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Bhattacharya M, Kashyap H, Reddy YJ. Cognitive Training in Obsessive-Compulsive Disorder: A Systematic Review. Indian J Psychol Med 2024; 46:110-118. [PMID: 38725718 PMCID: PMC11076946 DOI: 10.1177/02537176231207781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Background Cognitive training (CT) for illness-linked neuropsychological deficits has been attempted in psychiatric disorders and, more recently, in obsessive-compulsive disorder (OCD). However, studies are few and far between, with a limited understanding of factors contributing to efficacy. This article aims to provide a comprehensive critical review of studies employing CT in OCD. Methods This systematic review follows the Preferred Reporting of Items for Systematic Review and Meta-Analyses Protocols. Empirical studies that used any form of CT/remediation in individuals with OCD were included. Results Eight articles met the criteria for inclusion, of which five were randomized controlled trials, two were case series, and one was an open-label trial. The studies have predominantly demonstrated improved trained cognitive functions, with only two showing generalization to untrained domains like clinical symptoms and socio-occupational functioning. Conclusion There are few controlled trials of CT in OCD, which limits conclusions of efficacy. Given the sparse research in the area, the review summarizes the current status of research and examines important methodological considerations that may inform future studies.
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Affiliation(s)
- Mahashweta Bhattacharya
- Dept. of Clinical Psychology, National Institute of Mental health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
- Obsessive-Compulsive Disorder Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
- Accelerator Program for Discovery in Brain Disorders using Stem cells (ADBS), Government of India
| | - Himani Kashyap
- Dept. of Clinical Psychology, National Institute of Mental health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
- Obsessive-Compulsive Disorder Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Y.C. Janardhan Reddy
- Obsessive-Compulsive Disorder Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
- Accelerator Program for Discovery in Brain Disorders using Stem cells (ADBS), Government of India
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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2
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Varinelli A, Caricasole V, Pellegrini L, Hall N, Garg K, Mpavaenda D, Dell'Osso B, Albert U, Fineberg NA. Functional interventions as augmentation strategies for obsessive-compulsive disorder (OCD): scoping review and expert survey from the international college of obsessive-compulsive spectrum disorders (ICOCS). Int J Psychiatry Clin Pract 2022; 26:92-107. [PMID: 33502269 DOI: 10.1080/13651501.2021.1872646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patients with obsessive-compulsive disorder (OCD) commonly exhibit a range of functional difficulties, presumed linked to neurocognitive changes. Evidence-based first-line treatments have limited effect on improving these cognitive-functional problems. Candidate interventions could be used to augment evidence-based treatments by the multi-professional mental health team. METHODS A scoping review was performed to identify any intervention with at least one peer-reviewed report of clinical improvement in any of the 13 functional domains of the Cognitive Assessment Instrument of Obsessions and Compulsions (CAIOC-13). Next, an online survey of experts of the International College of Obsessive-Compulsive Spectrum Disorders was conducted. RESULTS Forty-four studies were identified reporting a positive outcome for 27 different kinds of intervention. Twenty-six experts from 12 different countries, including at least one expert from each continent, completed the opinion survey. Five interventions were identified as 'highly promising', none of which was moderated by rater-related factors, suggesting global applicability. CONCLUSION Patients with OCD may benefit from a detailed functional assessment, to identify areas of unmet need. A variety of interventions show theoretical promise for treating the complex functional difficulties in OCD as adjuncts to first-line treatments, but the published evidence is weak. Randomised controlled trials are needed to determine the clinical effectiveness of these interventions.HighlightsFunctional-cognitive problems are common in patients with OCD.First-line evidence-based treatments have limited effect on these functionalcognitive difficulties.In our scoping review we found 44 studies reporting of improved clinical outcomes in any of the 13 functional domains of the Cognitive Assessment Instrument of Obsessions and Compulsions (CAIOC-13).An online survey of experts of the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) was conducted and identified five interventions as "highly promising" candidate treatments for functional-cognitive problems in OCD.Randomised controlled trials are needed to determine the clinical effectiveness of these interventions.
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Affiliation(s)
- Alberto Varinelli
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco, University of Milan, Milan, Italy
| | - Valentina Caricasole
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco, University of Milan, Milan, Italy
| | - Luca Pellegrini
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Natalie Hall
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Kabir Garg
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK
| | - Davis Mpavaenda
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Bernardo Dell'Osso
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco, University of Milan, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, Stanford, CA, USA.,'Aldo Ravelli' Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, UCO Clinica Psichiatrica, University of Trieste, Trieste, Italy
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- International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) Expert Survey Workgroup: Michael Van Ameringen (Canada), Leonardo Fontenelle (Brazil), Giacomo Grassi (Italy), Jamie Feusner (US), Lior Carmi (Israel), Edna Grunblatt (Switzerland), Susanne Walitza (Switzerland), Christine Lochner (South Africa), Carolyn Rodriguez (US), Alexander Bystritsky (US), Maria Ceica Rosario (US), Peter van Roessel (US), Dan Geller (US), Eric Hollander (US), Humberto Nicolini (Mexico), Joseph Zohar (Israel), José Menchón (Spain)
| | - Naomi A Fineberg
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Ramakrishnan S, Robbins TW, Zmigrod L. Cognitive Rigidity, Habitual Tendencies, and Obsessive-Compulsive Symptoms: Individual Differences and Compensatory Interactions. Front Psychiatry 2022; 13:865896. [PMID: 35573321 PMCID: PMC9094714 DOI: 10.3389/fpsyt.2022.865896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/01/2022] [Indexed: 11/24/2022] Open
Abstract
Recent theories have posited a range of cognitive risk factors for obsessive-compulsive disorder (OCD), including cognitive inflexibility and a maladaptive reliance on habits. However, empirical and methodological inconsistencies have obscured the understanding of whether inflexibility and habitual tendencies indeed shape OCD symptoms in clinical and sub-clinical populations, and whether there are notable interactions amongst these traits. The present investigation adopted an interactionist individual differences approach to examine the associations between behaviorally-assessed cognitive flexibility and subclinical OCD symptomatology in a healthy population. It also explored the nature of the interactions between cognitive flexibility and habitual tendencies, and the degree to which these cognitive traits predict subclinical OCD symptomatology. Across two studies, including a preregistration, Bayesian and regression analyses revealed that cognitive inflexibility and compulsive habitual tendencies act as unique and independent predictors of subclinical OCD symptomatology in healthy populations. Furthermore, there was a significant interaction between cognitive rigidity and habitual compulsivity, which accounted for 49.4% of the variance in subclinical OCD symptomatology in Study 1, and 37.3% in Study 2. In-depth analyses revealed a compensatory effect between cognitive inflexibility and habitual compulsivity such that both are necessary for OCD symptomatology, but neither is sufficient. These results imply that in order to generate reliable and nuanced models of the endophenotype of OCD symptomatology, it is essential to account for interactions between psychological traits. Moreover, the present findings have important implications for theories on the cognitive roots of OCD, and potentially in the development of interventions that target both cognitive inflexibility and habitual compulsivity.
