prevalent, chronic, and severe neuropsychiatric disorder that leads to illness-related disability. Despite the availability of several treatments, many OCD patients respond inadequately, because the underlying neural mechanisms remain unclear, necessitating the establishment of many animal models, particularly mouse models, to elucidate disease mechanisms and therapeutic strategies better. Although the development of animal models is ongoing, there remain many comprehensive summaries and updates in recent research, hampering efforts to develop novel treatments and enhance existing interventions. This review summarizes the phenotypes of several commonly used models and mechanistic insights from transgenic models of OCD, such as knockout mouse models. In addition, we present the advantages and limitations of these models and discuss their future in helping further understand the pathophysiology and advanced treatment. Here, we highlight current frontline treatment approaches for OCD, including neuromodulation and surgical interventions, and propose potential future directions. By studying gene mutations and observing phenotypes from available OCD animal models, researchers have classified the molecular signatures of each model reminiscent of changes in brain areas and neural pathways, with the hope of guiding the future selection of the most appropriate models for specific research in the OCD field.

A network analysis of affective and motivational individual differences and error monitoring in a non-clinical sample

Error monitoring, which plays a crucial role in shaping adaptive behavior, is influenced by a complex interplay of affective and motivational factors. Understanding these associations often proves challenging due to the intricate nature of these variables. With the aim of addressing previous inconsistencies and methodological gaps, in this study, we utilized network analysis to investigate the relationship between affective and motivational individual differences and error monitoring. We employed six Gaussian Graphical Models on a non-clinical population ($N$ = 236) to examine the conditional dependence between the amplitude of response-related potentials (error-related negativity; correct-related negativity) and 29 self-report measures related to anxiety, depression, obsessive thoughts, compulsive behavior, and motivation while adjusting for covariates: age, handedness, and latency of error-related negativity and correct-related negativity. We then validated our results on an independent sample of 107 participants. Our findings revealed unique associations between error-related negativity amplitudes and specific traits. Notably, more pronounced error-related negativity amplitudes were associated with increased rumination and obsessing, and decreased reward sensitivity. Importantly, in our non-clinical sample, error-related negativity was not directly associated with trait anxiety. These results underscore the nuanced effects of affective and motivational traits on error processing in healthy population.

Stimulus-related oscillatory brain activity discriminates hoarding disorder from OCD and healthy controls

Hoarding disorder (HD) and obsessive-compulsive disorder (OCD) are highly comorbid and genetically related, but their similarities and differences at the neural level are not well characterized. The present study examined the time-frequency information contained in stimulus-related EEG data as participants worked on a visual flanker task. Three groups were included: participants diagnosed with HD (N = 33), OCD (N = 26), and healthy controls (N = 35). Permutation-controlled mass-univariate analyses found no differences between groups in terms of the magnitude of the oscillatory responses. Differences between groups were found selectively for phase-based measures (phase-locking across trials and across sensors) in time ranges well after those consistent with initial visuocortical processes, in the alpha (10 Hz) as well as theta and beta frequency bands, centered around 6 Hz and 15 Hz, respectively. Specifically, HD showed attenuated phase locking in theta and alpha compared to OCD and HC, while OCD showed heightened inter-site phase locking in alpha/beta. Including age as a covariate attenuated, but did not eliminate, the group differences. These findings point to signatures of cortical dynamics and cortical communication task processing that are unique to HD, and which are specifically present during higher-order visual cognition such as stimulus-response mapping, response selection, and action monitoring.

Beyond peaks and troughs: Multiplexed performance monitoring signals in the EEG

With the discovery of event-related potentials elicited by errors more than 30 years ago, a new avenue of research on performance monitoring, cognitive control, and decision making emerged. Since then, the field has developed and expanded fulminantly. After a brief overview on the EEG correlates of performance monitoring, this article reviews recent advancements based on single-trial analyses using independent component analysis, multiple regression, and multivariate pattern classification. Given the close interconnection between performance monitoring and reinforcement learning, computational modeling and model-based EEG analyses have made a particularly strong impact. The reviewed findings demonstrate that error- and feedback-related EEG dynamics represent variables reflecting how performance-monitoring signals are weighted and transformed into an adaptation signal that guides future decisions and actions. The model-based single-trial analysis approach goes far beyond conventional peak-and-trough analyses of event-related potentials and enables testing mechanistic theories of performance monitoring, cognitive control, and decision making.

Disentangling associations between impulsivity, compulsivity, and performance monitoring

Disorders marked by high levels of impulsivity and compulsivity have been linked to changes in performance monitoring, specifically the error-related negativity (ERN). We investigated the relationship between performance monitoring and individual differences in impulsivity and compulsivity. A total of 142 participants were recruited into four groups, each with different combinations of impulsivity and compulsivity, and they performed a flanker task to assess error-related brain activity. We defined error-related brain activity as ERN amplitude and theta power. Single-trial regression was employed to analyze the amplitude differences between incorrect and correct trials within the ERN time window. The findings revealed that impulsivity, compulsivity, and different measures of response processing exhibited distinct interactions, which were influenced by the configuration of impulsivity and compulsivity, but also depended on the measure of response processing. Specifically, high compulsivity predicted larger ERN amplitudes in individuals with low impulsivity, whereas high impulsivity had no significant effect on ERN amplitude in individuals with low compulsivity. Furthermore, when both impulsivity and compulsivity were high, no significant increase in ERN amplitude was observed; instead, there was a reduced difference between incorrect and correct trials. No significant differences were found for theta power. While the association between error-related brain activity and transdiagnostic markers or psychopathology may be smaller than generally assumed, considering the interaction between different transdiagnostic markers and their facets can enhance our understanding of the complex associations that arise during the investigation of neural correlates of performance monitoring, specifically the ERN.

