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Zhang X, Zhou J, Chen Y, Guo L, Yang Z, Robbins TW, Fan Q. Pathological Networking of Gray Matter Dendritic Density With Classic Brain Morphometries in OCD. JAMA Netw Open 2023; 6:e2343208. [PMID: 37955895 PMCID: PMC10644219 DOI: 10.1001/jamanetworkopen.2023.43208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 10/04/2023] [Indexed: 11/14/2023] Open
Abstract
Importance The pathogenesis of obsessive-compulsive disorder (OCD) may involve altered dendritic morphology, but in vivo imaging of neurite morphology in OCD remains limited. Such changes must be interpreted functionally within the context of the multimodal neuroimaging approach to OCD. Objective To examine whether dendritic morphology is altered in patients with OCD compared with healthy controls (HCs) and whether such alterations are associated with other brain structural metrics in pathological networks. Design, Setting, and Participants This case-control study used cross-sectional data, including multimodal brain images and clinical symptom assessments, from 108 patients with OCD and 108 HCs from 2014 to 2017. Patients with OCD were recruited from Shanghai Mental Health Center, Shanghai, China, and HCs were recruited via advertisements. The OCD group comprised unmedicated adults with a Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) diagnosis of OCD, while the HCs were adults without any DSM-IV diagnosis, matched for age, sex, and education level. Data were analyzed from September 2019 to April 2023. Exposure DSM-IV diagnosis of OCD. Main Outcomes and Measures Multimodal brain imaging was used to compare neurite microstructure and classic morphometries between patients with OCD and HCs. The whole brain was searched to identify regions exhibiting altered morphology in patients with OCD and explore the interplay between the brain metrics representing these alterations. Brain-symptom correlations were analyzed, and the performance of different brain metric configurations were evaluated in distinguishing patients with OCD from HCs. Results Among 108 HCs (median [IQR] age, 26 [23-31] years; 50 [46%] female) and 108 patients with OCD (median [IQR] age, 26 [24-31] years; 46 [43%] female), patients with OCD exhibited deficient neurite density in the right lateral occipitoparietal regions (peak t = 3.821; P ≤ .04). Classic morphometries also revealed widely-distributed alterations in the brain (peak t = 4.852; maximum P = .04), including the prefrontal, medial parietal, cingulate, and fusiform cortices. These brain metrics were interconnected into a pathological brain network associated with OCD symptoms (global strength: HCs, 0.253; patients with OCD, 0.941; P = .046; structural difference, 0.572; P < .001). Additionally, the neurite density index exhibited high discriminatory power in distinguishing patients with OCD from HCs (accuracy, ≤76.85%), and the entire pathological brain network also exhibited excellent discriminative classification properties (accuracy, ≤82.87%). Conclusions and Relevance The findings of this case-control study underscore the utility of in vivo imaging of gray matter dendritic density in future OCD research and the development of neuroimaging-based biomarkers. They also endorse the concept of connectopathy, providing a potential framework for interpreting the associations among various OCD symptom-related morphological anomalies.
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Affiliation(s)
- Xiaochen Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiajia Zhou
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongjun Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Now with Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Lei Guo
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi Yang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Now with Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Trevor W. Robbins
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Qing Fan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
- Mental Health Branch, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
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Geffen T, Smallwood J, Finke C, Olbrich S, Sjoerds Z, Schlagenhauf F. Functional connectivity alterations between default mode network and occipital cortex in patients with obsessive-compulsive disorder (OCD). Neuroimage Clin 2021; 33:102915. [PMID: 34933233 PMCID: PMC8688720 DOI: 10.1016/j.nicl.2021.102915] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/06/2021] [Accepted: 12/12/2021] [Indexed: 01/26/2023]
Abstract
Altered brain network connectivity is a potential biomarker for obsessive-compulsive disorder (OCD). A meta-analysis of resting-state MRI studies by Gürsel et al. (2018) described altered functional connectivity in OCD patients within and between the default mode network (DMN), the salience network (SN), and the frontoparietal network (FPN), as well as evidence for aberrant fronto-striatal circuitry. Here, we tested the replicability of these meta-analytic rsfMRI findings by measuring functional connectivity during resting-state fMRI in a new sample of OCD patients (n = 24) and matched controls (n = 33). We performed seed-to-voxel analyses using 30 seed regions from the prior meta-analysis. OCD patients showed reduced functional connectivity between the SN and the DMN compared to controls, replicating previous findings. We did not observe significant group differences of functional connectivity within the DMN, SN, nor FPN. Additionally, we observed reduced connectivity between the visual network to both the DMN and SN in OCD patients, in particular reduced functional connectivity between lateral parietal seeds and the left inferior lateral occipital pole. Furthermore, the right lateral parietal seed (associated with the DMN) was more strongly correlated with a cluster in the right lateral occipital cortex and precuneus (a region partly overlapping with the Dorsal Attentional Network (DAN)) in patients. Importantly, this latter finding was positively correlated to OCD symptom severity. Overall, our study partly replicated prior meta-analytic findings, highlighting hypoconnectivity between SN and DMN as a potential biomarker for OCD. Furthermore, we identified changes between the SN and the DMN with the visual network. This suggests that abnormal connectivity between cortex regions associated with abstract functions (transmodal regions such as the DMN), and cortex regions associated with constrained neural processing (unimodal regions such as the visual cortex), may be important in OCD.
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Affiliation(s)
- Tal Geffen
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Germany.
| | | | - Carsten Finke
- Department of Neurology, Charité - Universitätsmedizin, Berlin, Germany; Humboldt-Universitaet zu Berlin, Berlin School of Mind and Brain, Berlin, Germany
| | - Sebastian Olbrich
- Department for Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Zsuzsika Sjoerds
- Cognitive Psychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands; Leiden Institute for Brain & Cognition, Leiden University, Leiden, Netherlands
| | - Florian Schlagenhauf
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Germany; Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Bernstein Center for Computational Neuroscience, Berlin, Germany
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3
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Bijanki KR, Pathak YJ, Najera RA, Storch EA, Goodman WK, Simpson HB, Sheth SA. Defining functional brain networks underlying obsessive-compulsive disorder (OCD) using treatment-induced neuroimaging changes: a systematic review of the literature. J Neurol Neurosurg Psychiatry 2021; 92:776-786. [PMID: 33906936 PMCID: PMC8223624 DOI: 10.1136/jnnp-2020-324478] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 02/24/2021] [Accepted: 03/24/2021] [Indexed: 01/09/2023]
Abstract
Approximately 2%-3% of the population suffers from obsessive-compulsive disorder (OCD). Several brain regions have been implicated in the pathophysiology of OCD, but their various contributions remain unclear. We examined changes in structural and functional neuroimaging before and after a variety of therapeutic interventions as an index into identifying the underlying networks involved. We identified 64 studies from 1990 to 2020 comparing pretreatment and post-treatment imaging of patients with OCD, including metabolic and perfusion, neurochemical, structural, functional and connectivity-based modalities. Treatment class included pharmacotherapy, cognitive-behavioural therapy/exposure and response prevention, stereotactic lesions, deep brain stimulation and transcranial magnetic stimulation. Changes in several brain regions are consistent and correspond with treatment response despite the heterogeneity in treatments and neuroimaging modalities. Most notable are decreases in metabolism and perfusion of the caudate, anterior cingulate cortex, thalamus and regions of prefrontal cortex (PFC) including the orbitofrontal cortex (OFC), dorsolateral PFC (DLPFC), ventromedial PFC (VMPFC) and ventrolateral PFC (VLPFC). Modulating activity within regions of the cortico-striato-thalamo-cortical system may be a common therapeutic mechanism across treatments. We identify future needs and current knowledge gaps that can be mitigated by implementing integrative methods. Future studies should incorporate a systematic, analytical approach to testing objective correlates of treatment response to better understand neurophysiological mechanisms of dysfunction.
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Affiliation(s)
- Kelly R Bijanki
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Yagna J Pathak
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Ricardo A Najera
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - H Blair Simpson
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
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Brozka H, Alexova D, Radostova D, Janikova M, Krajcovic B, Kubík Š, Svoboda J, Stuchlik A. Plasticity-Related Activity in the Hippocampus, Anterior Cingulate, Orbitofrontal, and Prefrontal Cortex Following a Repeated Treatment with D 2/D 3 Agonist Quinpirole. Biomolecules 2021; 11:84. [PMID: 33440912 PMCID: PMC7827652 DOI: 10.3390/biom11010084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/31/2020] [Accepted: 01/06/2021] [Indexed: 01/30/2023] Open
Abstract
Quinpirole (QNP) sensitization is a well-established model of stereotypical checking relevant to obsessive-compulsive disorder. Previously, we found that QNP-treated rats display deficits in hippocampus-dependent tasks. The present study explores the expression of immediate early genes (IEG) during QNP-induced stereotypical checking in the hippocampus, anterior cingulate cortex (ACC), orbitofrontal cortex (OFC), and medial prefrontal cortex (mPFC). Adult male rats were injected with QNP (0.5 mg/mL/kg; n = 15) or saline (n = 14) daily for 10 days and exposed to an arena enriched with two objects. Visits to the objects and the corners of the arena were recorded. QNP-treated rats developed an idiosyncratic pattern of visits that persisted across experimental days. On day 11, rats were exposed to the arena twice for 5 min and sacrificed. The expression of IEGs Arc and Homer1a was determined using cellular compartment analysis of temporal activity by fluorescence in situ hybridization. IEG-positive nuclei were counted in the CA1 area of the hippocampus, ACC, OFC, and mPFC. We found significantly fewer IEG-positive nuclei in the CA1 in QNP-treated rats compared to controls. The overlap between IEG expressing neurons was comparable between the groups. We did not observe significant differences in IEG expression between QNP treated and control rats in ACC, OFC, and mPFC. In conclusion, treatment of rats with quinpirole decreases plasticity-related activity in the hippocampus during stereotypical checking.
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Affiliation(s)
- Hana Brozka
- Laboratory of the Neurophysiology of Memory, Institute of Physiology of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (D.A.); (D.R.); (M.J.); (B.K.); (Š.K.); (J.S.)
| | - Daniela Alexova
- Laboratory of the Neurophysiology of Memory, Institute of Physiology of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (D.A.); (D.R.); (M.J.); (B.K.); (Š.K.); (J.S.)
- Second Faculty of Medicine, Charles University, 142 20 Prague, Czech Republic
| | - Dominika Radostova
- Laboratory of the Neurophysiology of Memory, Institute of Physiology of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (D.A.); (D.R.); (M.J.); (B.K.); (Š.K.); (J.S.)
- Second Faculty of Medicine, Charles University, 142 20 Prague, Czech Republic
| | - Martina Janikova
- Laboratory of the Neurophysiology of Memory, Institute of Physiology of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (D.A.); (D.R.); (M.J.); (B.K.); (Š.K.); (J.S.)
- First Faculty of Medicine, Charles University, 142 20 Prague, Czech Republic
| | - Branislav Krajcovic
- Laboratory of the Neurophysiology of Memory, Institute of Physiology of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (D.A.); (D.R.); (M.J.); (B.K.); (Š.K.); (J.S.)
- Third Faculty of Medicine, Charles University, 142 20 Prague, Czech Republic
| | - Štěpán Kubík
- Laboratory of the Neurophysiology of Memory, Institute of Physiology of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (D.A.); (D.R.); (M.J.); (B.K.); (Š.K.); (J.S.)
| | - Jan Svoboda
- Laboratory of the Neurophysiology of Memory, Institute of Physiology of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (D.A.); (D.R.); (M.J.); (B.K.); (Š.K.); (J.S.)
| | - Ales Stuchlik
- Laboratory of the Neurophysiology of Memory, Institute of Physiology of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (D.A.); (D.R.); (M.J.); (B.K.); (Š.K.); (J.S.)