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Affiliation(s)
- Smriti Ramakrishnan
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Trevor W Robbins
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom.,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
| | - Leor Zmigrod
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom.,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
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4
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Manarte L, Andrade AR, do Rosário L, Sampaio D, Figueira ML, Morgado P, Sahakian BJ. Executive functions and insight in OCD: a comparative study. BMC Psychiatry 2021; 21:216. [PMID: 33926404 PMCID: PMC8082868 DOI: 10.1186/s12888-021-03227-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/19/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Around 25 to 30% of patients with obsessive-compulsive disorder (OCD) do not respond to treatment. These patients have the longest duration of disease and the worst prognosis. Following years of research on this topic, insight has emerged as a potential explanation for this therapeutic resistance. Therefore, it has become important to characterize OCD patients with poor insight. Few studies have focused on the neuropsychological and cognitive characteristics of these patients. METHODS To help fill this gap, we divided 57 patients into two groups, one with good insight and the other with poor insight, assessed their neuropsychological functions-through a Rey's figure test, a California verbal learning test, a Toulouse-Piéron test and a Wisconsin Card Sorting Test (WCST)-and compared the results with those of a paired control group. RESULTS The statistical analysis, with a significance level of 95%, revealed differences in the executive function tests, and particularly in the WCST (p ≤ 0.001) and trail-making-test (TMT A/B) (p = 0.002). CONCLUSIONS These differences suggest that the neuropsychological profile of poor-insight patients is different from their good-insight counterparts, emphasize the role played by the executive functions in insight and highlights the need for more accurate neurocognitive research and treatment.
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Affiliation(s)
- Lucas Manarte
- Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal.
| | - António R Andrade
- IDMEC. Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais 1, 1049-001, Lisbon, Portugal
| | - Linete do Rosário
- Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Daniel Sampaio
- Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Maria Luísa Figueira
- Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Pedro Morgado
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, R. da Universidade, 4710-057, Braga, Portugal
| | - Barbara J Sahakian
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
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5
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Fajnerova I, Gregus D, Francova A, Noskova E, Koprivova J, Stopkova P, Hlinka J, Horacek J. Functional Connectivity Changes in Obsessive-Compulsive Disorder Correspond to Interference Control and Obsessions Severity. Front Neurol 2020; 11:568. [PMID: 32973642 PMCID: PMC7468468 DOI: 10.3389/fneur.2020.00568] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 05/19/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction: Deficits in neurocognitive mechanisms such as inhibition control and cognitive flexibility have been suggested to mediate the symptoms in obsessive-compulsive disorder (OCD). These mechanisms are proposedly controlled by the "affective" and "executive" orbitofronto-striato-thalamo-cortical (CSTC) circuits with well-documented morphological and functional alterations in OCD that are associated with OCD symptoms. The precuneus region has been suggested in OCD as another key structure associated with the mechanism of "thought-action fusion." Our study aimed to elucidate the association of the altered functional coupling of the CSTC nodes (and precuneus), the OCD symptoms, and interference control/cognitive flexibility. Methods: In a group of 36 (17 medicated and 19 drug-free) OCD patients and matched healthy volunteers, we tested functional connectivity (FC) within the constituents of the dorsolateral prefrontal cortex "executive" CSTC, the orbitofrontal cortex/anterior cingulate "affective" CSTC, and precuneus. The functional connections showing the strongest effects were subsequently entered as explanatory variables to multiple regression analyses to identify possible associations between observed alterations of functional coupling and cognitive (Stroop test) and clinical measures (obsessions, compulsions, and anxiety level). Results: We observed increased FC (FWE p < 0.05 corr.) between CSTC seeds and regions of the parieto-occipital cortex, and between the precuneus and the angular gyrus and dorsolateral prefrontal cortex. Decreased FC was observed within the CSTC loop (caudate nucleus and thalamus) and between the anterior cingulate cortex and the limbic lobe. Linear regression identified a relationship between the altered functional coupling of thalamus with the right somatomotor parietal cortex and the Stroop color-word score. Similar association of thalamus FC has been identified also for obsessions severity. No association was observed for compulsions and anxiety. Conclusions: Our findings demonstrate altered FC in OCD patients with a prevailing increase in FC originating in CSTC regions toward other cortical areas, and a decrease in FC within the constituents of CSTC loops. Moreover, our results support the role of precuneus in OCD. The association of the cognitive and clinical symptoms with the FC between the thalamus and somatomotor cortex indicates that cognitive flexibility and inhibitory control are strongly linked and both mechanisms might contribute to the symptomatology of OCD.