Normal congruency sequence effects in psychopathology: A behavioral and electrophysiological examination using a confound-minimized design

Clinical studies of adaptive control emphasize the role disruptions in control play in psychopathology. However, many studies used confound-laden designs and examined only one type of psychopathology. Recent studies of event-related potentials (ERPs) suggest that robust congruency sequence effects (CSEs)-a popular index of adaptive control-appear in confound-minimized designs. Thus, the present study sought to determine whether a confound-minimized CSE paradigm could identify adaptive control dysfunction in people with major depressive disorder (MDD), generalized anxiety disorder (GAD), and obsessive-compulsive disorder (OCD). We predicted that participants with MDD and GAD would show smaller ERP CSEs and that participants with OCD would show larger ERP CSEs than healthy controls. Data from 44 people with GAD, 51 people with MDD, 31 people with OCD, and 56 healthy comparison participants revealed normal CSEs as indexed by response times (RTs) and ERPs in the psychopathology groups. Moreover, psychiatric symptoms did not moderate these CSEs. Finally, we observed a strong mean-variance relationship in RT CSEs, such that participants with stronger post-recruitment of control in mean RT scores showed the most consistent post-conflict responses (i.e., the least intraindividual variability). These findings suggest that prior findings from confound-laden tasks indicating altered CSEs in psychopathology stem from processes that are unrelated to adaptive control. Future research should employ experimental designs that isolate these processes to advance our understanding of abnormal CSEs in psychopathology.

Early Action Error Processing Is Due to Domain-General Surprise, Whereas Later Processing Is Error Specific

The ability to adapt behavior after erroneous actions is one of the key aspects of cognitive control. Error commission typically causes people to slow down their subsequent actions [post-error slowing (PES)]. Recent work has challenged the notion that PES reflects adaptive, controlled processing and instead suggests that it is a side effect of the surprising nature of errors. Indeed, human neuroimaging suggests that the brain networks involved in processing errors overlap with those processing error-unrelated surprise, calling into question whether there is a specific system for error processing in the brain at all. In the current study, we used EEG decoding and a novel behavioral paradigm to test whether there are indeed unique, error-specific processes that contribute to PES beyond domain-general surprise. Across two experiments in male and female humans (N = 76), we found that both errors and error-unrelated surprise were followed by slower responses when response-stimulus intervals were short. Furthermore, the early neural processes following error-specific and domain-general surprise showed significant cross-decoding. However, at longer intervals, which provided additional processing time, only errors were still followed by post-trial slowing. Furthermore, this error-specific PES effect was reflected in sustained neural activity that could be decoded from that associated with domain-general surprise, with the strongest contributions found at lateral frontal, occipital, and sensorimotor scalp sites. These findings suggest that errors and surprise initially share common processes, but that after additional processing time, unique, genuinely error-specific processes take over and contribute to behavioral adaptation.SIGNIFICANCE STATEMENT Humans typically slow their actions after errors (PES). Some suggest that PES is a side effect of the unexpected, surprising nature of errors, challenging the notion of a genuine error processing system in the human brain. Here, we used multivariate EEG decoding to identify behavioral and neural processes uniquely related to error processing. Action slowing occurred following both action errors and error-unrelated surprise when time to prepare the next response was short. However, when there was more time to react, only errors were followed by slowing, further reflected in sustained neural activity. This suggests that errors and surprise initially share common processing, but that after additional time, error-specific, adaptive processes take over.

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.

Transdiagnostic Approach and Obsessive Compulsive Disorder

The categorical approach of traditional psychiatric nosology has been a forceful approach for a very long time for explaining psychological disorders which are defined by symptom based diagnostic categories. However, in recent years, the importance of the "transdiagnostic" approach which is a new classification system is increasing. The transdiagnostic approach aims to examine dimensionally the common cognitive, behavioral, interpersonal and biological processes underlying many psychopathologies away from the categorical approach that classifies psychopathologies according to observable symptoms. This approach intends to treat the disorders through the common underlying processes and risk factors, thus heterogeneous and comorbid symptoms are better addressed and diagnostic categories that may change during treatment are avoided. In this review study, the current problems in diagnosing based on classification and gaps in the field were examined, and the approach itself was proposed as a solution. RDoC (Research Domain Criteria) which is a new classification system for psychiatric disorders within the scope of the approach, has created a new structure using modern research approaches in genetics, neuroscience and behavioral sciences. In the present study, the definition and emergence of the transdiagnostic approach, obsessive compulsive disorder and RDoC in the context of transdiagnostic approach and transdiagnostic treatment are explained. This review is intended to be a resource for both basic psychopathology research and the development of treatment methods within the framework of a transdiagnostic approach.