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Park J, Kim T, Kim M, Lee TY, Kwon JS. Functional Connectivity of the Striatum as a Neural Correlate of Symptom Severity in Patient with Obsessive-Compulsive Disorder. Psychiatry Investig 2020; 17:87-95. [PMID: 32000480 PMCID: PMC7047004 DOI: 10.30773/pi.2019.0206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/13/2019] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE It is well established that the cortico-striato-thalamo-cortical (CSTC) circuit is implicated in the pathophysiology of obsessive- compulsive disorder (OCD). However, reports on corticostriatal functional connectivity (FC) in OCD have been inconsistent due to the structural and functional heterogeneity of the striatum. Therefore, in the present study, we investigated corticostriatal FC using a fine 12-seed striatal parcellation to overcome this heterogeneity and discover the neural correlates of symptoms in OCD patients. METHODS We recruited 23 OCD patients and 23 healthy controls (HCs). Whole-brain FC based on striatal seeds was examined using resting-state functional magnetic resonance imaging data and compared across OCD patients and HCs. We conducted correlation analysis between FCs of striatal subregions with significant group differences and symptom severity scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Rating Scale for Depression, and Hamilton Rating Scale for Anxiety (HAM-A). RESULTS Compared to HCs, patients demonstrated increased FC of the dorsal caudal putamen and ventral rostral putamen (VRP) with several cortical regions, such as the intracalcarine cortex, inferior frontal gyrus, supramarginal/angular gyrus (SMG/AG), and postcentral gyrus (PCG). Furthermore, FC between the VRP and SMG/AG and between the VRP and PCG was negatively correlated with scores on the Y-BOCS compulsive subscale and the HAM-A, respectively. CONCLUSION These findings suggest that striatal subregions have strengthened FC with extensive cortical regions, which may reflect neural correlates of compulsive and anxious symptoms in OCD patients. These results contribute to an improved understanding of OCD pathophysiology by complementing the current evidence regarding striatal FC.
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Affiliation(s)
- Junha Park
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Taekwan Kim
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Young Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Institute of Human Behavioral Medicine, Seoul National University-Medical Research Center, Seoul, Republic of Korea
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6
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Kim M, Kwak S, Yoon YB, Kwak YB, Kim T, Cho KIK, Lee TY, Kwon JS. Functional connectivity of the raphe nucleus as a predictor of the response to selective serotonin reuptake inhibitors in obsessive-compulsive disorder. Neuropsychopharmacology 2019; 44:2073-2081. [PMID: 31189178 PMCID: PMC6898154 DOI: 10.1038/s41386-019-0436-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/06/2019] [Accepted: 06/03/2019] [Indexed: 11/10/2022]
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are first-line pharmacological agents for treating obsessive-compulsive disorder (OCD). However, because nearly half of patients show insufficient SSRI responses, serotonergic dysfunction in heterogeneous OCD patients should be investigated for precision medicine. We aimed to determine whether functional connectivity (FC) of the raphe nucleus (RN), the major source of most serotonergic neurons, was altered in OCD patients and could predict the SSRI response. A total of 102 medication-free OCD patients and 101 matched healthy control (HC) subjects participated in resting-state functional magnetic resonance imaging. Among them, 54 OCD patients were treated with SSRIs for 16 weeks, resulting in 26 responders and 28 nonresponders. Seed-based whole brain FC with the RN as a seed region was compared between the OCD and HC groups, as well as between SSRI responders and nonresponders. FC cluster values showing significant group differences were used to investigate factors correlated with symptomatic severity before treatment and predictive of SSRI response. Compared to HCs, OCD patients exhibited significantly larger FC between the RN and temporal cortices including the middle temporal gyrus (MTG), paracingulate gyrus, amygdala, hippocampus, putamen, thalamus, and brain stem. Greater RN-left MTG FC was positively correlated with OC symptom severity at baseline. In addition, larger FC of the RN-left MTG was also found in SSRI nonresponders compared to responders, which was a significant predictor of SSRI response after 16 weeks. The FC of RN may reflect the neurobiological underpinning of OCD and could aid future precision medicine as a differential brain-based biomarker.
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Affiliation(s)
- Minah Kim
- 0000 0001 0302 820Xgrid.412484.fDepartment of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea ,0000 0004 0470 5905grid.31501.36Department of Psychiatry, Seoul National University College of Medicine, 101 Daehak-no, Chongno-gu, Seoul, 03080 Republic of Korea
| | - Seoyeon Kwak
- 0000 0004 0470 5905grid.31501.36Department of Brain and Cognitive Sciences, Seoul National University College of Natural Science, Seoul, Republic of Korea
| | - Youngwoo Bryan Yoon
- 0000 0001 2355 7002grid.4367.6Department of Psychiatry, Washington University in St. Louis, St. Louis, MO USA
| | - Yoo Bin Kwak
- 0000 0004 0470 5905grid.31501.36Department of Brain and Cognitive Sciences, Seoul National University College of Natural Science, Seoul, Republic of Korea
| | - Taekwan Kim
- 0000 0004 0470 5905grid.31501.36Department of Brain and Cognitive Sciences, Seoul National University College of Natural Science, Seoul, Republic of Korea
| | - Kang Ik K. Cho
- 0000 0004 0470 5905grid.31501.36Department of Brain and Cognitive Sciences, Seoul National University College of Natural Science, Seoul, Republic of Korea
| | - Tae Young Lee
- 0000 0001 0302 820Xgrid.412484.fDepartment of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea. .,Department of Psychiatry, Seoul National University College of Medicine, 101 Daehak-no, Chongno-gu, Seoul, 03080, Republic of Korea. .,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Science, Seoul, Republic of Korea. .,Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea.
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Tezcan D, Tümkaya S. Situation Awareness in Obsessive Compulsive Disorder and Their Relatives: an Endophenotype Study. ACTA ACUST UNITED AC 2019; 55:370-375. [PMID: 30622396 DOI: 10.5152/npa.2017.20571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 08/09/2017] [Indexed: 11/22/2022]
Abstract
Introduction It has been theorized that endophenotype models will help to understand the etiology of heterogeneous brain disorders such as obsessive-compulsive disorder (OCD). In this study, it was aimed to determine whether "situational awareness" impairments which can be defined as partially naturalistic working memory deficits, are an endofenotype for OCD. Methods In this study, situational awareness (SA) task performances of 67 OCD patients, 50 their unaffected first-degree relatives, and 41 healthy controls who matched with regard to sex, age and years of education were measured to investigate endophenotypes in OCD. For this purpose, a visuospatial working memory test was used. Results As a result, the relatives showed a task performance between patients with OCD and control group in both SA1 and SA2 tasks. Patients with OCD performed significantly worse than control group on SA1 single and dual task. On the other hand, there were no significant differences between relatives and patients of any SA assessment. Conclusion These results indicated that poor situational awareness may be a candidate endophenotype for OCD. Early perceptual dysfunctions such as poor performance on SA1 task can mediate the genetic risk for OCD.
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Affiliation(s)
- Didem Tezcan
- İzzet Baysal Research and Training Hospital, Department of Psychiatry, Bolu, Turkey
| | - Selim Tümkaya
- Pamukkale University Medicine Faculty, Department of Psychiatry, Denizli, Turkey
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8
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Shreedhara AS, Bhargava GK, Kenchaiah R, Ravindranadh CM, Arima A, Bharath RD, Saini J, Chandana N, Rajeswaran J, Rao MB, Satishchandra P, Janardhana Reddy YC, Sinha S. Improvement in Obsessive-Compulsive Disorder Following Right Anterior Temporal Lobectomy and Amygdalohippocampectomy in a Patient with Refractory Temporal Lobe Epilepsy with Right Mesial Temporal Sclerosis. Ann Indian Acad Neurol 2018; 21:321-324. [PMID: 30532367 PMCID: PMC6238557 DOI: 10.4103/aian.aian_399_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
There are reports of co-occurrence of obsessive-compulsive disorder (OCD) in patients with temporal lobe epilepsy (TLE). We present a report of a patient with refractory TLE due to hippocampal sclerosis with concomitant OCD on pharmacotherapy for both. She underwent surgery for standard anterior temporal lobectomy with amygdalohippocampectomy and reported improvement in obsessive-compulsive symptoms subsequently. We seek to further evidence of interaction between the two conditions and argue to undertake future research exploration on the same.
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Affiliation(s)
- A S Shreedhara
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - G K Bhargava
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.,Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Raghavendra Kenchaiah
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - C M Ravindranadh
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Arivazhagan Arima
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | | | | | - Jamuna Rajeswaran
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Malla Bhaskara Rao
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Y C Janardhana Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sanjib Sinha
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Cool and Hot Aspects of Executive Function in Childhood Obsessive-Compulsive Disorder. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2018; 45:1195-1205. [PMID: 27838893 DOI: 10.1007/s10802-016-0229-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Aspects of executive functioning (EF) have been put forward as endophenotypes in obsessive- compulsive disorder (OCD) and meta-analyses support EF underperformance in adult samples. Childhood-onset OCD has been suggested to constitute a separate neurodevelopmental subtype of the disorder but studies on neuropsychological functioning in childhood OCD are limited. The aim of the present study was to investigate performance-based EF in pediatric OCD using observed and latent variable analyses. A case-control design was applied including 50 unmedicated children and adolescents with OCD aged 7-17 years of which 70% were female, 50 pairwise age and gender matched non-psychiatric controls (NP) and 38 children and adolescents with mixed anxiety disorders (MA). Participants underwent structured diagnostic interviews and assessment with a battery encompassing cool EF tasks of working memory, set shifting, inhibition, and planning, and hot EF tasks of decision making and dot probe paradigm affective interference. First, groups were compared on observed variables with multilevel mixed-effects linear regression and analysis of variance. Then the latent structure of cool EF was tested with confirmatory factor analysis (CFA) and groups were compared on the CFA scores. No significant differences between groups appeared on individual cool EF tasks. On the hot EF tasks the OCD group displayed significant interference effects on the dot probe paradigm OCD-specific stimuli relative to NP, but not compared to MA and no group differences emerged for decision making. In the CFA a one-factor solution showed best fit, but the groups did not differ significantly on the resulting latent variable. The present study does not support cool or hot EF impairments in childhood OCD.
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Abstract
Anxiety disorders are among the most prevalent psychological issues worldwide, displaying the youngest age of onset and greatest chronicity of any mood or substance abuse disorder. Given the high social and economic cost imposed by these disorders, developing effective treatments is of the utmost importance. Anxiety disorders manifest in a variety of symptomatic phenotypes and are highly comorbid with other psychological diseases such as depression. These facts have made unraveling the complex underlying neural circuity an ever-present challenge for researchers. We offer a brief review on the neuroanatomy of anxiety disorders and discuss several currently available therapeutic options.
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Affiliation(s)
| | - Shehzad Khalid
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies
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11
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van der Straten AL, Denys D, van Wingen GA. Impact of treatment on resting cerebral blood flow and metabolism in obsessive compulsive disorder: a meta-analysis. Sci Rep 2017; 7:17464. [PMID: 29234089 PMCID: PMC5727319 DOI: 10.1038/s41598-017-17593-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 11/28/2017] [Indexed: 12/23/2022] Open
Abstract
Neurobiological models of obsessive-compulsive disorder (OCD) posit that its clinical symptoms such as repetitive thoughts and behaviors are related to hyperactivity in the cortico-striato-thalamo-cortical (CSTC) circuit. Small scale neuroimaging studies have shown that treatment of OCD is associated with reduced activity across different brain structures within this circuitry. We performed the first meta-analysis of positron emission tomography (PET) and single photon emission computed tomography (SPECT) studies that investigated cerebral blood flow or glucose metabolism in patients with OCD before and after pharmacological or psychological treatment. We calculated standardized mean differences for the regions-of-interest most often reported. The meta-analysis revealed small reductions in activity in the caudate nucleus and orbitofrontal cortex after treatment with a serotonin reuptake inhibitor or cognitive behavioral therapy. Small reductions were also observed in the thalamus when one SPECT study with a large opposite effect was excluded from the analysis. Meta-regression analyses for the caudate nucleus showed no significant effect of the type of treatment, decrease in symptom severity, mean duration until the follow-up scan, or year of publication. These results show that pharmacological and psychological treatments reduce resting CSTC circuit activity, and provide further support for the CSTC circuit model in OCD.