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Affiliation(s)
- Iveta Fajnerova
- National Institute of Mental Health (NIMH), Klecany, Czechia
| | - David Gregus
- National Institute of Mental Health (NIMH), Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Anna Francova
- National Institute of Mental Health (NIMH), Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Eliska Noskova
- National Institute of Mental Health (NIMH), Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Jana Koprivova
- National Institute of Mental Health (NIMH), Klecany, Czechia
| | - Pavla Stopkova
- National Institute of Mental Health (NIMH), Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Jaroslav Hlinka
- National Institute of Mental Health (NIMH), Klecany, Czechia.,Institute of Computer Science, Czech Academy of Sciences, Prague, Czechia
| | - Jiri Horacek
- National Institute of Mental Health (NIMH), Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
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Kavanaugh BC, Cancilliere MK, Fryc A, Tirrell E, Oliveira J, Oberman LM, Wexler BE, Carpenter LL, Spirito A. Measurement of executive functioning with the National Institute of Health Toolbox and the association to anxiety/depressive symptomatology in childhood/adolescence. Child Neuropsychol 2020; 26:754-769. [PMID: 31876232 PMCID: PMC10629577 DOI: 10.1080/09297049.2019.1708295] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 12/18/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Despite preliminary research, there remain inconsistent findings with regard to the role of executive functioning (EF) deficits in childhood anxiety and depression. This report examined the association of The National Institute of Health (NIH) Toolbox to clinical neuropsychological measures and to childhood, anxiety/depressive symptomatology. Methods: One-hundred eight children and adolescents completed the three EF measures from the NIH Toolbox (List Sorting Working Memory Test [LSWMT], Dimensional Change Card Sorting Test [DCCST], and Flanker Test of Attention and Inhibition [Flanker]) in an outpatient neuropsychology program. These tests were compared to established measures of EF in terms of linear correlations and detection of impairment. Heaton's Global Deficit Score (GDS) was utilized to calculate impairment. The Toolbox-EF measures were paired with parent-reported EF symptoms (Behavior Rating Inventory of Executive Function [BRIEF2]) to identify the role of EF in childhood anxiety/depressive symptomatology. RESULTS Toolbox-EF measures displayed medium sized correlations with their clinically comparable counterparts, and generally did not differ in their detection of impairment. Toolbox-GDS was associated with depression diagnosis and clinically significant child-reported anxiety and depressive symptoms. Together, Toolbox/BRIEF2 accounted for 26.8-30.9% of elevated depressive symptom variance, but only 13.2-14% of elevated anxiety symptom variance. Further, EF impairment was associated with depression across self report, parent report, and clinical diagnosis. DISCUSSION The NIH Toolbox-EF measures display comparable psychometric properties to clinically available EF measures in a pediatric (primarily psychiatric) neuropsychology setting. The Toolbox appears to display an appropriate ability to detect EF deficits secondary to self-reported depression in childhood.
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Affiliation(s)
- Brian C. Kavanaugh
- Department of Psychiatry & Human Behavior, Emma Pendleton Bradley Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Alexa Fryc
- Department of Psychology, University of Rhode Island, South Kingstown, RI, USA
| | - Eric Tirrell
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychiatry & Human Behavior, Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Providence, RI, USA
| | - Jane Oliveira
- Department of Psychiatry & Human Behavior, Emma Pendleton Bradley Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Lindsay M. Oberman
- Center for Neuroscience and Regenerative Medicine, Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA
| | - Bruce E. Wexler
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Linda L. Carpenter
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychiatry & Human Behavior, Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Providence, RI, USA
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Neural Correlates of Strategy Switching in the Macaque Orbital Prefrontal Cortex. J Neurosci 2020; 40:3025-3034. [PMID: 32098903 DOI: 10.1523/jneurosci.1969-19.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/29/2020] [Accepted: 01/31/2020] [Indexed: 11/21/2022] Open
Abstract
We can adapt flexibly to environment changes and search for the most appropriate rule to a context. The orbital prefrontal cortex (PFo) has been associated with decision making, rule generation and maintenance, and more generally has been considered important for behavioral flexibility. To better understand the neural mechanisms underlying the flexible behavior, we studied the ability to generate a switching signal in monkey PFo when a strategy is changed. In the strategy task, we used a visual cue to instruct two male rhesus monkeys either to repeat their most recent choice (i.e., stay strategy) or to change it (i.e., shift strategy). To identify the strategy switching-related signal, we compared nonswitch and switch trials, which cued the same or a different strategy from the previous trial, respectively. We found that the switching-related signal emerged during the cue presentation and it was combined with the strategy signal in a subpopulation of cells. Moreover, the error analysis showed that the activity of the switch-related cells reflected whether the monkeys erroneously switched or not the strategy, rather than what was required for that trial. The function of the switching signal could be to prompt the use of different strategies when older strategies are no longer appropriate, conferring the ability to adapt flexibly to environmental changes. In our task, the switching signal might contribute to the implementation of the strategy cued, overcoming potential interference effects from the strategy previously cued. Our results support the idea that ascribes to PFo an important role for behavioral flexibility.SIGNIFICANCE STATEMENT We can flexibly adapt our behavior to a changing environment. One of the prefrontal areas traditionally associated with the ability to adapt to new contingencies is the orbital prefrontal cortex (PFo). We analyzed the switching related activity using a strategy task in which two rhesus monkeys were instructed by a visual cue either to repeat or change their most recent choice, respectively using a stay or a shift strategy. We found that PFo neurons were modulated by the strategy switching signal, pointing to the importance of PFo in behavioral flexibility by generating control over the switching of strategies.
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8
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Sen B, Bernstein GA, Mueller BA, Cullen KR, Parhi KK. Sub-graph entropy based network approaches for classifying adolescent obsessive-compulsive disorder from resting-state functional MRI. NEUROIMAGE-CLINICAL 2020; 26:102208. [PMID: 32065968 PMCID: PMC7025090 DOI: 10.1016/j.nicl.2020.102208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/17/2020] [Accepted: 02/04/2020] [Indexed: 11/16/2022]
Abstract
The proposed classification scheme improves the best-known adolescent OCD vs. healthy controls classification accuracy from 78% to 89%. This paper validates the efficacy of sub-graph entropy for classifying OCD vs. healthy groups. The proposed technique identifies a predictive sub-network that partially consists of regions from well-known cortico-striato-thalamic-cortical (CSTC) network. For both predictive sub-network and CSTC sub-network, sub-graph entropy is significantly lower in OCD patients compared with healthy controls. Sub-graph entropy using 1-hop neighborhood is effective in the classification task. Sub-graph entropy using 2-hop neighborhood has a lower classification accuracy.
This paper presents a novel approach for classifying obsessive-compulsive disorder (OCD) in adolescents from resting-state fMRI data. Currently, the state-of-the-art for diagnosing OCD in youth involves interviews with adolescent patients and their parents by an experienced clinician, symptom rating scales based on Diagnostic and Statistical Manual of Mental Disorders (DSM), and behavioral observation. Discovering signal processing and network-based biomarkers from functional magnetic resonance imaging (fMRI) scans of patients has the potential to assist clinicians in their diagnostic assessments of adolescents suffering from OCD. This paper investigates the clinical diagnostic utility of a set of univariate, bivariate and multivariate features extracted from resting-state fMRI using an information-theoretic approach in 15 adolescents with OCD and 13 matched healthy controls. Results indicate that an information-theoretic approach based on sub-graph entropy is capable of classifying OCD vs. healthy subjects with high accuracy. Mean time-series were extracted from 85 brain regions and were used to calculate Shannon wavelet entropy, Pearson correlation matrix, network features and sub-graph entropy. In addition, two special cases of sub-graph entropy, namely node and edge entropy, were investigated to identify important brain regions and edges from OCD patients. A leave-one-out cross-validation method was used for the final predictor performance. The proposed methodology using differential sub-graph (edge) entropy achieved an accuracy of 0.89 with specificity 1 and sensitivity 0.80 using leave-one-out cross-validation with in-fold feature ranking and selection. The high classification accuracy indicates the predictive power of the sub-network as well as edge entropy metric.