Obsessive-compulsive disorder: Etiology, neuropathology, and cognitive dysfunction

BACKGROUND

This review provides an overview of obsessive-compulsive disorder (OCD) symptoms, including the four partially distinct subtypes of the disorder, current diagnostic criteria, and common comorbidities. Critically, it focuses on the etiology of OCD, including its underlying neuropathology, and examines cognitive dysfunction in OCD.

METHODS

This review study was conducted by library method.

RESULTS

We show how dysfunction in cortico-striato-thalamo-cortical (CSTC) circuits may underpin symptoms; and shed light on the putative neurochemistry within these loops such as the role of serotonin, dopamine, and glutamate systems. We also show how OCD is characterized by cognitive dysfunction including problems in cognitive flexibility, visuospatial memory, response inhibition, and goal-directed behavior, linked to aberrant activity within CSTC circuits.

CONCLUSIONS

In brief, research questions we shed light on include (1) what are the symptoms in OCD; (2) what is the etiology of the disorder and do existing models explain OCD; and (3) what are key cognitive deficits in OCD and do these improve with treatment?

Parenting Styles and Psychological Resilience: The Mediating Role of Error Monitoring

Parenting styles are associated with children's psychological resilience. However, the underlying mechanisms of this have not been investigated. Parenting styles influence how individuals respond to self-inflicted errors, and error monitoring is related to psychological resilience. Therefore, this study proposed that error monitoring might be a bridging factor between parenting styles and psychological resilience. Seventy-two young healthy adults were recruited for this study. Parenting styles were assessed using the Parental Bonding Instrument, and psychological resilience was measured using the Connor-Davidson Resilience Scale. Error monitoring was investigated in the Flanker task using event-related potentials (ERPs), and two error-related components of ERPs were measured: error-related negativity (ERN) and error positivity. Mediation analyses showed that the ERN partially mediated the relationship between parenting styles and psychological resilience. Specifically, a higher level of self-reported parental overprotection was related to larger ERN amplitude, which in turn was associated with lower psychological resilience. Additionally, a higher level of self-reported parental allowance of autonomy was related to lower ERN amplitude, which in turn was linked to higher psychological resilience. These results suggest that shaping children's sensitivity in early automatic error detection is one possible mechanism through which parental styles influence their psychological resilience.

Electrophysiological evidence of mal-adaptation to error in remitted depression

Identifying risk markers for major depressive disorder (MDD) that persist into remission is key to address MDD's high rate of recurrence. Central to MDD recurrence are the disorder's negative information processing biases, such as heightened responses to errors, which may subsequently impair abilities to monitor performance and adjust behaviors based on environmental demands. However, little is known regarding the neurophysiological correlates of post-error adaptation in depression. The current study investigated event-related potentials (ERPs) and behavioral performance following errors from a flanker task in 58 participants with remitted MDD (rMDD) and 118 healthy controls (HC). Specifically, using trial-level data, we tested: (a) the impact of errors on response-locked ERPs of the current and post-error trials (error-related negativity [ERN] and correct response negativity [CRN]) and (b) longer-term adaptation to errors (ERN/CRN) over the course of the task. Compared to HC, rMDD participants showed a larger ERN to the current trial and smaller habituation in ERN over time. On trials immediately following errors, rMDD participants showed slower reaction times that were predicted by the previous-trial ERN amplitude but comparable accuracy to HC, suggesting a deficient ability to disengage from errors and/or a compensatory effort to mitigate accuracy decrements. Critically, this pattern of responding: (a) was concurrently associated with greater levels of anhedonia symptoms, more severe MDD history, and interpersonal impairment (but lower impairment in life activities) and (b) predicted more anhedonia symptoms at one-year follow-up. Collectively, a hyperactive performance monitoring system may be a useful risk marker for future MDD recurrence.

Error-related brain activity: A time-domain and time-frequency investigation in pediatric obsessive-compulsive disorder

Increased error-related negativity (ERN), a measure of error monitoring, has been suggested as a biomarker of obsessive-compulsive disorder (OCD). Additional insight into error monitoring is possible using time-frequency decomposition of electroencephalographic (EEG) data, as it allows disentangling the brain's parallel processing of information. Greater error-related theta is thought to reflect an error detection signal, while delta activity may reflect more elaborative post-detection processes (i.e., strategic adjustments). Recent investigations show that decreased error-related alpha may index attentional engagement following errors; additionally, increases and decreases in error-related beta could reflect motor inhibition and motor preparation, respectively. However, time-frequency dynamics of error monitoring in OCD are largely unknown. The present study examined time-frequency theta, delta, alpha and beta power in early adolescents with OCD using a data-driven, cluster-based approach. The aim was to explore electrocortical measures of error monitoring in early adolescents with (n = 27, 15 females) and without OCD (n = 27, 14 females) during an arrowhead version of the flanker task while EEG activity was recorded. Results indicated that the OCD group was characterized by increased ERN and error-related theta, as well as reduced error-related beta power decrease (i.e., greater power) compared to participants without OCD. Greater error-related beta explained variance in OCD over and above the ERN and error-related theta. By examining separate time-frequency measures, the present study provides novel insights into the dynamics of error monitoring, suggesting that pediatric OCD may be characterized by enhanced error monitoring (i.e., greater theta power) and post-error inhibition (i.e., reduced beta power decrease).