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Affiliation(s)
- A L van der Straten
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
- Brain Imaging Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands.
| | - D Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Brain Imaging Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - G A van Wingen
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Brain Imaging Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
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12
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Bhikram T, Abi-Jaoude E, Sandor P. OCD: obsessive-compulsive … disgust? The role of disgust in obsessive-compulsive disorder. J Psychiatry Neurosci 2017; 42:300-306. [PMID: 28375077 PMCID: PMC5573572 DOI: 10.1503/jpn.160079] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Recent research has identified the important role of disgust in the symptomatology of obsessive-compulsive disorder (OCD). Exaggerated and inappropriate disgust reactions may drive some of the symptoms of OCD, and in some cases, may even eclipse feelings of anxiety. This paper reviews behavioural and neuroimaging research that recognizes the prominent role of disgust in contributing to OCD symptoms, especially contamination-based symptoms. We discuss how elevated behavioural and biological markers of disgust reported in OCD populations support the need for alternative clinical treatment strategies and theoretical models of OCD.
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Affiliation(s)
- Tracy Bhikram
- Correspondence to: T. Bhikram, University Health Network, Tourette Syndrome Neurodevelopmental Clinic, 399 Bathurst St, Toronto, ON M5T 2S8;
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Servaes S, Glorie D, Verhaeghe J, Stroobants S, Staelens S. Preclinical molecular imaging of glutamatergic and dopaminergic neuroreceptor kinetics in obsessive compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2017; 77:90-98. [PMID: 28365375 DOI: 10.1016/j.pnpbp.2017.02.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 02/06/2017] [Accepted: 02/27/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Molecular neuroimaging was applied in the quinpirole rat model for compulsive checking in OCD to visualize the D2- and mGluR5-receptor occupancy with Raclopride and ABP-688 microPET/CT. METHODS Animals (n=48) were exposed to either saline (CTRL; 1mL/kg) or quinpirole (QP; dopamine D2-agonist, 0.5mg/kg) in a single injection (RAC and ABP acute groups) or twice-weekly during 7weeks (chronic group). Animals underwent PET/CT after the 1st injection (acute) or before initial exposure and following the 10th injection in week 5 (chronic). For the latter, each injection was paired with an open field test and video tracking. RESULTS The QP animals displayed a strong increase in visiting frequency (checking) in the chronic group (+699.29%) compared to the control animals. Acute administration of the drug caused significant (p<0.01) decreases in D2R occupancy in the CP (-42.03%±4.01%). Chronical exposure resulted in significantly stronger decreases in the CP (-52.29%±3.79%). Furthermore significant increases in mGluR5 occupancy were found in the CP (10.36%±4.09%), anterior cingulate cortex (13.26%±4.01%), amygdala (24.36%±6.86%), entorhinal cortex (18.49%±5.14%) and nucleus accumbens (13.8%±4.87%) of the chronic group, not present after acute exposure. CONCLUSIONS Compared to acute exposure, sensitisation to QP as a model for OCD differs both on a dopaminergic and glutamateric level, indicating involvement of processes such as receptor internalization and changes in extracellular availability of both neurotransmitters.
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Affiliation(s)
- S Servaes
- Molecular Imaging Center Antwerp (MICA), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.
| | - D Glorie
- Molecular Imaging Center Antwerp (MICA), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.
| | - J Verhaeghe
- Molecular Imaging Center Antwerp (MICA), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.
| | - S Stroobants
- Molecular Imaging Center Antwerp (MICA), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium; Department of Nuclear Medicine, University Hospital Antwerp, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.
| | - S Staelens
- Molecular Imaging Center Antwerp (MICA), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.
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14
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Zhou DD, Wang W, Wang GM, Li DQ, Kuang L. An updated meta-analysis: Short-term therapeutic effects of repeated transcranial magnetic stimulation in treating obsessive-compulsive disorder. J Affect Disord 2017; 215:187-196. [PMID: 28340445 DOI: 10.1016/j.jad.2017.03.033] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 02/07/2017] [Accepted: 03/06/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study was conducted to evaluate the short-term therapeutic effects of using repeated transcranial magnetic stimulation (rTMS) to treat obsessive-compulsive disorder (OCD) and to examine potential influencing factors. METHOD We searched the PubMed, EMBASE, CENTRAL, Wanfang, CNKI, and Sinomed databases on September 18, 2016 and reviewed the references of previous meta-analyses. Sham-controlled, randomized clinical trials using rTMS to treat OCD were included. Hedge's g was calculated for the effect size. Subgroup analyses and univariate meta-regressions were conducted. RESULTS Twenty studies with 791 patients were included. A large effect size (g=0.71; 95%CI, 0.55-0.87; P<0.001) was found for the therapeutic effect. Targeting the supplementary motor area (SMA) (g=0.56; 95%CI, 0.12-1.01; P<0.001), left dorsolateral prefrontal cortex (DLPFC) (g=0.47; 95%CI, 0.02-0.93; P=0.02), bilateral DLPFC (g=0.65; 95%CI, 0.38-0.92; P<0.001) and right DLPFC (g=0.93; 95%CI, 0.70-1.15; P<0.001), excluding the orbitofrontal cortex (OFC) (g=0.56; 95%CI, -0.05-1.18; P=0.07), showed significant improvements over sham treatments. Both low-frequency (g=0.73; 95%CI, 0.50-0.96; P<0.001) and high-frequency (g=0.70; 95%CI, 0.51-0.89; P<0.001) treatments were significantly better than sham treatments, with no significant differences between the effects of the two frequencies. The subgroup analyses indicated that patients who were non-treatment resistant, lacked concurrent major depressive disorder (MDD) and received threshold-intensity rTMS showed larger therapeutic effects than the corresponding subgroups. The subgroup analysis according to sham strategy showed that tilted coils yielded larger effects than sham coils. Meta-regression analyses revealed that none of the continuous variables were significantly associated with the therapeutic effects. LIMITATIONS Only short-term therapeutic effects were assessed in this study. CONCLUSIONS Based on this study, the short-term therapeutic effects of rTMS are superior to those of sham treatments. The site of stimulation, stimulation frequency and intensity and sham condition were identified as potential factors modulating short-term therapeutic effects. The findings of this study may inspire future research.
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Affiliation(s)
- Dong-Dong Zhou
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Wo Wang
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Gao-Mao Wang
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Da-Qi Li
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Li Kuang
- Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, China; Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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15
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Hu X, Du M, Chen L, Li L, Zhou M, Zhang L, Liu Q, Lu L, Mreedha K, Huang X, Gong Q. Meta-analytic investigations of common and distinct grey matter alterations in youths and adults with obsessive-compulsive disorder. Neurosci Biobehav Rev 2017; 78:91-103. [PMID: 28442404 DOI: 10.1016/j.neubiorev.2017.04.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 04/15/2017] [Accepted: 04/15/2017] [Indexed: 02/05/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a disabling illness with onset generally in childhood. OCD-youths differ from OCD-adults with regard to gender distribution, comorbidity patterns and treatment options. However, little is known about the neural correlate differences underpin those two populations. The current meta-analysis summarizes voxel based morphometry findings to elucidate whether differences of neural correlates exist between these two populations. Both OCD-youths and OCD-adults demonstrated greater striatal volume and smaller prefrontal grey matter volume (GMV). However, smaller GMV in left visual cortex was observed in OCD-youths only, while smaller GMV in anterior cingulate gyrus and greater GMV in cerebellum were demonstrated only in OCD-adults. Meta-regression showed greater GMV in left putamen was most prominent in samples with higher percentages of medicated OCD-adults. Our findings confirmed the most consistent GMV alterations in OCD were in prefrontal-striatal circuitry. Besides, other regions may involve at different developmental stages including deficits of visual cortex in OCD-youths and abnormalities of limbic-cerebellar circuit in OCD-adults. Medication effect may be more pronounced in the striatum, especially the putamen.
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Affiliation(s)
- Xinyu Hu
- Huaxi MR Research Centre(HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Mingying Du
- Department of Radiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Lizhou Chen
- Huaxi MR Research Centre(HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Lei Li
- Huaxi MR Research Centre(HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Ming Zhou
- Huaxi MR Research Centre(HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Lianqing Zhang
- Huaxi MR Research Centre(HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Qi Liu
- Huaxi MR Research Centre(HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Lu Lu
- Huaxi MR Research Centre(HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Kunal Mreedha
- Huaxi MR Research Centre(HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaoqi Huang
- Huaxi MR Research Centre(HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.
| | - Qiyong Gong
- Huaxi MR Research Centre(HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.
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Dogan H, Oztop D, Eker OO, Ozsoy SD, Özkartal CŞ, Arıcıoğlu F, Tüzün E, Keleş R, Kandemir C, Şirvancı S, Küçükali Cİ, Utkan T, Şahin TD, Yazir Y, Halbutoğulları ZS, Gocmez SS, Arıcıoğlu F, Gülbahar ÖSB, Mahmood A, Zsoldos E, Allan CL, Topiwala A, Ebmeier KP, Ceylan V, Kose S, Akin E, Turkcapar MH, Akin E, Kose S, Ceylan V, Temel G, Turkcapar MH, Kose S, Yalcin M, Akin E, Ceylan V, Turkcapar H, Badur I, Badur NB, Kıvrak Y, Taşdelen Y, Yağcı İ, Aydın F, Aytekin AI, Saka M, Aydin S, Garip B, Kayir H, Öztürk P, Zincir S, Yükselir C, Unal FE, Gıca Ş, Hariri AG. 9th International Congress on Psychopharmacology & 5th International Symposium on Child and Adolescent Psychopharmacology. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1310447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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17
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Yamamuro K, Ota T, Iida J, Kishimoto N, Nakanishi Y, Matsuura H, Uratani M, Okazaki K, Kishimoto T. A longitudinal event-related potential study of selective serotonin reuptake inhibitor therapy in treatment-naïve pediatric obsessive compulsive disorder patients. Psychiatry Res 2016; 245:217-223. [PMID: 27552672 DOI: 10.1016/j.psychres.2016.07.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/04/2016] [Accepted: 07/18/2016] [Indexed: 11/18/2022]
Abstract
Obsessive-compulsive disorder (OCD) is characterized by obsessive thoughts and/or compulsive behaviors, involving specific cognition and/or information processing disorders. Event-related potentials (ERPs) are commonly used as physiological measures of cognitive function. In conscious patients, ERPs are easily and non-invasively measured. Previous ERP studies have revealed differences between OCD patients and control subjects. Whether ERPs reflect the pharmacological effects of OCD treatment, particularly in treatment-naïve pediatric patients, remains unknown. We used the Child's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) to evaluate the symptomatic severity of 12 treatment-naïve pediatric OCD patients. Comparisons were made with 12 age-, sex-, and intelligence-matched controls. The P300 and mismatch negativity (MMN) components were measured during an auditory odd-ball task at baseline in both groups and after the 3-year serotonin reuptake inhibitor (SSRI) treatment in OCD patients. Compared with controls, P300 amplitudes were smaller n the OCD group at Fz, Cz, Pz, C3, and C4. After SSRI treatment, P300 amplitudes increased partly at Fz and C4 in association with symptomatic improvements. We found a significant positive correlation between P300 amplitude in C4 and CY-BOCS scores. Our findings confirm the utility of SSRIs in pediatric OCD, and suggest the utility of ERPs for evaluating pharmacological effects in treatment-naïve pediatric OCD patients.