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Affiliation(s)
- Bhaskar Sen
- Department of Electrical and Computer Engineering, University of Minnesota, Minneapolis
| | - Gail A Bernstein
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis
| | - Bryon A Mueller
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis
| | - Kathryn R Cullen
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis
| | - Keshab K Parhi
- Department of Electrical and Computer Engineering, University of Minnesota, Minneapolis.
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9
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Abstract
Obsessive-compulsive disorder (OCD) is a debilitating mental illness characterized by an early onset and chronic course. Evidence from several lines of research suggests significant neuropsychological deficits in patients with OCD; executive dysfunction and nonverbal memory deficits have been reported consistently in OCD. These deficits persist despite controlling potential confounders such as comorbidity, severity of illness, and medications. Neuropsychological impairments are independent of illness severity, thus suggesting that the neuropsychological deficits are trait markers of the disease. In addition, these deficits are seen in first-degree relatives of individuals with OCD. These reports suggest that neuropsychological deficits are potential endophenotype markers in OCD. Neuropsychological studies in pediatric OCD are limited; they show impairments of small effect size across multiple domains but with doubtful clinical significance. Preliminary evidence shows that different symptom dimensions of OCD may have unique neuropsychological deficits suggestive of discrete but overlapping neuroanatomical regions for individual symptom dimensions. Overall, neuropsychological deficits further support the role of frontostriatal circuits in the neurobiology of OCD. In addition, emerging literature also suggests the important role of other areas, in particular parietal cortex. Preliminary evidence suggests the possible role of neuropsychological deficits to be markers of treatment response but needs to be examined in future. Longitudinal studies with examination of patients at different time points and examination of their potential utility as predictors of treatment response are needed in future.
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Affiliation(s)
- Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Naren P Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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10
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Kurt E, Yildirim E, Topçuoğlu V. Executive Functions of Obsessive Compulsive Disorder and Panic Disorder Patients in Comparison to Healty Controls. ACTA ACUST UNITED AC 2017; 54:312-317. [PMID: 29321703 DOI: 10.5152/npa.2016.14872] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction Patients with obsessive compulsive disorder (OCD) have impaired cognitive functions, including attention, verbal and visual memory, and visual-spatial abilities as well as executive function But some studies did not show any disturbance in executive function of patients with OCD. To date, only few studies have been conducted on neuropsychological functioning of patients with panic disorder (PD). There are limited studies to reach a definite conclusion on executive functions of patients with OCD and those with PD. In this study, we aimed to measure executive functions of patients with OCD and those with PD compared with those of healthy controls. Although there are many studies on cognitive functions of patients with OCD, there appears to be no consistency in results and no findings have been obtained to enable us to reach definite conclusions. Although there are very few studies on neuropsychological functions of patients with PD, impairments on a set of cognitive functions have been demonstrated. To date, no finding with respect to impairment in executive functions of patients with PD has been published. PD and OCD are disorders manifesting similar characteristics, with the presence of anxiety and avoidance behavior. Besides this, patients with OCD also have symptoms such as obsessions and compulsions that are characteristics of this disorder. We aim to compare executive functions in the three groups (patients with OCD, those with PD, and healthy controls) in this study. Method Seventeen patients with OCD and 15 patients with PD who were diagnosed according to Diagnostic and Statistical Manual of Mental Disorder -IV-TR (DSM-IV-TR) and 26 healthy control subjects were included in this study. Patients who used medication as well as those with medical illnesses and Axis-I comorbidities were excluded. The healthy control group subjects were matched with the patients in terms of age, gender, and education. Structured Clinical Interview for DSM-IV Axis-I Disorders-Clinical Version (SCID-I), Hamilton Depression Rating Scale (HDRS), and Yale-Brown obsessive compulsive scale tests (Y-BOCS) were administered to the patients. Trail Making Tests (TMT), verbal fluency tests (Controlled Oral Word Association Test and Categorical Naming), Stroop Test, and Wisconsin Card Sorting Test (WCST) were administered to the study groups. Results According to our results, there was no statistically significant difference between the three study groups with respect to executive functions. There was also no significant correlation between executive tests' results and Y-BOCS'in the OCD group. Conclusion The results of the PD group are in line with that reported in literature. The results of the OCD group can be explained by a lack of medication usage and any comorbidity including depression. A small sample size is the major limitation of our study.
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Affiliation(s)
- Emel Kurt
- Department of Psychiatry, Medicana International Hospital, İstanbul, Turkey
| | - Erol Yildirim
- Department of Psychology, Medipol University, School of Humanities and Social Sciences, İstanbul, Turkey
| | - Volkan Topçuoğlu
- Clinic of Psychiatry, Marmara University School of Medicine Training and Research Hospital, İstanbul, Turkey
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11
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Jiujias M, Kelley E, Hall L. Restricted, Repetitive Behaviors in Autism Spectrum Disorder and Obsessive-Compulsive Disorder: A Comparative Review. Child Psychiatry Hum Dev 2017; 48:944-959. [PMID: 28281020 DOI: 10.1007/s10578-017-0717-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This review paper critically examines literature regarding restricted and repetitive behaviors (RRBs) in Autism Spectrum Disorder (ASD) and Obsessive-Compulsive Disorder (OCD). The similar behavioral profiles of these disorders presents the potential for confusion regarding diagnoses and intervention efforts. As such, this review highlights the similarities and differences between RRBs in ASD and OCD. The developmental trajectories of RRBs are presented, followed by an exploration of three constructs implicated in RRB manifestation: anxiety, executive functioning, and sensory phenomena. While RRBs tend to develop with some similarity in both disorders, the differing role of anxiety highlights important distinctions between ASD and OCD. We urge researchers and clinicians to think critically about the dimensions that affect RRB presentation. Future research should use this review as a starting point to further elucidate the differences between RRBs in these two populations.