Error-related brain activity associated with obsessive-compulsive symptoms in youth

BACKGROUND

Subclinical obsessive-compulsive symptoms (OCS) are common in children, and increase risk for later onset of obsessive-compulsive disorder (OCD). In pediatric patients with OCD, neuroimaging research implicates altered neural mechanisms for error-processing, but whether abnormal brain response occurs with subclinical OCS remains poorly understood.

METHODS

Using functional magnetic resonance imaging (fMRI), 113 youth (8-18 years; 45 female) from a community sample were scanned during an error-eliciting Go/No-Go task. OCS were assessed dimensionally using the obsessive-compulsive subscale of the Child Behavior Checklist. The association between OCS scores and error-related brain activity was examined at the whole-brain level.

RESULTS

Lower OCS scores associated with stronger response to errors in dorsal anterior cingulate cortex (dACC), caudate, putamen, thalamus, and occipital cortex. Additionally, lower OCS related to higher capacity for inhibitory control, as indexed by greater accuracy on No-Go trials during fMRI scanning. The relationship between lower OCS and better accuracy on No-Go trials was mediated by greater error-related dACC activity.

CONCLUSIONS

The inverse relationship between OCS and error-related activity in the dACC and extended cortical-striatal-thalamic circuitry may index an adaptive process by which subclinical OCS are minimized in youth. Further, these results identify an observable pattern of brain activity that tracks with subclinical OCS severity. Understanding the link between neural networks for error processing and the normal to abnormal range of OCS may pave the way for brain-based strategies to identify children who are more likely to develop OCD and enable the targeting of preventive strategies to reduce risk.

Cognitive Neuroscience of Obsessive-Compulsive Disorder

Cognitive neuroscientific research has the ability to yield important insights into the complex neurobiological processes underlying obsessive-compulsive disorder (OCD). This article provides an updated review of neuroimaging studies in seven neurocognitive domains. Findings from the literature are discussed in the context of obsessive-compulsive phenomenology and treatment. Expanding our knowledge of the neural mechanisms involved in OCD could help optimize treatment outcomes and guide the development of novel interventions.

Neurophysiological mechanisms of error monitoring in human and non-human primates

Performance monitoring is an important executive function that allows us to gain insight into our own behaviour. This remarkable ability relies on the frontal cortex, and its impairment is an aspect of many psychiatric diseases. In recent years, recordings from the macaque and human medial frontal cortex have offered a detailed understanding of the neurophysiological substrate that underlies performance monitoring. Here we review the discovery of single-neuron correlates of error monitoring, a key aspect of performance monitoring, in both species. These neurons are the generators of the error-related negativity, which is a non-invasive biomarker that indexes error detection. We evaluate a set of tasks that allows the synergistic elucidation of the mechanisms of cognitive control across the two species, consider differences in brain anatomy and testing conditions across species, and describe the clinical relevance of these findings for understanding psychopathology. Last, we integrate the body of experimental facts into a theoretical framework that offers a new perspective on how error signals are computed in both species and makes novel, testable predictions.

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.

Associations of neural error-processing with symptoms and traits in a dimensional sample recruited across the obsessive-compulsive spectrum

The error-related negativity (ERN), a neural response to errors, has been associated with several forms of psychopathology and assumed to represent a neural risk marker for obsessive-compulsive disorder (OCD) and anxiety disorders. Yet, it is still unknown which specific symptoms or traits best explain ERN variation. This study investigated performance-monitoring in participants (N = 100) recruited across a spectrum of obsessive-compulsive characteristics (n = 26 patients with OCD; n = 74 healthy participants including n = 24 with low, n = 24 with medium, and n = 26 with high OC-characteristics). Several compulsivity- and anxiety-associated characteristics were assessed and submitted to exploratory principal axis factor analysis. Associations of raw measures and derived factors with ERN and correct-related negativity (CRN) were examined. Patients with OCD showed increased ERN amplitudes compared to healthy participants. The ERN was associated with a variety of traits related to anxiety and negative affect. Factor analysis results revealed a most prominent association of the ERN with a composite measure of anxiety and neuroticism, whereas the CRN was specifically associated with compulsivity. Results support differential associations for the ERN and CRN and demonstrate that a dimensional recruitment approach and use of composite measures can improve our understanding of characteristics underlying variation in neural performance monitoring.

Altered processing of conflicting body representations in women with restrictive anorexia nervosa

Cognitive and affective impairments in processing body image have been observed in patients with Anorexia Nervosa (AN) and may induce the hypercontrolled and regulative behaviors observed in this disorder. Here, we aimed to probe the link between activation of body representations and cognitive control by investigating the ability to resolve body-related representational conflicts in women with restrictive AN and matched healthy controls (HC). Participants performed a modified version of the Flanker task in which underweight and overweight body images were presented as targets and distractors; a classic version of the task, with letters, was also administered as a control. The findings indicated that performance was better among the HC group in the task with bodies compared to the task with letters; however, no such facilitation was observed in AN patients, whose overall performance was poorer than that of the HC group in both tasks. In the task with body stimuli, performance among patients with AN was the worst on trials presenting underweight targets with overweight bodies as flankers. These results may reflect a dysfunctional association between the processing of body-related representations and cognitive control mechanisms that may aid clinicians in the development of optimal individualized treatments.