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Affiliation(s)
- Kazuhiko Yamamuro
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan.
| | - Toyosaku Ota
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Junzo Iida
- Faculty of Nursing, Nara Medical University School of Medicine, Kashihara, Japan
| | - Naoko Kishimoto
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Yoko Nakanishi
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | | | - Mitsuhiro Uratani
- Department of Psychiatry, Nara Prefectural General Rehabilitation Center, Shiki, Japan
| | - Kosuke Okazaki
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Toshifumi Kishimoto
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
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18
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Hatalova H, Radostova D, Pistikova A, Vales K, Stuchlik A. Detrimental effect of clomipramine on hippocampus-dependent learning in an animal model of obsessive-compulsive disorder induced by sensitization with d2/d3 agonist quinpirole. Behav Brain Res 2016; 317:210-217. [PMID: 27659555 DOI: 10.1016/j.bbr.2016.09.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 09/15/2016] [Accepted: 09/18/2016] [Indexed: 11/27/2022]
Abstract
Quinpirole (QNP) sensitization is one of the commonly used animal models of obsessive-compulsive disorder (OCD). We have previously shown that QNP-sensitized animals display a robust cognitive flexibility deficit in an active place avoidance task with reversal in Carousel maze. This is in line with numerous human studies showing deficits in cognitive flexibility in OCD patients. Here we explored the effect of clomipramine, an effective OCD drug that attenuates compulsive checking in QNP, on sensitized rats in acquisition and reversal performances in an active place avoidance task. We found that the addition of clomipramine to QNP-sensitization impairs acquisition learning to a degree that reversal learning could not be tested. In a hippocampal-independent two-way active avoidance task clomipramine did not have an effect on acquisition learning in QNP-treated rats; suggesting that the detrimental effect of clomipramine is hippocampus based. We also tested the effect of risperidone in QNP-sensitized animals, which is not effective in OCD treatment. Risperidone also marginally impaired acquisition learning of QNP-sensitized animals, but not reversal. Moreover, we explored the effect of the augmentation of clomipramine treatment with risperidone in QNP-sensitized rats- a common step in treating SRI-unresponsive OCD patients. Only under this treatment regime animals were unimpaired in both acquisition and reversal learning. Augmentation of SRI with neuroleptics therefore could be beneficial for improving cognitive flexibility, and possibly be considered a first line of treatment in patients with reduced cognitive flexibility.
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Affiliation(s)
- Hana Hatalova
- Institute of Physiology, Academy of Sciences of the Czech Republic, Videnska 1083, 142 20, Prague, Czech Republic.
| | - Dominika Radostova
- Institute of Physiology, Academy of Sciences of the Czech Republic, Videnska 1083, 142 20, Prague, Czech Republic
| | - Adela Pistikova
- Institute of Physiology, Academy of Sciences of the Czech Republic, Videnska 1083, 142 20, Prague, Czech Republic
| | - Karel Vales
- Institute of Physiology, Academy of Sciences of the Czech Republic, Videnska 1083, 142 20, Prague, Czech Republic; National Institute of Mental Health, Topolova 748, 250 67, Klecany, Czech Republic
| | - Ales Stuchlik
- Institute of Physiology, Academy of Sciences of the Czech Republic, Videnska 1083, 142 20, Prague, Czech Republic.
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Abstract
Obsessive compulsive disorder (OCD) is a relatively common psychiatric illness with a lifetime prevalence of 2-3% in general population. The pathophysiology of OCD is not yet fully understood, however over the last few decades, evidence for abnormalities of cortico-striatal-thalamic-cortico (CSTC) circuitry in etiopathogenesis of OCD has accumulated. Recent brain imaging techniques have been particularly convincing in suggesting that CSTC circuits are responsible for mediation of OCD symptoms. Neuroimaging studies, especially more recent studies using functional neuroimaging methods have looked for possible changes seen in the brain of patients with OCD, the specificity of the findings (as compared to other psychiatric illnesses) and the effects of treatment (pharmacotherapy/psychotherapy) on such changes were observed. This narrative review discusses the neuroimaging findings seen in patients with OCD with a special focus on relatively more recent neuroimaging modalities such as magnetic resonance spectroscopy and magnetoencephalography.
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Affiliation(s)
- Arpit Parmar
- Department of Psychiatry, All Institute of Medical Sciences, New Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry, All Institute of Medical Sciences, New Delhi, India
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Seo HJ, Jung YE, Lim HK, Um YH, Lee CU, Chae JH. Adjunctive Low-frequency Repetitive Transcranial Magnetic Stimulation over the Right Dorsolateral Prefrontal Cortex in Patients with Treatment-resistant Obsessive-compulsive Disorder: A Randomized Controlled Trial. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2016; 14:153-60. [PMID: 27121426 PMCID: PMC4857874 DOI: 10.9758/cpn.2016.14.2.153] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/09/2015] [Accepted: 10/01/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The ratio of 2nd to 4th digit length (2D:4D) is a sexually dimorphic trait. Men have a relatively shorter second digit than fourth digit. This ratio is thought to be influenced by higher prenatal testosterone level or greater sensitivity to androgen. The purpose of this study is to investigate the relationship between alcohol dependence and 2D:4D in a Korean sample and whether 2D:4D can be a biologic marker in alcohol dependence. OBJECTIVE The present study aimed to evaluate the efficacy of low frequency (LF) repetitive transcranial magnetic stimulation (rTMS) over the right dorsolateral prefrontal cortex (DLPFC) for the treatment of obsessive-compulsive disorder (OCD). METHODS Twenty-seven patients with treatment resistant OCD were randomly assigned to 3 week either active (n=14) or sham (n=13) rTMS. The active rTMS parameters consisted of 1 Hz, 20-minute trains (1,200 pulses/day) at 100% of the resting motor threshold (MT). OCD symptoms, mood, and anxiety were assessed at baseline and every week throughout the treatment period. RESULTS A repeated-measures analysis of variance (ANOVA) was used to evaluate changes on the Yale-Brown Obsessive Compulsive Scale (YBOCS). Our results revealed a significant reduction in YBOCS scores in the active group compared with the sham group after 3 weeks. Similarly, a repeated-measures ANOVA revealed significant effect of time and time×group interaction on scores on the Hamilton Depression Rating Scale and the Clinical Global Impression-Severity scale. There were no reports of any serious adverse effects following the active and sham rTMS treatments. CONCLUSION LF rTMS over the right DLPFC appeared to be superior to sham rTMS for relieving OCD symptoms and depression in patients with treatment-resistant OCD. Further trials with larger sample sizes should be conducted to confirm the present findings.
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Affiliation(s)
- Ho-Jun Seo
- Department of Psychiatry, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Young-Eun Jung
- Department of Psychiatry, Jeju National University School of Medicine, Jeju, Korea
| | - Hyun Kook Lim
- Department of Psychiatry, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Yoo-Hyun Um
- Department of Psychiatry, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Chang Uk Lee
- Department of Psychiatry Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong-Ho Chae
- Department of Psychiatry Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Hu X, Liu Q, Li B, Tang W, Sun H, Li F, Yang Y, Gong Q, Huang X. Multivariate pattern analysis of obsessive-compulsive disorder using structural neuroanatomy. Eur Neuropsychopharmacol 2016; 26:246-254. [PMID: 26708318 DOI: 10.1016/j.euroneuro.2015.12.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 11/15/2015] [Accepted: 12/01/2015] [Indexed: 02/05/2023]
Abstract
Magnetic resonance imaging (MRI) studies have revealed brain structural abnormalities in obsessive-compulsive disorder (OCD) patients, involving both gray matter (GM) and white matter (WM). However, the results of previous publications were based on average differences between groups, which limited their usages in clinical practice. Therefore, the aim of this study was to examine whether the application of multivariate pattern analysis (MVPA) to high-dimensional structural images would allow accurate discrimination between OCD patients and healthy control subjects (HCS). High-resolution T1-weighted images were acquired from 33 OCD patients and 33 demographically matched HCS in a 3.0 T scanner. Differences in GM and WM volume between OCD and HCS were examined using two types of well-established MVPA techniques: support vector machine (SVM) and Gaussian process classifier (GPC). We also drew a receiver operating characteristic (ROC) curve to evaluate the performance of each classifier. The classification accuracies for both classifiers using GM and WM anatomy were all above 75%. The highest classification accuracy (81.82%, P<0.001) was achieved with the SVM classifier using WM information. Regional brain anomalies with high discriminative power were based on three distributed networks including the fronto-striatal circuit, the temporo-parieto-occipital junction and the cerebellum. Our study illustrated that both GM and WM anatomical features may be useful in differentiating OCD patients from HCS. WM volume using the SVM approach showed the highest accuracy in our population for revealing group differences, which suggested its potential diagnostic role in detecting highly enriched OCD patients at the level of the individual.
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Affiliation(s)
- Xinyu Hu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Qi Liu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Bin Li
- Mental Health Center, Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Wanjie Tang
- Mental Health Center, Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Huaiqiang Sun
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Fei Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Yanchun Yang
- Mental Health Center, Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
| | - Xiaoqi Huang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
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Yamamuro K, Okada K, Kishimoto N, Ota T, Iida J, Kishimoto T. A longitudinal, event-related potential pilot study of adult obsessive-compulsive disorder with 1-year follow-up. Neuropsychiatr Dis Treat 2016; 12:2463-2471. [PMID: 27713631 PMCID: PMC5045237 DOI: 10.2147/ndt.s117100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIM Earlier brain imaging research studies have suggested that brain abnormalities in obsessive-compulsive disorder (OCD) normalize as clinical symptoms improve. However, although many studies have investigated event-related potentials (ERPs) in patients with OCD compared with healthy control subjects, it is currently unknown whether ERP changes reflect pharmacological and psychotherapeutic effects. As such, the current study examined the neurocognitive components of OCD to elucidate the pathophysiological abnormalities involved in the disorder, including the frontal-subcortical circuits. METHODS The Yale-Brown Obsessive-Compulsive Scale was used to evaluate 14 adult patients with OCD. The present study also included ten age-, sex-, and IQ-matched controls. The P300 and mismatch negativity (MMN) components during an auditory oddball task at baseline for both groups and after 1 year of treatment for patients with OCD were measured. RESULTS Compared with controls, P300 amplitude was attenuated in the OCD group at Cz and C4 at baseline. Pharmacotherapy and psychotherapy treatment for 1 year reduced OCD symptomology. P300 amplitude after 1 year of treatment was significantly increased, indicating normalization compared with baseline at Fz, Cz, C3, and C4. We found no differences in P300 latency, MMN amplitude, or MMN latency between baseline and after one year of treatment. CONCLUSION ERPs may be a useful tool for evaluating pharmacological and cognitive behavioral therapy in adult patients with OCD.
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Affiliation(s)
- Kazuhiko Yamamuro
- Department of Psychiatry, Nara Medical University School of Medicine
| | - Koji Okada
- Department of Psychiatry, Jingumaecocorono-Clinic
| | - Naoko Kishimoto
- Department of Psychiatry, Nara Medical University School of Medicine
| | - Toyosaku Ota
- Department of Psychiatry, Nara Medical University School of Medicine
| | - Junzo Iida
- Faculty of Nursing, Nara Medical University School of Medicine, Kashihara, Japan
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Mintzopoulos D, Gillis TE, Robertson HR, Dalia T, Feng G, Rauch SL, Kaufman MJ. Striatal magnetic resonance spectroscopy abnormalities in young adult SAPAP3 knockout mice. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2016; 1:39-48. [PMID: 26858992 PMCID: PMC4742338 DOI: 10.1016/j.bpsc.2015.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obsessive compulsive disorder (OCD) is a debilitating condition with lifetime prevalence of 1-3%. OCD typically arises in youth but delays in diagnosis impede optimal treatment and developmental studies of the disorder. Research using genetically modified rodents may provide models of etiology that enable earlier detection and intervention. The SAPAP3 knockout (KO) transgenic mouse was developed as an animal model of OCD and related disorders (OCRD). KO mice exhibit compulsive self-grooming behavior analogous to behaviors found in people with OCRD. Striatal hyperactivity has been reported in these mice and in humans with OCD. METHODS Striatal and medial frontal cortex 9.4 Tesla proton spectra were acquired from young adult SAPAP3 KO and wild-type control mice to determine whether KO mice have metabolic and neurochemical abnormalities. RESULTS Young adult KO mice had lower striatal lactate (P=0.006) and glutathione (P=0.039) levels. Among all mice, striatal lactate and glutathione levels were associated (R=0.73, P=0.007). We found no group differences in medial frontal cortex metabolites. At the age range studied, only 1 of 8 KO mice had skin lesions indicative of severe compulsive grooming. CONCLUSION Young adult SAPAP3 KO mice have striatal but not medial frontal cortex MRS abnormalities that may reflect striatal hypermetabolism accompanied by oxidative stress. These abnormalities typically preceded the onset of severe compulsive grooming. Our findings are consistent with striatal hypermetabolism in OCD. Together, these results suggest that striatal MRS measures of lactate or glutathione might be useful biomarkers for early detection of risk for developing compulsive behavior disorders.