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Affiliation(s)
- Marina Jiujias
- Psychology Department, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Elizabeth Kelley
- Psychology Department, Queen's University, Kingston, ON, K7L 3N6, Canada. .,Queen's University, Humphrey Hall Room 351, 62 Arch Street, Kingston, ON, K7L 3N6, Canada.
| | - Layla Hall
- Psychology Department, Queen's University, Kingston, ON, K7L 3N6, Canada
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12
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Rus OG, Reess TJ, Wagner G, Zaudig M, Zimmer C, Koch K. Structural alterations in patients with obsessive-compulsive disorder: a surface-based analysis of cortical volume, surface area and thickness. J Psychiatry Neurosci 2017; 42:395-403. [PMID: 28832321 PMCID: PMC5662461 DOI: 10.1503/jpn.170030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mounting evidence indicates the presence of structural brain alterations in individuals with obsessive-compulsive disorder (OCD). Findings are, however, rather heterogeneous, which may be partly because of differences in methodological approaches or clinical sample characteristics. The aim of the present study was to analyze the whole brain cortical volume, surface area and thickness in a large sample of patients with OCD compared with age- and sex-matched healthy controls. METHODS We conducted whole brain surface-based analyses of grey matter measures using the automated FreeSurfer software in patients with OCD and matched controls. Group analyses were performed and corrected for multiple testing using Monte Carlo simulations (p < 0.05). Altered brain regions and their average morphological values were associated to symptom severity and type (Yale-Brown Obsessive Compulsive Scale scores). RESULTS We included 75 patients and 75 controls in our analyses. Patients with OCD showed decreases in both volume and surface area compared with healthy controls in inferior-superior parieto-occipital regions. In addition, the precuneus, posterior cingulate areas, middle frontal and orbitofrontal areas, and middle inferior temporal areas extending to the fusiform gyrus were characterized by a reduced surface area only. There were no differences in grey matter thickness between the groups. LIMITATIONS The presence of comorbidities, medication usage and the multisymptomatic feature of OCD could have influenced our results to a certain degree. CONCLUSION Our results suggest decreased grey matter volume and surface area in several key regions in patients with OCD. Parietal regions showed reductions in both volume and surface area, which underlines the potential relevance of these regions for the pathophysiology of the disorder.
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Affiliation(s)
- Oana Georgiana Rus
- Correspondence to: G. Rus, Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675 Munich, Germany;
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13
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Sahoo P, Sethy RR, Ram D. Functional Impairment and Quality of Life in Patients with Obsessive Compulsive Disorder. Indian J Psychol Med 2017; 39:760-765. [PMID: 29284808 PMCID: PMC5733425 DOI: 10.4103/ijpsym.ijpsym_53_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND This study was carried out to enumerate the level of difference in functional impairment and quality of life (QOL) in obsessive-compulsive disorder (OCD) patients and normal control group to find out the relationship among ICD functional impairment and QOL. METHODOLOGY Thirty patients diagnosed with OCD as per International Classification of Diseases Diagnostic Criteria for Research-10 were taken for study. The control group consists of 30 normal participants from the community. Functional impairment and QOL questionnaires were administered on both groups to measure functional impairment and QOL in OCD. RESULTS The mean age of onset of OCD was (23.8 ± 7.25), mean duration of illness was (6.3 ± 4.47), and mean duration of treatment was (2.56 ± 2.47). It was also observed that total score as well as all the domains of the World Health Organization QOL-BREF, OCD patients scored significantly less (P < 0.001) compared to normal controls. Dysfunctional Analysis Questionnaire (DAQ)-Social area and DAQ-Personal area had statistically significant positive correlation (P < 0.05) with an obsessive subscale of Yale-Brown Obsessive Compulsive Scale (Y-BOCS) whereas DAQ-social area (P < 0.05), DAQ-Personal Area (P < 0.05) had statistically significant positive correlation with a total score of Y-BOCS. CONCLUSION The presence of functional impairment leads to poor QOL in the persons with OCD.
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Affiliation(s)
- Puspita Sahoo
- Department of Psychiatry, IMS and Sum Hospital, Bhubaneswar, Odisha, India
| | - Rati Ranjan Sethy
- Department of Psychiatry, IMS and Sum Hospital, Bhubaneswar, Odisha, India
| | - Daya Ram
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
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14
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Saremi AA, Shariat SV, Nazari MA, Dolatshahi B. Neuropsychological Functioning in Obsessive-Compulsive Washers: Drug-Naive Without Depressive Symptoms. Basic Clin Neurosci 2017; 8:233-248. [PMID: 28781731 PMCID: PMC5535329 DOI: 10.18869/nirp.bcn.8.3.233] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 11/25/2016] [Accepted: 12/19/2016] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Obsessive-Compulsive Disorder (OCD) is a complex and heterogeneous neuropsychiatric syndrome. Contamination obsessions and washing/cleaning compulsions are the most frequent clinical OCD subtypes. The current study aimed at examining the neuropsychological impairments in drug-naive obsessive-compulsive (OC) washers without depressive symptoms and their association with the severity of symptoms. METHODS In the current causal-comparative study, 35 patients with diagnostic and statistical mental disorders class (DSM)-IV diagnosed with washing-subtype OCD and 35 healthy subjects were selected by the convenience sampling method and evaluated by computerized neuropsychology battery and clinical tests as Stroop Color-Word Test (SCWT), Wisconsin Card Sorting Test (WCST), Go/No-Go Test, Digits Forward (DF), Digits Backward (DB), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and General Health Questionnaire (GHQ)-28. The patients were matched to the comparison group with regard to age, gender, intelligence quotient (IQ), education, and handedness. All the tests were standardized in Iran. SPSS version 20.00 was used for descriptive and analytical data analysis. RESULTS There was no statistically significant different between the OCD washing and the control groups regarding socio-demographic variables or IQ. There were significant differences between the OC washer and the healthy control groups on the neuropsychological functioning. The obtained results suggested that OC washers performed significantly worse on neuropsychological measures than the controls. There was no significant association between the severity of OC symptoms and the neuropsychological functions in the OCD washing group. CONCLUSION It was concluded that executive function impairment, which is a core feature in OC washers was trait-like in nature.