Error-related activity of the sensorimotor network contributes to the prediction of response to cognitive-behavioral therapy in obsessive-compulsive disorder

BACKGROUND

Although cognitive behavioral therapy is a highly effective treatment for obsessive-compulsive disorder (OCD), yielding large symptom reductions on the group level, individual treatment response varies considerably. Identification of treatment response predictors may provide important information for maximizing individual treatment response and thus achieving efficient treatment resource allocation. Here, we investigated the predictive value of previously identified biomarkers of OCD, namely the error-related activity of the supplementary motor area (SMA) and the sensorimotor network (SMN, postcentral gyrus/precuneus).

METHODS

Seventy-two participants with a primary diagnosis of OCD underwent functional magnetic resonance imaging (fMRI) scanning while performing a flanker task prior to receiving routine-care CBT.

RESULTS

Error-related BOLD response of the SMN significantly contributed to the prediction of treatment response beyond the variance accounted for by clinical and sociodemographic variables. Stronger error-related SMN activity at baseline was associated with a higher likelihood of treatment response.

CONCLUSIONS

The present results illustrate that the inclusion of error-related SMN activity can significantly increase treatment response prediction quality in OCD. Stronger error-related activity of the SMN may reflect the ability to activate symptom-relevant processing networks and may thus facilitate response to exposure-based CBT interventions.

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.

Non-invasive brain stimulation modulates neural correlates of performance monitoring in patients with obsessive-compulsive disorder

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Effects of tDCS on performance monitoring examined in OCD and healthy individuals.

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A preregistered, randomized, sham-controlled tDCS–EEG study was conducted.

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Cathodal tDCS over the pre-SMA reduced the error-related negativity (ERN).

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Correct-response negativity was enhanced, error positivity reduced by cathodal tDCS.

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The findings substantiate the role of the ERN as a target for new interventions.

Overactive performance monitoring, as reflected by enhanced neural responses to errors (the error-related negativity, ERN), is considered a biomarker for obsessive-compulsive disorder (OCD) and may be a promising target for novel treatment approaches. Prior research suggests that non-invasive brain stimulation with transcranial direct current stimulation (tDCS) may reduce the ERN in healthy individuals, yet no study has investigated its efficacy in attenuating the ERN in OCD. In this preregistered, randomized, sham-controlled, crossover study, we investigated effects of tDCS on performance monitoring in patients with OCD (n = 28) and healthy individuals (n = 28). Cathodal and sham tDCS was applied over the presupplementary motor area (pre-SMA) in two sessions, each followed by electroencephalogram recording during a flanker task. Cathodal tDCS reduced the ERN amplitude compared to sham tDCS, albeit this effect was only marginally significant (p = .052; mean difference: 0.86 μV). Additionally, cathodal tDCS reduced the correct-response negativity and increased the error positivity. These neural modulations were not accompanied by behavioral changes. Moreover, we found no evidence that the tDCS effect was more pronounced in the patient group. In summary, our findings indicate that tDCS over the pre-SMA modulates neural correlates of performance monitoring across groups. Therefore, this study represents a valuable starting point for future research to determine whether repeated tDCS application induces a more pronounced ERN attenuation and normalizes aberrant performance monitoring in the long term, thereby potentially alleviating obsessive-compulsive symptoms and providing a psychophysiological intervention strategy for individuals who do not benefit sufficiently from existing interventions.

The prefrontal cortex and OCD

Obsessive Compulsive Disorder (OCD) is a highly prevalent and severe neuropsychiatric disorder, with an incidence of 1.5-3% worldwide. However, despite the clear public health burden of OCD and relatively well-defined symptom criteria, effective treatments are still limited, spotlighting the need for investigation of the neural substrates of the disorder. Human neuroimaging studies have consistently highlighted abnormal activity patterns in prefrontal cortex (PFC) regions and connected circuits in OCD during both symptom provocation and performance of neurocognitive tasks. Because of recent technical advances, these findings can now be leveraged to develop novel targeted interventions. Here we will highlight current theories regarding the role of the prefrontal cortex in the generation of OCD symptoms, discuss ways in which this knowledge can be used to improve treatments for this often disabling illness, and lay out challenges in the field for future study.

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.

In the Face of Potential Harm: The Predictive Validity of Neural Correlates of Performance Monitoring for Perceived Risk, Stress, and Internalizing Psychopathology During the COVID-19 Pandemic

Background

The COVID-19 pandemic is a major life stressor posing serious threats not only to physical but also to mental health. To better understand mechanisms of vulnerability and identify individuals at risk for psychopathological symptoms in response to stressors is critical for prevention and intervention. The error-related negativity (ERN) has been discussed as a neural risk marker for psychopathology, and this study examined its predictive validity for perceived risk, stress, and psychopathological symptoms during the COVID-19 pandemic.

Methods

A total of 113 individuals who had participated as healthy control participants in previous electroencephalography studies (2014–2019) completed a follow-up online survey during the first COVID-19 wave in Germany. Associations of pre-pandemic ERN and correct-response negativity (CRN) with perceived risk regarding COVID-19 infection, stress, and internalizing symptoms during the pandemic were examined using mediation models.