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Macatee RJ, Allan NP, Gajewska A, Norr AM, Raines AM, Albanese BJ, Boffa JW, Schmidt NB, Cougle JR. Shared and Distinct Cognitive/Affective Mechanisms in Intrusive Cognition: An Examination of Worry and Obsessions. COGNITIVE THERAPY AND RESEARCH 2015; 40:80-91. [PMID: 26957678 DOI: 10.1007/s10608-015-9714-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Generalized anxiety disorder and obsessive-compulsive disorder are defined by chronic intrusive thoughts. The aim of the present study was to evaluate the relationship between cognitive (attentional control) and motivational (negative urgency) mechanisms potentially underlying worry and obsessions. Participants (N = 526) completed an online questionnaire battery consisting of self-report measures of worry, OCD symptoms, attentional control (AC), negative urgency (NU), and trait negative affect. After controlling for trait negative affect, self-reported AC was negatively related to worry, repugnant obsessions, and ordering symptoms. Greater NU was associated with increased worry and repugnant obsessions. Further, self-reported AC and NU interacted such that greater NU was associated with greater worry at high but not low levels of AC. AC and NU were independently associated with repugnant obsessions. Perceived executive functioning impairments may confer risk for intrusive thoughts, particularly worries, whereas distress-driven impulsivity may contribute to the involuntary, ego-dystonic features of intrusions.
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Affiliation(s)
- Richard J Macatee
- Department of Psychology, Florida State University, P.O. Box 3064301, Tallahassee, FL 32306, USA
| | - Nicholas P Allan
- Department of Psychology, Florida State University, P.O. Box 3064301, Tallahassee, FL 32306, USA
| | - Agnieszka Gajewska
- Department of Psychology, Florida State University, P.O. Box 3064301, Tallahassee, FL 32306, USA
| | - Aaron M Norr
- Department of Psychology, Florida State University, P.O. Box 3064301, Tallahassee, FL 32306, USA
| | - Amanda Medley Raines
- Department of Psychology, Florida State University, P.O. Box 3064301, Tallahassee, FL 32306, USA
| | - Brian J Albanese
- Department of Psychology, Florida State University, P.O. Box 3064301, Tallahassee, FL 32306, USA
| | - Joseph W Boffa
- Department of Psychology, Florida State University, P.O. Box 3064301, Tallahassee, FL 32306, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, P.O. Box 3064301, Tallahassee, FL 32306, USA
| | - Jesse R Cougle
- Department of Psychology, Florida State University, P.O. Box 3064301, Tallahassee, FL 32306, USA
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Vandborg SK, Hartmann TB, Bennedsen BE, Pedersen AD, Thomsen PH. Are there reliable changes in memory and executive functions after cognitive behavioural therapy in patients with obsessive-compulsive disorder? Cogn Neuropsychiatry 2015; 20:128-43. [PMID: 25420427 DOI: 10.1080/13546805.2014.981649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Patients with obsessive-compulsive disorder (OCD) have impaired memory and executive functions, but it is unclear whether these functions improve after cognitive behavioural therapy (CBT) of OCD symptoms. The primary aim of this study was to investigate whether memory and executive functions change after CBT in patients with OCD. METHODS We assessed 39 patients with OCD before and after CBT with neuropsychological tests of memory and executive functions. To correct for practice effects, 39 healthy controls (HCs) were assessed at two parallel time intervals with the neuropsychological tests. RESULTS There were no changes in memory and executive functions after CBT in patients with OCD when results were corrected for practice effects. Patients performed worse on a test of visuospatial memory and organisational skills (Rey complex figure test [RCFT]) compared to HCs both before and after CBT (ps = .002-.036). CONCLUSIONS The finding of persistent poor RCFT performances indicates that patients with OCD have impaired visuospatial memory and organisational skills that may be trait-related rather than state-dependent. These impairments may need to be considered in treatment. Our findings underline the importance of correcting for practice effects when investigating changes in cognitive functions.
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Affiliation(s)
- Sanne Kjær Vandborg
- a Clinic for OCD and Anxiety Disorders , Aarhus University Hospital Risskov , Tretommervej 1, 8240 Risskov , Denmark
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Thomas SJ, Gonsalvez CJ, Johnstone SJ. Electrophysiology of facilitation priming in obsessive-compulsive and panic disorders. Clin Neurophysiol 2015; 127:464-478. [PMID: 26111486 DOI: 10.1016/j.clinph.2015.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 04/01/2015] [Accepted: 05/26/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Repeated experience with stimuli often primes faster, more efficient neuronal and behavioural responses. Exaggerated repetition priming effects have previously been reported in obsessive-compulsive disorder (OCD), however little is known of their underlying neurobiology or disorder-specificity, hence we investigated these factors. METHODS We examined event-related potentials (ERPs) and behaviour while participants with OCD, panic disorder and healthy controls (20 per group) performed a Go/NoGo task which manipulated target repetition sequences. RESULTS Both clinical groups showed stronger reaction time (RT) priming than HCs, which in OCD was greater in a checking, than washing, subgroup. Both clinical groups had similar RT deficits and ERP anomalies across several components, which correlated with psychopathology and RT priming. In OCD alone, N1 latency tended to increase to repeated stimuli, correlated with O-C symptoms, whereas it decreased in other groups. OCD-checkers had smaller target P2 amplitude than all other groups. CONCLUSIONS Enhanced neural priming is not unique to OCD and may contribute to salient sensory-cognitive experiences in anxiety generally. These effects are related to symptom severity and occur to neutral stimuli and in the context of overall RT impairment, suggesting they may be clinically relevant and pervasive. The results indicate overlapping information-processing and neurobiological factors across disorders, with indications of OCD-specific trends and subgroup differences. SIGNIFICANCE This first electrophysiological investigation of OCD priming in OCD to include anxious controls and OCD subgroups allows for differentiation between overlapping and OCD-specific phenomena, to advance neurobiological models of OCD.
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Affiliation(s)
- Susan J Thomas
- Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, NSW, Australia; Graduate School of Medicine, University of Wollongong, NSW, Australia.
| | - Craig J Gonsalvez
- Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, NSW, Australia; Centre for Psychophysics, Psychophysiology & Psychopharmacology, University of Wollongong, NSW, Australia; University of Western Sydney, NSW, Australia
| | - Stuart J Johnstone
- Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, NSW, Australia; Centre for Psychophysics, Psychophysiology & Psychopharmacology, University of Wollongong, NSW, Australia
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Nakao T, Okada K, Kanba S. Neurobiological model of obsessive-compulsive disorder: evidence from recent neuropsychological and neuroimaging findings. Psychiatry Clin Neurosci 2014; 68:587-605. [PMID: 24762196 DOI: 10.1111/pcn.12195] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 12/16/2022]
Abstract
Obsessive-compulsive disorder (OCD) was previously considered refractory to most types of therapeutic intervention. There is now, however, ample evidence that selective serotonin reuptake inhibitors and behavior therapy are highly effective methods for treatment of OCD. Furthermore, recent neurobiological studies of OCD have found a close correlation between clinical symptoms, cognitive function, and brain function. A large number of previous neuroimaging studies using positron emission tomography, single-photon emission computed tomography or functional magnetic resonance imaging (fMRI) have identified abnormally high activities throughout the frontal cortex and subcortical structures in patients with OCD. Most studies reported excessive activation of these areas during symptom provocation. Furthermore, these hyperactivities were decreased after successful treatment using either selective serotonin reuptake inhibitors or behavioral therapy. Based on these findings, an orbitofronto-striatal model has been postulated as an abnormal neural circuit that mediates symptomatic expression of OCD. On the other hand, previous neuropsychological studies of OCD have reported cognitive dysfunction in executive function, attention, nonverbal memory, and visuospatial skills. Moreover, recent fMRI studies have revealed a correlation between neuropsychological dysfunction and clinical symptoms in OCD by using neuropsychological tasks during fMRI. The evidence from fMRI studies suggests that broader regions, including dorsolateral prefrontal and posterior regions, might be involved in the pathophysiology of OCD. Further, we should consider that OCD is heterogeneous and might have several different neural systems related to clinical factors, such as symptom dimensions. This review outlines recent neuropsychological and neuroimaging studies of OCD. We will also describe several neurobiological models that have been developed recently. Advanced findings in these fields will update the conventional biological model of OCD.
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Affiliation(s)
- Tomohiro Nakao
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Zlomuzica A, Dere D, Machulska A, Adolph D, Dere E, Margraf J. Episodic memories in anxiety disorders: clinical implications. Front Behav Neurosci 2014; 8:131. [PMID: 24795583 PMCID: PMC4005957 DOI: 10.3389/fnbeh.2014.00131] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 03/31/2014] [Indexed: 11/19/2022] Open
Abstract
The aim of this review is to summarize research on the emerging role of episodic memories in the context of anxiety disorders (AD). The available literature on explicit, autobiographical, and episodic memory function in AD including neuroimaging studies is critically discussed. We describe the methodological diversity of episodic memory research in AD and discuss the need for novel tests to measure episodic memory in a clinical setting. We argue that alterations in episodic memory functions might contribute to the etiology of AD. We further explain why future research on the interplay between episodic memory function and emotional disorders as well as its neuroanatomical foundations offers the promise to increase the effectiveness of modern psychological treatments. We conclude that one major task is to develop methods and training programs that might help patients suffering from AD to better understand, interpret, and possibly actively use their episodic memories in a way that would support therapeutic interventions and counteract the occurrence of symptoms.
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Affiliation(s)
- Armin Zlomuzica
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum , Bochum , Germany
| | - Dorothea Dere
- Center for Psychological Consultation and Psychotherapy, Georg-August University Göttingen , Göttingen , Germany
| | - Alla Machulska
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum , Bochum , Germany
| | - Dirk Adolph
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum , Bochum , Germany
| | - Ekrem Dere
- UMR 7102, Neurobiologie des Processus Adaptatifs, Université Pierre et Marie Curie , Paris , France
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum , Bochum , Germany
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Shin DJ, Jung WH, He Y, Wang J, Shim G, Byun MS, Jang JH, Kim SN, Lee TY, Park HY, Kwon JS. The effects of pharmacological treatment on functional brain connectome in obsessive-compulsive disorder. Biol Psychiatry 2014; 75:606-14. [PMID: 24099506 DOI: 10.1016/j.biopsych.2013.09.002] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 09/01/2013] [Accepted: 09/04/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous neuroimaging studies of obsessive-compulsive disorder (OCD) have reported both baseline functional alterations and pharmacological changes in localized brain regions and connections; however, the effects of selective serotonin reuptake inhibitor (SSRI) treatment on the whole-brain functional network have not yet been elucidated. METHODS Twenty-five drug-free OCD patients underwent resting-state functional magnetic resonance imaging. After 16-weeks, seventeen patients who received SSRI treatment were rescanned. Twenty-three matched healthy control subjects were examined at baseline for comparison, and 21 of them were rescanned after 16 weeks. Topological properties of brain networks (including small-world, efficiency, modularity, and connectivity degree) were analyzed cross-sectionally and longitudinally with graph-theory approach. RESULTS At baseline, OCD patients relative to healthy control subjects showed decreased small-world efficiency (including local clustering coefficient, local efficiency, and small-worldness) and functional association between default-mode and frontoparietal modules as well as widespread altered connectivity degrees in many brain areas. We observed clinical improvement in OCD patients after 16 weeks of SSRI treatment, which was accompanied by significantly elevated small-world efficiency, modular organization, and connectivity degree. Improvement of obsessive-compulsive symptoms was significantly correlated with changes in connectivity degree in right ventral frontal cortex in OCD patients after treatment. CONCLUSIONS This is first study to use graph-theory approach for investigating valuable biomarkers for the effects of SSRI on neuronal circuitries of OCD patients. Our findings suggest that OCD phenomenology might be the outcome of disrupted optimal balance in the brain networks and that reinstating this balance after SSRI treatment accompanies significant symptom improvement.