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Affiliation(s)
- Ali Akbar Saremi
- Department of Cognitive Neuroscience, Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | - Seyed Vahid Shariat
- Mental Health Research Center, Tehran Institute of Psychiatry, School of Behavioural Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Nazari
- Department of Psychology, Faculty of Education & Psychology, University of Tabriz, Tabriz, Iran
| | - Behrooz Dolatshahi
- Department of Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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15
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Modulation of motor inhibition by subthalamic stimulation in obsessive-compulsive disorder. Transl Psychiatry 2016; 6:e922. [PMID: 27754484 PMCID: PMC5315551 DOI: 10.1038/tp.2016.192] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/22/2016] [Accepted: 08/17/2016] [Indexed: 01/07/2023] Open
Abstract
High-frequency deep brain stimulation of the subthalamic nucleus can be used to treat severe obsessive-compulsive disorders that are refractory to conventional treatments. The mechanisms of action of this approach possibly rely on the modulation of associative-limbic subcortical-cortical loops, but remain to be fully elucidated. Here in 12 patients, we report the effects of high-frequency stimulation of the subthalamic nucleus on behavior, and on electroencephalographic responses and inferred effective connectivity during motor inhibition processes involved in the stop signal task. First, we found that patients were faster to respond and had slower motor inhibition processes when stimulated. Second, the subthalamic stimulation modulated the amplitude and delayed inhibition-related electroencephalographic responses. The power of reconstructed cortical current densities decreased in the stimulation condition in a parietal-frontal network including cortical regions of the inhibition network such as the superior parts of the inferior frontal gyri and the dorsolateral prefrontal cortex. Finally, dynamic causal modeling revealed that the subthalamic stimulation was more likely to modulate efferent connections from the basal ganglia, modeled as a hidden source, to the cortex. The connection from the basal ganglia to the right inferior frontal gyrus was significantly decreased by subthalamic stimulation. Beyond motor inhibition, our study thus strongly suggests that the mechanisms of action of high-frequency subthalamic stimulation are not restricted to the subthalamic nucleus, but also involve the modulation of distributed subcortical-cortical networks.
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16
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Abstract
Obsessive-compulsive disorder (OCD) is a mental disorder featuring obsessions (intrusive thoughts) and compulsions (repetitive behaviors performed in the context of rigid rituals). There is strong evidence for a neurobiological basis of this disorder, involving limbic cortical regions and related basal ganglion areas. However, more research is needed to lift the veil on the precise nature of that involvement and the way it drives the clinical expression of OCD. Altered cognitive functions may underlie the symptoms and thus draw a link between the clinical expression of the disorder and its neurobiological etiology. Our extensive review demonstrates that OCD patients do present a broad range of neuropsychological dysfunctions across all cognitive domains (memory, attention, flexibility, inhibition, verbal fluency, planning, decision-making), but some methodological issues temper this observation. Thus, future research should have a more integrative approach to cognitive functioning, gathering contributions of both experimental psychology and more fundamental neurosciences.
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Affiliation(s)
- Nabil Benzina
- "Behaviour, Emotion, and Basal Ganglia" Team, Inserm U1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S1127, Institut du Cerveau et de la Moelle épinière, ICM, 75013, Paris, France.
| | - Luc Mallet
- "Behaviour, Emotion, and Basal Ganglia" Team, Inserm U1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S1127, Institut du Cerveau et de la Moelle épinière, ICM, 75013, Paris, France
- AP-HP, Service de Psychiatrie, DHU PePsy, Hôpital Henri Mondor, Université Paris-Est Créteil, INSERM U955, Fondation FondaMental, Créteil, France
| | - Eric Burguière
- "Behaviour, Emotion, and Basal Ganglia" Team, Inserm U1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S1127, Institut du Cerveau et de la Moelle épinière, ICM, 75013, Paris, France
| | - Karim N'Diaye
- "Behaviour, Emotion, and Basal Ganglia" Team, Inserm U1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S1127, Institut du Cerveau et de la Moelle épinière, ICM, 75013, Paris, France
| | - Antoine Pelissolo
- AP-HP, Service de Psychiatrie, DHU PePsy, Hôpital Henri Mondor, Université Paris-Est Créteil, INSERM U955, Fondation FondaMental, Créteil, France
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17
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Zhang L, Dong Y, Ji Y, Tao R, Chen X, Ye J, Zhang L, Yu F, Zhu C, Wang K. Trait-related decision making impairment in obsessive-compulsive disorder: evidence from decision making under ambiguity but not decision making under risk. Sci Rep 2015; 5:17312. [PMID: 26601899 PMCID: PMC4658550 DOI: 10.1038/srep17312] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 10/28/2015] [Indexed: 11/09/2022] Open
Abstract
This study aimed to investigate whether deficits in decision making were potential
endophenotype markers for OCD considering different phases of the disease.
Fifty-seven non-medicated OCD patients (nmOCD), 77 medicated OCD patients (mOCD), 48
remitted patients with OCD (rOCD) and 115 healthy controls were assessed with the
Iowa Gambling Task (IGT), which measured decision making under ambiguity, and the
Game of Dice Task (GDT), which measured decision making under risk. While the three
patients groups showed impaired performance on the IGT compared with healthy
controls, all patients showed intact performance on the GDT. Furthermore, the rOCD
patients showed a preference for deck B, indicating that they showed more
sensitivity to the frequency of loss than to the magnitude of loss, whereas the mOCD
patients showed a preference for deck A, indicating that they had more sensitivity
to the magnitude of loss than to the frequency of loss. These data suggested that
OCD patients had trait-related impairments in decision making under ambiguity but
not under risk, and that dissociation of decision making under ambiguity and under
risk is an appropriate potential neurocognitive endophenotype for OCD. The subtle
but meaningful differences in decision making performance between the OCD groups
require further study.