Results

Pre-pandemic ERN and CRN were associated with increased perceived risk regarding a COVID-19 infection. Via this perceived risk, the ERN and CRN were associated with increased stress during the pandemic. Furthermore, risk perception and stress mediated indirect effects of ERN and CRN on internalizing psychopathology, including anxiety, depression, and obsessive-compulsive symptoms, while controlling for the effects of pre-pandemic symptom levels.

Conclusions

In summary, heightened pre-pandemic performance monitoring showed indirect associations with increases in psychopathological symptoms during the first COVID-19 wave via effects on perceived COVID-19 risk and stress. These results further strengthen the notion of performance monitoring event-related potentials as transdiagnostic neural risk markers and highlight the relevance of stress as a catalyst for symptom development.

Neurophysiological predictors of gaze-contingent music reward therapy among adults with social anxiety disorder

Social anxiety disorder (SAD) is associated with fear of negative evaluation and heightened performance monitoring. The best-established treatments help only a subset of patients, and there are no well-established predictors of treatment response. The current study investigated whether individual differences in processing errors might predict response to gaze-contingent music reward therapy (GC-MRT). At baseline, healthy control subjects (HC; n = 20) and adults with SAD (n = 29), ages 19-43 years, completed the Flanker Task while electroencephalography (EEG) data were recorded. SAD participants then received up to 12 sessions over 8 weeks of GC-MRT, designed to train participants' attention away from threatening and toward neutral faces. Clinical assessments were completed 9- (post-treatment) and 20-weeks (follow-up) after initiating the treatment. At baseline, compared to HC, SAD performed the task more accurately and exhibited increased error-related negativity (ERN) and delta power to error commission. After controlling for age and baseline symptoms, more negative ERN and increased frontal midline theta (FMT) predicted reduced self-reported social anxiety symptoms at post-treatment, and FMT also predicted clinician-rated and self-reported symptom reduction at the follow-up assessment. Hypervigilance to error is characteristic of SAD and warrants further research as a predictor of treatment response for GC-MRT.

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.

Mistakes that matter: An event-related potential study on obsessive-compulsive symptoms and social performance monitoring in different responsibility contexts

Mistakes that affect others often are linked to increased feelings of responsibility and guilt. This especially holds for individuals high in obsessive-compulsive symptoms (OCS), who are characterized by inflated feelings of responsibility and a fear of causing harm to others. This event-related potential study investigated individual differences in OCS in social performance monitoring with a focus on the role of responsibility for other’s harm and the error-related negativity (ERN). Healthy volunteers low (N = 27) or high (N = 24) in OCS performed a Flanker task in the presence of a gender-matched peer in three conditions. Mistakes could either have negative monetary consequences for 1) oneself, 2) the other, or 3) no one. Results showed enhanced ERNs for mistakes that harmed others instead of the self for individuals high in OCS, whereas individuals low in OCS showed decreased amplitudes specifically for mistakes affecting no one versus oneself. Amplitudes of the error positivity but not the ERN also were larger in the high OCS group. These findings indicate that high OCS are associated with enhanced performance monitoring in a social responsibility context, when mistakes harm others instead of the self, and demonstrate the importance of integrating the social context in performance monitoring research as a way to shed more light on obsessive-compulsive symptomatology.

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.

Performance monitoring in obsessive-compulsive disorder: Insights from internal capsule/nucleus accumbens deep brain stimulation

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Theta phase coherence is increased following negative performance feedback.

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Deep brain stimulation globally modulates theta phase coherence.

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Fronto-striatal connectivity is related to OCD symptom severity.

Background

Symptoms of obsessive–compulsive disorder (OCD) are partly related to impaired cognitive control processes and theta modulations constitute an important electrophysiological marker for cognitive control processes such as signaling negative performance feedback in a fronto-striatal network. Deep brain stimulation (DBS) targeting the anterior limb of the internal capsule (ALIC)/nucleus accumbens (NAc) shows clinical efficacy in OCD, while the exact influence on the performance monitoring system remains largely unknown.

Methods

Seventeen patients with treatment-refractory OCD performed a probabilistic reinforcement learning task. Analyses were focused on 4–8 Hz (theta) power, intertrial phase coherence (ITPC) and debiased weighted Phase-Lag Index (dwPLI) in response to negative performance feedback. Combined EEG and local field potential (LFP) recordings were obtained shortly after DBS electrode implantation to investigate fronto-striatal network modulations. To assess the impact of clinically effective DBS on negative performance feedback modulations, EEG recordings were obtained pre-surgery and at follow-up with DBS on and off.

Results

Medial frontal cortex ITPC, striatal ITPC and striato-frontal dwPLI were increased following negative performance feedback. Decreased right-lateralized dwPLI was associated with pre-surgery symptom severity. ITPC was globally decreased during DBS-off.

Conclusion

We observed a theta phase coherence mediated fronto-striatal performance monitoring network. Within this network, decreased connectivity was related to increased OCD symptomatology, consistent with the idea of impaired cognitive control in OCD. While ALIC/NAc DBS decreased theta network activity globally, this effect was unrelated to clinical efficacy and performance monitoring.