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Affiliation(s)
- Da-Jung Shin
- Department of Brain and Cognitive Sciences-World Class University Program, College of Natural Sciences, Seoul, Republic of Korea
| | - Wi Hoon Jung
- Institute of Human Behavioral Medicine, Seoul National University-MRC, Seoul, Republic of Korea
| | - Yong He
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Jinhui Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China; Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Geumsook Shim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min Soo Byun
- Institute of Human Behavioral Medicine, Seoul National University-MRC, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joon Hwan Jang
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung Nyun Kim
- Institute of Human Behavioral Medicine, Seoul National University-MRC, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Young Lee
- Institute of Human Behavioral Medicine, Seoul National University-MRC, Seoul, Republic of Korea
| | - Hye Youn Park
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Brain and Cognitive Sciences-World Class University Program, College of Natural Sciences, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, Seoul National University-MRC, Seoul, Republic of Korea.
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Mantovani A, Rossi S, Bassi BD, Simpson HB, Fallon BA, Lisanby SH. Modulation of motor cortex excitability in obsessive-compulsive disorder: an exploratory study on the relations of neurophysiology measures with clinical outcome. Psychiatry Res 2013; 210:1026-32. [PMID: 24064461 PMCID: PMC7325264 DOI: 10.1016/j.psychres.2013.08.054] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 07/03/2013] [Accepted: 08/29/2013] [Indexed: 12/19/2022]
Abstract
Low-frequency repetitive transcranial magnetic stimulation (rTMS) to supplementary motor area (SMA) showed clinical benefit in obsessive-compulsive disorder (OCD). Here we tested whether clinical improvement was associated with enhanced cortical inhibition as measured by single and paired-pulse TMS variables. In 18 OCD patients receiving 4 weeks of either active or sham rTMS in a double-blind randomized trial, we assessed bilateral resting and active motor thresholds (RMT and AMT), cortical silent period (CSP), short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF). We tested correlations between changes in Yale-Brown Obsessive Compulsive Scale-Self-report (Y-BOCS-SR), Clinical Global Impression-Severity subscale (CGI-S) and cortical excitability measures. Active rTMS increased right hemisphere RMT whose change correlated with Y-BOCS-SR improvement. Baseline RMT hemispheric asymmetry, defined as the difference between left and right hemispheres RMT, and its normalization after active rTMS correlated with Y-BOCS-SR and CGI-S improvements. Active rTMS also increased right hemisphere SICI whose change correlated with Y-BOCS-SR and CGI-S at week 4, and with normalization of baseline RMT hemispheric asymmetry. Treatment-induced changes in cortical excitability measures are consistent with an inhibitory action of SMA rTMS on dysfunctional motor circuits in OCD. Correlations of neurophysiology measures with therapeutic outcome are supportive of the role of SMA in the modulation of OCD symptoms.
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Affiliation(s)
- Antonio Mantovani
- Division of Experimental Therapeutics, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY, USA; Division of Psychiatry, Department of Neuroscience, Siena University, Siena, Italy.
| | - Simone Rossi
- Department of Neurological and Neurosensorial Sciences, Neurology and Clinical Neurophysiology Section, Siena University, Siena, Italy
| | - Bruce D. Bassi
- University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Helen B. Simpson
- Anxiety Disorders Clinic, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY, USA
| | - Brian A. Fallon
- Anxiety Disorders Clinic, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY, USA
| | - Sarah H. Lisanby
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, USA
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Aronson JP, Katnani HA, Eskandar EN. Neuromodulation for obsessive-compulsive disorder. Neurosurg Clin N Am 2013; 25:85-101. [PMID: 24262902 DOI: 10.1016/j.nec.2013.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article describes the basis for neuromodulation procedures for obsessive-compulsive disorder (OCD) and summarizes the literature on the efficacy of these interventions. Discussion includes neural circuitry underlying OCD pathology, the history and types of ablative procedures, the targets and modalities used for neuromodulation, and future therapeutic directions.
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Affiliation(s)
- Joshua P Aronson
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Karadağ F, Kalkan Oğuzhanoğlu N, Yüksel D, Kıraç S, Cura C, Ozdel O, Ateşci F. The comparison of pre- and post-treatment (99m)Tc HMPAO brain SPECT images in patients with obsessive-compulsive disorder. Psychiatry Res 2013; 213:169-77. [PMID: 23149026 DOI: 10.1016/j.pscychresns.2012.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 06/20/2012] [Accepted: 07/11/2012] [Indexed: 01/09/2023]
Abstract
The objective of the present study was to compare brain activation in patients with obsessive-compulsive disorder (OCD) who received pharmacotherapy (selective serotonin reuptake inhibitor (SSRI) or a SSRI-risperidone combination) with that in healthy controls using (99m)Tc-hexamethyl propyleneamine oxime (HMPAO) brain single photon emission tomography (SPECT). Twelve OCD patients achieving clinical response (seven SSRI responders, five patients responded to SSRI plus risperidone) underwent post-treatment SPECT scan. The baseline regional cerebral blood flow (rCBF) was significantly reduced in a large part of the cerebral cortex and the left cingulate gyrus in OCD patients compared with controls. After a 50% reduction of the OCD symptoms, bilaterally increased rCBF in the thalamus showed a significant effect of time in both of the patient groups. In the remitted state, although rCBF in the cingulate gyrus did not differ in SSRI responders compared with controls, patients who responded to the combination of SSRI+ risperidone showed significant hypoperfusion in the left anterior cingulate gyrus. SSRI responders had normalized rCBF in the frontal region relative to the control group. Consequently, based on our results, we attribute the observed thalamic rCBF alteration to SSRI treatment. Our results also suggested that brain perfusion changes associated with clinical remission may differ across patient subgroups.
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Affiliation(s)
- Filiz Karadağ
- Pamukkale University, Medical Faculty, Department of Psychiatry, Denizli 20100, Turkey
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Tempesta D, Mazza M, Serroni N, Moschetta FS, Di Giannantonio M, Ferrara M, De Berardis D. Neuropsychological functioning in young subjects with generalized anxiety disorder with and without pharmacotherapy. Prog Neuropsychopharmacol Biol Psychiatry 2013; 45:236-41. [PMID: 23796524 DOI: 10.1016/j.pnpbp.2013.06.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 05/31/2013] [Accepted: 06/04/2013] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to investigate the neuropsychological functioning and the effect of antidepressant drug intake on cognitive performance in a group of relatively young generalized anxiety disorder (GAD) patients. Forty patients with a DSM-IV diagnosis of GAD and 31 healthy subjects participated in the study (Control group, CON). None of the selected subjects had comorbid depression. GAD subjects were divided into two different subgroups: 18 were taking antidepressants [GAD-pharmacotherapy (GAD-p group)] and 22 were treatment-naïve (GAD group). Each group was administered with a comprehensive neuropsychological battery to assess attention, memory and executive functions. Performance on executive and non-verbal memory tasks of both GAD groups was largely worse than the CON group. However, these deficits seem to be more marked in patients taking antidepressants, especially in the domains of attention, non-verbal memory and executive functions. The present study indicates that GAD is associated with cognitive impairments among young adults. However, the observed association of neuropsychological deficits and the use of pharmacotherapy suggest a possible effect of antidepressant treatment on attention, executive functioning and non-verbal memory.
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Affiliation(s)
- D Tempesta
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy.
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Wen SL, Cheng MH, Cheng MF, Yue JH, Wang H. Pharmacotherapy response and regional cerebral blood flow characteristics in patients with obsessive-compulsive disorder. Behav Brain Funct 2013; 9:31. [PMID: 23898909 PMCID: PMC3733897 DOI: 10.1186/1744-9081-9-31] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 07/20/2013] [Indexed: 12/03/2022] Open
Abstract
Objective To analyze the correlation between the pharmacotherapy response and the characteristics of the pre-treatment regional cerebral blood flow (rCBF) in patients with obsessive-compulsive disorder (OCD). Methods Single-photon emission-computed tomography (SPECT) was used to determine the pre-treatment rCBF in 30 OCD patients and 30 normal controls. Based on their clinical remission response, the subjects were divided into two groups: selective serotonin reuptake inhibitors (SSRIs) and SSRIs plus quetiapine. The subjects with clinical remission response were identified after treatment for a period of 24 weeks, and the rCBF imaging data were processed using statistical parametric mapping (SPM) software with two-sample Z-tests. Results Nineteen OCD patients who achieved clinical remission were included in the study. Increased rCBF in forebrain regions, including the frontal lobe, cingulate gyrus, hypothalamus, and basal ganglia, was found in 11 responders to SSRIs compared to normal control patients. The eight SSRI plus quetiapine responders exhibited a decrease in rCBF within posterior brain regions, including the parietal lobe, cerebellar vermis, and occipital lobe, and an increase in rCBF in the frontal lobe, thalamus, basal ganglia, and cerebellum tonsil compared to normal control patients. Conclusions The characteristics of increased rCBF in forebrain regions and decreased rCBF in posterior brain regions before treatment of OCD patients was a potentially predictor of treatment response to guide treatment options.
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Tippett WJ, Alexander LD, Rizkalla MN, Sergio LE, Black SE. True functional ability of chronic stroke patients. J Neuroeng Rehabil 2013; 10:20. [PMID: 23405970 PMCID: PMC3599557 DOI: 10.1186/1743-0003-10-20] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 02/05/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a paucity of information regarding visuospatial (VS) and visuomotor (VM) task performance in patients with chronic right fronto-parietal lobe stroke, as the majority of knowledge to date in this realm has been gleaned from acute stroke patients. The goal of this paper is to determine how VS and VM performance in chronic stroke patients compare to the performance of healthy participants. METHODS Nine patients with stroke involving the right fronto-parietal region were evaluated against match controls on neuropsychological tests and a computerized visuomotor assessment task. RESULTS Initial evaluation indicated that performance between participant groups were relatively similar on all measures. However, an in-depth analysis of variability revealed observable differences between participant groups. In addition, large effect sizes were also observed supporting the theory that using only conventional examination (e.g., p-values) measures may result in miss-identifying crucial stroke-related differences. CONCLUSION Through conventional evaluation methods it would appear that the chronic stroke participants had made significant functional gains relatively to a control group many years post-stroke. It was shown that the type of evaluation used is essential to identifying group differences. Thus, supplementary methods of evaluation are required to unmask the true functional ability of individuals many years post-stroke.