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Affiliation(s)
- Long Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Laboratory of Neuropsychology, Anhui Medical University, Hefei, China
| | - Yi Dong
- Mental Health Center of Anhui Province, Hefei, China
| | - Yifu Ji
- Mental Health Center of Anhui Province, Hefei, China
| | - Rui Tao
- Mental Health Center of Anhui Province, Hefei, China
| | - Xuequan Chen
- Mental Health Center of Anhui Province, Hefei, China
| | - Jianguo Ye
- Psychological Consultation Center of Anhui Medical University, Hefei, China
| | - Lei Zhang
- Laboratory of Neuropsychology, Anhui Medical University, Hefei, China
| | - Fengqiong Yu
- Laboratory of Neuropsychology, Anhui Medical University, Hefei, China
| | - Chunyan Zhu
- Laboratory of Neuropsychology, Anhui Medical University, Hefei, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Laboratory of Neuropsychology, Anhui Medical University, Hefei, China
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18
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Barahona-Corrêa JB, Camacho M, Castro-Rodrigues P, Costa R, Oliveira-Maia AJ. From Thought to Action: How the Interplay Between Neuroscience and Phenomenology Changed Our Understanding of Obsessive-Compulsive Disorder. Front Psychol 2015; 6:1798. [PMID: 26635696 PMCID: PMC4655583 DOI: 10.3389/fpsyg.2015.01798] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/07/2015] [Indexed: 01/25/2023] Open
Abstract
The understanding of obsessive-compulsive disorder (OCD) has evolved with the knowledge of behavior, the brain, and their relationship. Modern views of OCD as a neuropsychiatric disorder originated from early lesion studies, with more recent models incorporating detailed neuropsychological findings, such as perseveration in set-shifting tasks, and findings of altered brain structure and function, namely of orbitofrontal corticostriatal circuits and their limbic connections. Interestingly, as neurobiological models of OCD evolved from cortical and cognitive to sub-cortical and behavioral, the focus of OCD phenomenology also moved from thought control and contents to new concepts rooted in animal models of action control. Most recently, the proposed analogy between habitual action control and compulsive behavior has led to the hypothesis that individuals suffering from OCD may be predisposed to rely excessively on habitual rather than on goal-directed behavioral strategies. Alternatively, compulsions have been proposed to result either from hyper-valuation of certain actions and/or their outcomes, or from excessive uncertainty in the monitoring of action performance, both leading to perseveration in prepotent actions such as washing or checking. In short, the last decades have witnessed a formidable renovation in the pathophysiology, phenomenology, and even semantics, of OCD. Nevertheless, such progress is challenged by several caveats, not least psychopathological oversimplification and overgeneralization of animal to human extrapolations. Here we present an historical overview of the understanding of OCD, highlighting converging studies and trends in neuroscience, psychiatry and neuropsychology, and how they influenced current perspectives on the nosology and phenomenology of this disorder.
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Affiliation(s)
- J Bernardo Barahona-Corrêa
- Department of Psychiatry and Mental Health, Faculdade de Ciências Médicas, Nova Medical School , Lisbon, Portugal ; Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental , Lisbon, Portugal ; Champalimaud Clinical Centre, Champalimaud Centre for the Unknown , Lisbon, Portugal ; Centro de Apoio ao Desenvolvimento Infantil , Cascais, Portugal
| | - Marta Camacho
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown , Lisbon, Portugal
| | - Pedro Castro-Rodrigues
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown , Lisbon, Portugal ; Centro Hospitalar Psiquiátrico de Lisboa , Lisbon, Portugal
| | - Rui Costa
- Champalimaud Research, Champalimaud Centre for the Unknown , Lisbon, Portugal
| | - Albino J Oliveira-Maia
- Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental , Lisbon, Portugal ; Champalimaud Clinical Centre, Champalimaud Centre for the Unknown , Lisbon, Portugal ; Champalimaud Research, Champalimaud Centre for the Unknown , Lisbon, Portugal
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19
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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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20
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Lei H, Zhu X, Fan J, Dong J, Zhou C, Zhang X, Zhong M. Is impaired response inhibition independent of symptom dimensions in obsessive-compulsive disorder? Evidence from ERPs. Sci Rep 2015; 5:10413. [PMID: 25990063 PMCID: PMC4438428 DOI: 10.1038/srep10413] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 04/13/2015] [Indexed: 01/14/2023] Open
Abstract
Impaired response inhibition has been consistently reported in patients diagnosed with obsessive-compulsive disorder (OCD). This clinically heterogeneous disorder is characterized by several symptom dimensions that may have distinct, but partially overlapping, neural correlates. The present study examined whether alterations in response inhibition may be related to symptom severity and symptom dimensions. Event-related potentials (ERPs) were recorded in a group of 42 medication-free OCD patients as well as 42 healthy controls during a stop-signal task. Symptom dimension scores were obtained using the Yale-Brown Obsessive Compulsive Scale symptom checklist. OCD patients showed longer stop-signal reaction times (SSRT, p < 0.01) and larger stop-N2 amplitudes (p < 0.01) compared to healthy controls. Neither the longer SSRT nor the larger stop-N2 scores were significantly correlated with symptom severity or present or lifetime OCD symptoms in OCD patients. These results indicate that deficient response inhibition is a common occurrence in OCD patients that is independent of global symptom severity and symptom dimensions. These data support the notion that impaired response inhibition may be a general attribute of patients with OCD.
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Affiliation(s)
- Hui Lei
- Medical Psychological Institute, Second Xiangya Hospital, Central South University, Changsha 410011, P.R. China
| | - Xiongzhao Zhu
- 1] Medical Psychological Institute, Second Xiangya Hospital, Central South University, Changsha 410011, P.R. China [2] National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha 410011, P.R. China
| | - Jie Fan
- Medical Psychological Institute, Second Xiangya Hospital, Central South University, Changsha 410011, P.R. China
| | - Jiaojiao Dong
- Medical Psychological Institute, Second Xiangya Hospital, Central South University, Changsha 410011, P.R. China
| | - Cheng Zhou
- Medical Psychological Institute, Second Xiangya Hospital, Central South University, Changsha 410011, P.R. China
| | - Xiaocui Zhang
- 1] Medical Psychological Institute, Second Xiangya Hospital, Central South University, Changsha 410011, P.R. China [2] National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha 410011, P.R. China
| | - Mingtian Zhong
- Center for Studies of Psychological Application, South China Normal University, Guangzhou 510631, P.R. China
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21
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Snyder HR, Kaiser RH, Warren SL, Heller W. Obsessive-compulsive disorder is associated with broad impairments in executive function: A meta-analysis. Clin Psychol Sci 2014; 3:301-330. [PMID: 25755918 DOI: 10.1177/2167702614534210] [Citation(s) in RCA: 180] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a serious and often chronically disabling condition. The current dominant model of OCD focuses on abnormalities in prefrontal-striatal circuits that support executive function (EF). While there is growing evidence for EF impairments associated with OCD, results have been inconsistent, making the nature and magnitude of these impairments controversial. The current meta-analysis uses random-effects models to synthesize 110 previous studies that compared participants with OCD to healthy control participants on at least one neuropsychological measure of EF. The results indicate that individuals with OCD are impaired on tasks measuring most aspects of EF, consistent with broad impairment in EF. EF deficits were not explained by general motor slowness or depression. Effect sizes were largely stable across variation in demographic and clinical characteristics of samples, although medication use, age, and gender moderated some effects.