Altered brain functional network dynamics in obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a debilitating and disabling neuropsychiatric disorder, whose neurobiological basis remains unclear. Although traditional static resting-state magnetic resonance imaging (rfMRI) studies have found aberrant functional connectivity (FC) in OCD, alterations in whole-brain FC and topological properties in the context of brain dynamics remain relatively unexplored. The rfMRI data of 29 patients with OCD and 40 healthy controls were analyzed using group independent component analysis to obtain independent components (ICs) and a sliding-window approach to generate dynamic functional connectivity (dFC) matrices. dFC patterns were clustered into three reoccurring states, and state transition metrics were obtained. Then, graph-theory methods were applied to dFC matrices to calculate the variability of network topological organization. The occurrence of a state (State 1) with the highest modularity index and lowest mean FC between networks was increased significantly in OCD, and the fractional time in brain State 1 was positively correlated with anxiety level in patients. State 1 was characterized by having positive connections within default mode (DMN) and salience networks (SAN), and negative coupling between the two networks. Additionally, ICs belonging to DMN and SAN showed lower temporal variability of nodal degree centrality and efficiency in patients, which was related to longer illness duration and higher current obsession ratings. Our results provide evidence of clinically relevant aberrant dynamic brain activity in OCD. Increased functional segregation among networks and impaired functional flexibility in connections among brain regions in DMN and SAN may play important roles in the neuropathology of OCD.

Altered spontaneous activity and effective connectivity of the anterior cingulate cortex in obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a disabling neuropsychiatric disorder whose neurobiological basis remains unclear. Magnetic resonance imaging (MRI) studies have reported functional and structural alterations of the anterior cingulate cortex (ACC) in OCD. In this study, we explored the functional activity of subregions of the ACC and effective connectivity (EC) between ACC subregions and the whole brain in OCD. We used a Granger causality analysis (GCA) to identify the direction of information flow and whether the impact of that flow was excitatory or inhibitory. We performed resting-state functional MRI in 31 patients with OCD and 36 healthy controls and analyzed the amplitude of low-frequency fluctuation (ALFF) and coefficient-based GCA. The left pregenual ACC (pACC) in patients with OCD showed decreased ALFF relative to controls. There was significantly decreased excitatory output from the left pACC to both right dorsal superior frontal gyrus (dSFG) and left precuneus in patients compared with controls. Patients also had decreased inhibitory input to left pACC from left ventral SFG and left thalamus and caudate relative to controls. Results were similar in drug-naive patients and those with prior but not current psychopharmacological treatment. In patients, path coefficients of GCA from left pACC to right dSFG showed significant negative correlations with obsession and anxiety ratings. Decreased spontaneous neural activity and altered EC of pACC with widely distributed cortical circuitry, and associations with clinical ratings highlight the importance of pACC functional alteration in OCD.

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.

Functional Brain Imaging and OCD

In the last 20 years, functional magnetic resonance imaging (fMRI) has been extensively used to investigate system-level abnormalities in the brain of patients with obsessive-compulsive disorder (OCD). In this chapter, we start by reviewing the studies assessing regional brain differences between patients with OCD and healthy controls in task-based fMRI. Specifically, we review studies on executive functioning and emotional processing, protocols in which these patients have been described to show alterations at the behavioral level, as well as research using symptom provocation protocols. Next, we review studies on brain connectivity alterations, focusing on resting-state studies evaluating disruptions in fronto-subcortical functional connectivity and in cortical networks. Likewise, we also review research on effective connectivity, which, different from functional connectivity, allows for ascertaining the directionality of inter-regional connectivity alterations. We conclude by reviewing the most significant findings on a topic of translational impact, such as the use of different fMRI measurements to predict response across a variety of treatment approaches. Overall, results suggest that there exists a pattern of regions, involving, but not limited to, different nodes of the cortico-striatal-thalamo-cortical circuits, showing robust evidence of functional alteration across studies, although the nature of the alterations critically depends on the specific tasks and their particular demands. Moreover, such findings have been, to date, poorly translated into clinical practice. It is suggested that this may be partially accounted for by the difficulty to integrate into a common framework results obtained under a wide variety of analysis approaches.

Evoking network profiles of the dorsal anterior cingulate in youth with Obsessive-Compulsive Disorder during motor control and working memory

Interest in the pathology of Obsessive-Compulsive Disorder\has focused on brain network profiles of the dorsal Anterior Cingulate Cortex (dACC), given its role as a principal control region. Both motor control and working memory tasks induce dysfunctional dACC profiles in OCD. H H We contrasted dACC network profiles in OCD and age-comparable controls during both tasks (from data collected in the same participants). The motor task required participants to tap their right forefinger in response to a flashing white probe; the memory task was a standard n-back (2-Back) requiring participants to identify if a current stimulus was identical to the one presented two items before it in the sequence. Network interactions were modeled using Psychophysiological Interactions (PPI), a model of directional functional connectivity. Inter-group analyses indicated a) that the motor control task evoked greater dACC modulation than the working memory task, and b) that the modulatory effect was significantly greater in the OCD group. We also investigated the relationship between OCD symptom dimensions (lifetime obsession and lifetime compulsion measured using the CY-BOCS) and dACC network profiles in OCD. This analysis revealed a dichotomy between Obsessive-Compulsive symptom dimensions and the degree of dACC modulation: primarily increased obsessions predicted increased modulation during the motor control task, but primarily increased compulsions predicted increased modulation during the working memory task. These results re-emphasize the salience of the dACC in OCD, and the primacy of tasks of motor control in evoking dACC pathology in the disorder.