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Affiliation(s)
- William J Tippett
- L.C. Campbell Cognitive Neurology Research Unit, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre Research Institute, Toronto, ON, Canada
- Heart and Stroke Foundation Centre for Stroke Recovery, Toronto, ON, Canada
- Department of Psychology, University of Northern British Columbia, 3333 University Way, Prince George, BC, Canada
| | - Lisa D Alexander
- L.C. Campbell Cognitive Neurology Research Unit, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre Research Institute, Toronto, ON, Canada
- Heart and Stroke Foundation Centre for Stroke Recovery, Toronto, ON, Canada
| | - Mireille N Rizkalla
- Department of Psychology, University of Northern British Columbia, 3333 University Way, Prince George, BC, Canada
| | - Lauren E Sergio
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
- Centre for Vision Research, York University, Toronto, ON, Canada
| | - Sandra E Black
- L.C. Campbell Cognitive Neurology Research Unit, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre Research Institute, Toronto, ON, Canada
- Heart and Stroke Foundation Centre for Stroke Recovery, Toronto, ON, Canada
- Department of Medicine at Sunnybrook Health Sciences Centre & University of Toronto, Toronto, ON, Canada
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Neural correlates of altered response inhibition and dysfunctional connectivity at rest in obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2013; 40:340-6. [PMID: 23146681 DOI: 10.1016/j.pnpbp.2012.11.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 10/30/2012] [Accepted: 11/05/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Functional imaging studies of obsessive-compulsive disorder (OCD) have reported altered fronto-striatal activity during executive tasks. Additionally, altered connectivity of these regions during resting state was found. However, the relationship between brain activity during tasks and resting state remains poorly understood. The present study investigated neural correlates associated with abnormal response inhibition in OCD and to examine how resting state functional connectivity relates to task-related activity. METHOD Eighteen unmedicated adult OCD patients and 18 age- and sex-matched control subjects underwent functional magnetic resonance imaging scans during both resting state and a response inhibition task. Brain activation during response inhibition was compared between groups. Fronto-striatal regions showing altered task-related activity were used as seeds for connectivity analyses during resting state. RESULTS During the response inhibition task, OCD patients had lower activation in areas including the cingulate cortex and basal ganglia regions. Compared with control subjects, patients with OCD showed increased functional connectivity of the caudate nucleus with the middle cingulate cortex and precentral gyrus during rest, suggesting hyperactive striatal-cortical connections. CONCLUSION This study found altered function in fronto-striatal regions during response inhibition and its relation to resting state functional connectivity in OCD. Our results suggest that dysfunctional striatal-cortical connections even during rest may result in the failure of response inhibition and error monitoring observed in OCD patients.
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Neuropsychological predictors of response to randomized treatment in obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2012; 39:310-7. [PMID: 22789662 DOI: 10.1016/j.pnpbp.2012.07.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 06/29/2012] [Accepted: 07/02/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify neuropsychological predictors of treatment response to cognitive-behavioral therapy (CBT) and fluoxetine in treatment-naïve adults with obsessive-compulsive disorder (OCD). METHOD Thirty-eight adult outpatients with OCD underwent neuropsychological assessment, including tasks of intellectual function, executive functioning and visual and verbal memory, before randomization to a 12-week clinical trial of either CBT or fluoxetine. Neuropsychological measures were used to identify predictors of treatment response in OCD. RESULTS Neuropsychological measures that predicted a better treatment response to either CBT or fluoxetine were higher verbal IQ (Wechsler Abbreviated Scale of Intelligence) (p=0.008); higher verbal memory on the California Verbal Learning Test (p=0.710); shorter time to complete part D (Dots) (p<0.001), longer time to complete part W (Words) (p=0.025) and less errors on part C (Colors) (p<0.001) in the Victoria Stroop Test (VST). Fewer perseverations on the California Verbal Learning Test, a measure of mental flexibility, predicted better response to CBT, but worse response to fluoxetine (p=0.002). CONCLUSION In general, OCD patients with better cognitive and executive abilities at baseline were more prone to respond to either CBT or fluoxetine. Our finding that neuropsychological measures of mental flexibility predicted response to treatment in opposite directions for CBT and fluoxetine suggests that OCD patients with different neuropsychological profiles may respond preferentially to one type of treatment versus the other. Further studies with larger samples of OCD patients are necessary to investigate the heuristic value of such findings in a clinical context.
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Abramovitch A, Mittelman A, Henin A, Geller D. Neuroimaging and neuropsychological findings in pediatric obsessive–compulsive disorder: a review and developmental considerations. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/npy.12.40] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Jaafari N, Rachid F, Rotge JY, Polosan M, El-Hage W, Belin D, Vibert N, Pelissolo A. Safety and efficacy of repetitive transcranial magnetic stimulation in the treatment of obsessive-compulsive disorder: a review. World J Biol Psychiatry 2012; 13:164-77. [PMID: 21623668 DOI: 10.3109/15622975.2011.575177] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Obsessive-compulsive disorder (OCD) is a chronic, often severe, neuropsychiatric disorder leading to a dramatic impairment in interpersonal and occupational functions. rTMS has been tried out in several studies in patients with OCD with different characteristics. In this paper, we review the safety and efficacy of rTMS in the treatment of mostly severe resistant OCD. METHODS A review of the English literature from 1966 to 2010 pertaining to rTMS in the treatment of OCD was conducted using MEDLINE by selectively entering the search terms "transcranial magnetic stimulation", "repetitive transcranial magnetic stimulation", "obsessive-compulsive disorder" and "OCD". Twelve studies including open and randomized, sham-controlled trials were included in this review. RESULTS Although available data about the use of rTMS in OCD treatment are quite heterogeneous in terms of sample size, study design, stimulus parameters used and stimulation areas targeted, promising findings regarding rTMS efficacy appeared for two structures based on recent controlled studies: the supplementary motor area and the orbitofrontal cortex. On the other hand, rTMS of the dorsolateral prefrontal cortex is not significantly effective when compared to sham rTMS. CONCLUSIONS Three target areas have already been selected of which the supplementary motor area in particular and the orbitofrontal cortex seem to be the most promising in terms of potential efficacy and could more accurately be targeted with the help of neuronavigational techniques. Larger randomized controlled trials should be conducted in order to better clarify the therapeutic role of rTMS in OCD.
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Affiliation(s)
- Nematollah Jaafari
- Unité de recherche clinique intersectorielle en psychiatrie, Centre Hospitalier Henri Laborit , INSERM CIC-P 0802, CHU et faculté de médecine de Poitiers, Poitiers, France.
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Abstract
Over the last few years, neuroimaging techniques have contributed greatly to the identification of the structural and functional neuroanatomy of anxiety disorders. The amygdala seems to be a crucial structure for fear and anxiety, and has consistently been found to be activated in anxiety-provoking situations. Apart from the amygdala, the insula and anterior cinguiate cortex seem to be critical, and all three have been referred to as the “fear network.” In the present article, we review the main findings from three major lines of research. First, we examine human models of anxiety disorders, including fear conditioning studies and investigations of experimentally induced panic attacks. Then we turn to research in patients with anxiety disorders and take a dose look at post-traumatic stress disorder and obsessive-compulsive disorder. Finally, we review neuroimaging studies investigating neural correlates of successful treatment of anxiety, focusing on exposure-based therapy and several pharmacological treatment options, as well as combinations of both.
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Affiliation(s)
- Kathrin Holzschneider
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Psychiatry Neuroimaging Branch, Hamburg, Germany
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Vandborg SK, Hartmann TB, Bennedsen BE, Pedersen AD, Eskildsen A, Videbech PBH, Thomsen PH. Do cognitive functions in obsessive-compulsive disorder change after treatment? A systematic review and a double case report. Nord J Psychiatry 2012; 66:60-7. [PMID: 22050379 DOI: 10.3109/08039488.2011.626869] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Neuropsychological and neuroimaging studies have documented that patients with obsessive-compulsive disorder (OCD) have cognitive difficulties dependent upon fronto-striatal circuits in the brain. It is, however, unclear whether the cognitive difficulties change after treatment. Answering this question could help establish whether cognitive difficulties in OCD are state dependent or more trait-like. AIM To determine whether cognitive functions in OCD change after treatment, based on a systematic literature review, supplemented by a double case report of monozygotic twins with OCD. METHODS For the literature review, systematic searches were conducted in PubMed, Embase and PsycINFO from the earliest dates available to September 2010. For the double case report, monozygotic twins underwent blood samples and magnetic resonance imaging before treatment with cognitive behavioral therapy (CBT), antidepressants and small doses of antipsychotic medication. Before and after CBT they were assessed with measures of content and severity of OCD symptoms, and with a comprehensive battery of neuropsychological tests to assess cognitive functions. RESULTS Results from the studies under review (n = 14) were so inconsistent that it could not be concluded whether cognitive functions in OCD change after treatment. The twins improved some of their cognitive functions after treatment. CONCLUSIONS A better understanding of whether cognitive dysfunctions in OCD are state dependent or trait-like could bring important implications in understanding the pathology and future treatment of OCD.
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Affiliation(s)
- Sanne Kjær Vandborg
- Clinic for OCD, Aarhus University Hospital Risskov, Tretommervej 1, 8240 Risskov, Denmark.
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Del Casale A, Kotzalidis GD, Rapinesi C, Serata D, Ambrosi E, Simonetti A, Pompili M, Ferracuti S, Tatarelli R, Girardi P. Functional neuroimaging in obsessive-compulsive disorder. Neuropsychobiology 2011; 64:61-85. [PMID: 21701225 DOI: 10.1159/000325223] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 01/23/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIM Obsessive-compulsive disorder (OCD) is a severe, highly prevalent and chronically disabling psychiatric disorder that usually emerges during childhood or adolescence. This paper aims to review the literature on functional neuroimaging in OCD, analysing the reported dysfunctional connectivity in the corticostriatothalamocortical circuitry. METHOD This study included papers published in peer-reviewed journals dealing with functional imaging in OCD. RESULTS Striatal dysfunction, mainly of the caudate nucleus, leads to inefficient thalamic gating, resulting in hyperactivity within the orbitofrontal cortex (intrusive thoughts) and the anterior cingulate cortex (non-specific anxiety). Compulsions consist of ritualistic behaviours performed to recruit the inefficient striatum and neutralise unwanted thoughts and anxiety. Functional neuroimaging findings are discussed against the background of specific cognitive impairments, mainly regarding visuospatial processing, executive functioning and motor speed. Cognitive deficits are partial and specific, matching imaging data. CONCLUSIONS Several studies have targeted brain regions hypothesised to be involved in the pathogenesis of OCD, showing the existence of dysfunctional connectivity in the corticostriatothalamocortical circuitry. Improvements in spatial resolution of neuroimaging techniques may contribute to a better understanding of the neurocircuitry of OCD and other anxiety disorders.
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Affiliation(s)
- A Del Casale
- NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University and Sant'Andrea Hospital, Rome, Italy.
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Chiu CH, Lo YC, Tang HS, Liu IC, Chiang WY, Yeh FC, Jaw FS, Tseng WYI. White matter abnormalities of fronto-striato-thalamic circuitry in obsessive-compulsive disorder: A study using diffusion spectrum imaging tractography. Psychiatry Res 2011; 192:176-82. [PMID: 21546223 DOI: 10.1016/j.pscychresns.2010.09.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 09/21/2010] [Accepted: 09/22/2010] [Indexed: 11/28/2022]
Abstract
Previous studies have reported white matter abnormalities in patients with obsessive-compulsive disorder (OCD). This study aimed to further explore white matter abnormalities in OCD patients through diffusion spectrum imaging (DSI) and tractography of the two white matter tracts which most probably play an important role in OCD neuropathology: the anterior segment of cingulum bundles (ACB) and the anterior thalamic radiations (ATR). Twelve right-handed, medicated adult patients with OCD and 12 matched controls underwent DSI on a 3 tesla magnetic resonance imaging (MRI) system. Tractography based on DSI data was reconstructed to define the ACB and ATR. Mean generalized fractional anisotropy (GFA) was calculated for each targeted tract and was used to analyze local changes in microstructural integrity along individual tracts. There was a significantly lower mean GFA in both the right ATR and left ACB in OCD subjects compared to controls. OCD subjects also demonstrated decreased left-lateralized asymmetry of the ACB when compared to controls. Furthermore, the mean GFA of the left ACB positively correlated with OCD subjects' obsessive subscores on the Yale-Brown Obsessive-Compulsive scale. This study supports the white matter abnormalities in the ACB and ATR of OCD subjects, which corroborates neurobiological models that posit a defect in fronto-striato-thalamic circuitry in OCD.
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Affiliation(s)
- Chen-Huan Chiu
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
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Moers-Hornikx VMP, Vles JSH, Lim LW, Ayyildiz M, Kaplan S, Gavilanes AWD, Hoogland G, Steinbusch HWM, Temel Y. Periaqueductal grey stimulation induced panic-like behaviour is accompanied by deactivation of the deep cerebellar nuclei. THE CEREBELLUM 2011; 10:61-9. [PMID: 21076996 PMCID: PMC3038216 DOI: 10.1007/s12311-010-0228-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Until recently, the cerebellum was primarily considered to be a structure involved in motor behaviour. New anatomical and clinical evidence has shown that the cerebellum is also involved in higher cognitive functions and non-motor behavioural changes. Functional imaging in patients with anxiety disorders and in cholecystokinin tetrapeptide-induced panic-attacks shows activation changes in the cerebellum. Deep brain stimulation of the dorsolateral periaqueductal grey (dlPAG) and the ventromedial hypothalamus (VMH) in rats has been shown to induce escape behaviour, which mimics a panic attack in humans. We used this animal model to study the neuronal activation in the deep cerebellar nuclei (DCbN) using c-Fos immunohistochemistry. c-Fos expression in the DCbN decreased significantly after inducing escape behaviour by stimulation of the dlPAG and the VMH, indicating that the DCbN were deactivated. This study demonstrates that the DCbN are directly or indirectly involved in panic attacks. We suggest that the cerebellum plays a role in the selection of relevant information, and that deactivation of the cerebellar nuclei is required to allow inappropriate behaviour to occur, such as panic attacks.
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Han JY, Kang DH, Gu BM, Jung WH, Choi JS, Choi CH, Jang JH, Kwon JS. Altered brain activation in ventral frontal-striatal regions following a 16-week pharmacotherapy in unmedicated obsessive-compulsive disorder. J Korean Med Sci 2011; 26:665-74. [PMID: 21532859 PMCID: PMC3082120 DOI: 10.3346/jkms.2011.26.5.665] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 03/15/2011] [Indexed: 11/20/2022] Open
Abstract
Recent studies have reported that cognitive inflexibility associated with impairments in a frontal-striatal circuit and parietal region is a core cognitive deficit of obsessive-compulsive disorder (OCD). However, few studies have examined progressive changes in these regions following clinical improvement in obsessive-compulsive symptoms. To determine if treatment changes the aberrant activation pattern associated with task switching in OCD, we examined the activation patterns in brain areas after treatment. The study was conducted on 10 unmedicated OCD patients and 20 matched controls using event-related functional magnetic resonance imaging. Treatment improved the clinical symptoms measured by the Yale-Brown Obsessive Compulsive Scale and behavioral flexibility indicated by the switching cost. At baseline, OCD showed significantly less activation in the dorsal and ventral frontal-striatal circuit and parietal regions under the task-switch minus task-repeat condition compared with controls. After treatment, the neural responses in the ventral frontal-striatal circuit in OCD were partially normalized, whereas the activation deficit in dorsal frontoparietal regions that mediate shifting attention or behavioral flexibility persisted. It is suggested that altered brain activation in ventral frontal-striatal regions in OCD patients is associated with their cognitive flexibility and changes in these regions may underlie the pathophysiology of OCD.
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Affiliation(s)
- Ji Yeon Han
- Interdisciplinary Program in Neuroscience, Seoul National University, Seoul, Korea
- Clinical Cognitive Neuroscience Center, Neuroscience Institute, SNU-MRC, Seoul, Korea
| | - Do-Hyung Kang
- Department of Psychiatry, Seoul National University College of Medicine & Hospital, Seoul, Korea
| | - Bon-Mi Gu
- Clinical Cognitive Neuroscience Center, Neuroscience Institute, SNU-MRC, Seoul, Korea
| | - Wi Hoon Jung
- Interdisciplinary Program in Neuroscience, Seoul National University, Seoul, Korea
- Clinical Cognitive Neuroscience Center, Neuroscience Institute, SNU-MRC, Seoul, Korea
| | - Jung-Seok Choi
- Department of Psychiatry, Seoul National University College of Medicine & Hospital, Seoul, Korea
| | - Chi-Hoon Choi
- Department of Radiology, National Medical Center, Seoul, Korea
| | - Joon Hwan Jang
- Clinical Cognitive Neuroscience Center, Neuroscience Institute, SNU-MRC, Seoul, Korea
- Department of Psychiatry, Seoul National University College of Medicine & Hospital, Seoul, Korea
| | - Jun Soo Kwon
- Interdisciplinary Program in Neuroscience, Seoul National University, Seoul, Korea
- Clinical Cognitive Neuroscience Center, Neuroscience Institute, SNU-MRC, Seoul, Korea
- Department of Psychiatry, Seoul National University College of Medicine & Hospital, Seoul, Korea
- Brain and Cognitive Science-WCU Program, Seoul National University College of Natural Science, Seoul, Korea
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Apostolova I, Block S, Buchert R, Osen B, Conradi M, Tabrizian S, Gensichen S, Schröder-Hartwig K, Fricke S, Rufer M, Weiss A, Hand I, Clausen M, Obrocki J. Effects of behavioral therapy or pharmacotherapy on brain glucose metabolism in subjects with obsessive-compulsive disorder as assessed by brain FDG PET. Psychiatry Res 2010; 184:105-16. [PMID: 20947317 DOI: 10.1016/j.pscychresns.2010.08.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 08/22/2010] [Accepted: 08/24/2010] [Indexed: 10/18/2022]
Abstract
This prospective study investigated the effect of pharmacotherapy (PT) and cognitive behavioral therapy (CBT) on cerebral glucose metabolism in adults with obsessive-compulsive disorder (OCD). Dynamic positron emission tomography (PET) of the brain with F-18-fluorodeoxyglucose (FDG) was performed before and after treatment in 16 subjects diagnosed for OCD for at least 2 years (PT: n=7). Pre-to-post-treatment change of scaled local metabolic rate of glucose (SLMRGlc) was assessed separately in therapy responders and non-responders. Correlation was tested between SLMRGlc change and change of OCD, depression, or anxiety symptoms. SLMRGlc increased in the right caudate after successful therapy. The increase tended to correlate with the improvement of OCD symptom severity. The finding of increased local caudate activity after successful therapy is in contrast to most previous studies. Possible explanations include effects of therapy on concomitant depression symptoms and/or the large proportion of early-onset OCD in the present sample.
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Affiliation(s)
- Ivayla Apostolova
- Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Wobrock T, Gruber O, McIntosh AM, Kraft S, Klinghardt A, Scherk H, Reith W, Schneider-Axmann T, Lawrie SM, Falkai P, Moorhead TW. Reduced prefrontal gyrification in obsessive-compulsive disorder. Eur Arch Psychiatry Clin Neurosci 2010; 260:455-64. [PMID: 20112027 PMCID: PMC2940041 DOI: 10.1007/s00406-009-0096-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 12/23/2009] [Indexed: 12/01/2022]
Abstract
Structural magnetic resonance imaging (MRI) studies reveal evidence for brain abnormalities in obsessive-compulsive disorder (OCD), for instance, reduction of gray matter volume in the prefrontal cortex. Disturbances of gyrification in the prefrontal cortex have been described several times in schizophrenia pointing to a neurodevelopmental etiology, while gyrification has not been studied so far in OCD patients. In 26 OCD patients and 38 healthy control subjects MR-imaging was performed. Prefrontal cortical folding (gyrification) was measured bilaterally by an automated version of the automated-gyrification index (A-GI), a ratio reflecting the extent of folding, from the slice containing the inner genu of the corpus callosum up to the frontal pole. Analysis of covariance (ANCOVA, independent factor diagnosis, covariates age, duration of education) demonstrated that compared with control subjects, patients with OCD displayed a significantly reduced A-GI in the left hemisphere (p = 0.021) and a trend for a decreased A-GI in the right hemisphere (p = 0.076). Significant correlations between prefrontal lobe volume and A-GI were only observed in controls, but not in OCD patients. In conclusion, prefrontal hypogyrification in OCD patients may be a structural correlate of the impairment in executive function of this patient group and may point to a neurodevelopmental origin of this disease.
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Affiliation(s)
- Thomas Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University, Von-Siebold-Str. 5, 37075, Göttingen, Germany.
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Sanematsu H, Nakao T, Yoshiura T, Nabeyama M, Togao O, Tomita M, Masuda Y, Nakatani E, Nakagawa A, Kanba S. Predictors of treatment response to fluvoxamine in obsessive-compulsive disorder: an fMRI study. J Psychiatr Res 2010; 44:193-200. [PMID: 19758599 DOI: 10.1016/j.jpsychires.2009.08.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 06/22/2009] [Accepted: 08/17/2009] [Indexed: 10/20/2022]
Abstract
Recent neuroimaging studies suggest that the pathophysiology of obsessive-compulsive disorder (OCD) may involve more widely distributed large-scale brain systems, including the parietal, occipital, and cerebellar areas, rather than the conventional orbitofronto-striatal model. We hypothesized that not only orbitofrontal cortex and caudate nucleus activities but also posterior brain regions might be associated with subsequent treatment response to serotonin reuptake inhibitors in OCD. The participants were 17 patients with OCD. Each patient was required to undergo fluvoxamine pharmacotherapy for 12 weeks. Before treatment, fMRI images of the subjects were obtained in the context of a symptom-provocation paradigm. The percentage changes in total Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores, from pre- to post-treatment, served as the index of treatment response. Statistical Parametric Mapping was used to identify brain loci where pre-treatment brain activation significantly correlated with the subsequent treatment response. Fifteen of 17 patients completed the 12-week treatment. During the symptom provocation task, patients showed brain activation in the left superior temporal gyrus (STG), left precuneus, left frontal cortices, right cerebellum, and right frontal cortices. We found that pre-treatment activation in the right cerebellum (Z-score=5.10, x,y,z=22,-84,-18) and the left STG (Z-score=4.95, x,y,z=-62,-22,0) was positively correlated with the improvement in the Y-BOCS score. Our results suggest that pre-treatment activation in the right cerebellum and in the left STG predict subsequent reduction in OCD symptom severity. There is every possibility that fMRI can be used as a tool to predict treatment response.
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Affiliation(s)
- Hirokuni Sanematsu
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Gray matter alterations in obsessive-compulsive disorder: an anatomic likelihood estimation meta-analysis. Neuropsychopharmacology 2010; 35:686-91. [PMID: 19890260 PMCID: PMC3055616 DOI: 10.1038/npp.2009.175] [Citation(s) in RCA: 160] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Many voxel-based morphometry (VBM) studies have found abnormalities in gray matter density (GMD) in obsessive-compulsive disorder (OCD). Here, we performed a quantitative meta-analysis of VBM studies contrasting OCD patients with healthy controls (HC). A literature search identified 10 articles that included 343 OCD patients and 318 HC. Anatomic likelihood estimation meta-analyses were performed to assess GMD changes in OCD patients relative to HC. GMD was smaller in parieto-frontal cortical regions, including the supramarginal gyrus, the dorsolateral prefrontal cortex, and the orbitofrontal cortex, and greater in the basal ganglia (putamen) and the anterior prefrontal cortex in OCD patients relative to HC. No significant differences were found between children and adults. Our findings indicate differences in GMD in parieto-frontal areas and the basal ganglia between OCD patients and HC. We conclude that structural abnormalities within the prefrontal-basal ganglia network are involved in OCD pathophysiology.
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