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.

Conflict monitoring and the affective-signaling hypothesis-An integrative review

Conflict-monitoring theory proposes that conflict between incompatible responses is registered by a dedicated monitoring system, and that this conflict signal triggers changes of attentional filters and adapts control processes according to the current task demands. Extending the conflict-monitoring theory, it has been suggested that conflict elicits a negative affective reaction, and that it is this affective signal that is monitored and then triggers control adaptation. This review article summarizes research on a potential signaling function of affect for cognitive control. First, we provide an overview of the conflict-monitoring theory, discuss neurophysiological and behavioral markers of monitoring and control adaptation, and introduce the affective-signaling hypothesis. In a second part, we review relevant studies that address the questions of (i) whether conflict elicits negative affect, (ii) whether negative affect is monitored, and (iii) whether affect modulates control. In sum, the reviewed literature supports the claim that conflict and errors trigger negative affect and provides some support for the claim that affect modulates control. However, studies on the monitoring of negative affect and the influence of phasic affect on control are ambiguous. On the basis of these findings, in a third part, we critically reassess the affective-signaling hypothesis, discuss relevant challenges to this account, and suggest future research strategies.

Abnormal approach-related motivation but spared reinforcement learning in MDD: Evidence from fronto-midline Theta oscillations and frontal Alpha asymmetry

Major depression is characterized by abnormal reward processing and reinforcement learning (RL). This impairment might stem from deficient motivation processes, in addition to reduced reward sensitivity. In this study, we recorded 64-channel EEG in a large cohort of major depressive disorder (MDD) patients and matched healthy controls (HC) while they performed a standard RL task. Participants were asked to discover, by trial and error, several hidden stimulus-response associations having different reward probabilities, as enforced using evaluative feedback. We extracted induced fronto-midline Theta (FMT) power time-locked to the response and feedback as neurophysiological index of RL. Furthermore, we assessed approach-related motivation by measuring frontal alpha asymmetry concurrently. At the behavioral level, MDD patients and HCs showed comparable RL. At the EEG level, FMT power systematically varied as a function of reward probability, with opposing effects found at the response and feedback levels. Although this global pattern was spared in MDD, at the feedback level these patients showed however a steep FMT power decrease across trials when reward probability was low. Moreover, they showed impaired approach-related motivation during task execution, as reflected by frontal Alpha asymmetry. These results suggest a dissociation between (globally spared) RL and (impaired) approach motivation in MDD.

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 Utility of Event-Related Potentials in Clinical Psychology

Event-related potentials (ERPs) are direct measures of brain activity that can be leveraged for clinically meaningful research. They can relate robustly both to continuous measures of individual difference and to categorical diagnoses in ways that clarify similarities and distinctions between apparently related disorders and traits. ERPs can be linked to genetic risk, can act as moderators of developmental trajectories and responses to stress, and can be leveraged to identify those at greater risk for psychopathology, especially when used in combination with other neural and self-report measures. ERPs can inform models of the development of, and risk for, psychopathology. Finally, ERPs can be used as targets for existing and novel interventions and prevention efforts. We provide concrete examples for each of these possibilities by focusing on programmatic research on the error-related negativity and anxiety, and thus show that ERPs are poised to make greater contributions toward the identification, prediction, treatment, and prevention of mental disorders.

Neuroanatomical Substrates and Predictors of Response to Capsulotomy in Intractable Obsessive-Compulsive Disorder

BACKGROUND

Anterior capsulotomy that surgically targets fiber tracts connecting prefrontal cortex and subcortical nuclei is a therapeutic option for a subgroup of patients with treatment-refractory obsessive-compulsive disorder. The goal of this study was to investigate neural correlates to anterior capsulotomy and find predictors of clinical improvement following this procedure.

METHODS

Structural and diffusion imaging data and clinical evaluation were acquired from 31 patients with refractory obsessive-compulsive disorder who underwent anterior capsulotomy. Of the 31 patients, 16 were clinical responders defined by a ≥35% reduction in the Yale-Brown Obsessive Compulsive Scale scores. Analysis of variance was applied on 2 levels (surgery and response) to examine alterations of gray matter volume and fiber tract integrity (measured by generalized fractional anisotropy). The correlation between preoperative data and clinical response was further investigated.

RESULTS

After surgery, generalized fractional anisotropy was significantly decreased in the bilateral anterior limb of the internal capsule and anterior thalamic radiation, accompanied by a decrease in gray matter volume in the prefrontal cortex, anterior cingulate cortex, striatum, thalamus, and cerebellum. Moreover, atrophy of the right caudate was greater in responders than in nonresponders, which correlated with alteration in Yale-Brown Obsessive Compulsive Scale score. In addition, preoperative gray matter volume in the right inferior frontal gyrus and generalized fractional anisotropy in the left superior longitudinal fasciculus and right cingulum predicted improved response. More anterior location of the lesion area predicted better clinical response.

CONCLUSIONS

These results demonstrate that reduced volume of the right caudate might be associated with therapeutic response of capsulotomy and might offer a potential predictor of treatment outcome and a guide for lesion site.

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.