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Affiliation(s)
- Hannah R Snyder
- Department of Psychology, University of Denver, Frontier Hall, 2155 S. Race St. Denver, CO 80208, USA
| | - Roselinde H Kaiser
- Department of Psychiatry, Harvard Medical School, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
| | - Stacie L Warren
- Department of Mental Health, St. Louis VA Medical Center, #1 Jefferson Barracks Drive, 116B/JB, St. Louis, MO 63125, USA
| | - Wendy Heller
- Department of Psychology and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, 603 E. Daniel Street, Champaign, IL 61820, USA
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22
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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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23
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Spalletta G, Piras F, Fagioli S, Caltagirone C, Piras F. Brain microstructural changes and cognitive correlates in patients with pure obsessive compulsive disorder. Brain Behav 2014; 4:261-77. [PMID: 24683518 PMCID: PMC3967541 DOI: 10.1002/brb3.212] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 12/12/2013] [Accepted: 12/15/2013] [Indexed: 02/06/2023] Open
Abstract
OBJECT The aim of this study was to investigate macrostructural and microstructural brain changes in patients with pure obsessive compulsive disorder (OCD) and to examine the relationship between brain structure and neuropsychological deficits. METHOD 20 patients with OCD underwent a comprehensive neuropsychological battery. A combined voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) analysis was used to capture gray matter (GM) and white matter changes in OCD patients as compared to pair-matched healthy volunteers. Multiple regression designs explored the relationship between cognition and neuroimaging parameters. RESULTS OCD patients had increased mean diffusivity (MD) in GM nodes of the orbitofronto-striatal loop (left dorsal anterior cingulate [Z = 3.67, P < 0.001] left insula [Z = 3.35 P < 0.001] left thalamus [Z = 3.59, P < 0.001] left parahippocampal gyrus [Z = 3.77 P < 0.001]) and in lateral frontal and posterior associative cortices (right frontal operculum [Z = 3.42 P < 0.001], right temporal lobe [Z = 3.79 P < 0.001] left parietal lobe [Z = 3.91 P < 0.001]). Decreased fractional anisotropy (FA) was detected in intrahemispheric (left superior longitudinal fasciculus [Z = 4.07 P < 0.001]) and interhemispheric (body of corpus callosum [CC, Z = 4.42 P < 0.001]) bundles. Concurrently, the semantic fluency score, a measure of executive control processes, significantly predicted OCD diagnosis (Odds Ratio = 1.37; 95% Confidence Intervals = 1.09-1.73; P = 0.0058), while variation in performance was correlated with increased MD in left temporal (Z = 4.25 P < 0.001) and bilateral parietal regions (left Z = 3.94, right Z = 4.19 P < 0.001), and decreased FA in the right posterior corona radiata (Z = 4.07 P < 0.001) and the left corticospinal tract (Z = 3.95 P < 0.001). CONCLUSIONS The reported deficit in executive processes and the underlying microstructural alterations may qualify as behavioral and biological markers of OCD.
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Affiliation(s)
- Gianfranco Spalletta
- Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Santa Lucia Foundation Via Ardeatina 306, 00179, Rome, Italy
| | - Fabrizio Piras
- Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Santa Lucia Foundation Via Ardeatina 306, 00179, Rome, Italy
| | - Sabrina Fagioli
- Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Santa Lucia Foundation Via Ardeatina 306, 00179, Rome, Italy
| | - Carlo Caltagirone
- Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Santa Lucia Foundation Via Ardeatina 306, 00179, Rome, Italy ; Department of Neuroscience, Tor Vergata University of Rome Rome, Italy
| | - Federica Piras
- Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Santa Lucia Foundation Via Ardeatina 306, 00179, Rome, Italy
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Lambert AE, Hu Y, Magee JC, Beadel JR, Teachman BA. Thought suppression across time: Change in frequency and duration of thought recurrence. J Obsessive Compuls Relat Disord 2014; 3:21-28. [PMID: 24567889 PMCID: PMC3931447 DOI: 10.1016/j.jocrd.2013.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Some studies have found that trying to suppress thoughts increases their long-term recurrence, a phenomenon associated with psychopathology, particularly obsessive-compulsive disorder. However, effect sizes in thought suppression studies have often been small and inconsistent. The present study sought to improve thought suppression conceptualization and measurement by examining two distinct dimensions of thought recurrence - frequency and duration of a thought's return - and how they evolve over time. After a thought focus period, 100 adults were assigned to either suppress or monitor the recurrence of an unpleasant thought for 4 min. Then, during a second four-minute period, all participants were asked to monitor the thought's recurrence. Hierarchical linear modeling indicated that thought frequency declined across time and the rate of decline slowed as time went on. Initially, the extent of thought duration remained short and stable for those asked to suppress, and increased linearly over time for those asked to monitor. Later, this pattern reversed. Duration increased linearly for those initially asked to suppress but was short and stable for those who initially monitored. Accounting for change over time and means of measuring recurrence (frequency vs. duration) may help elucidate past mixed findings, and improve thought suppression research methodology.
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Affiliation(s)
- Ann E. Lambert
- University of Virginia, Box 400400, Charlottesville, VA 22904, USA
| | - Yueqin Hu
- University of Virginia, Box 400400, Charlottesville, VA 22904, USA
| | - Joshua C. Magee
- University of Virginia, Box 400400, Charlottesville, VA 22904, USA
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Klanker M, Feenstra M, Denys D. Dopaminergic control of cognitive flexibility in humans and animals. Front Neurosci 2013; 7:201. [PMID: 24204329 PMCID: PMC3817373 DOI: 10.3389/fnins.2013.00201] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 10/11/2013] [Indexed: 12/21/2022] Open
Abstract
Striatal dopamine (DA) is thought to code for learned associations between cues and reinforcers and to mediate approach behavior toward a reward. Less is known about the contribution of DA to cognitive flexibility—the ability to adapt behavior in response to changes in the environment. Altered reward processing and impairments in cognitive flexibility are observed in psychiatric disorders such as obsessive compulsive disorder (OCD). Patients with this disorder show a disruption of functioning in the frontostriatal circuit and alterations in DA signaling. In this review we summarize findings from animal and human studies that have investigated the involvement of striatal DA in cognitive flexibility. These findings may provide a better understanding of the role of dopaminergic dysfunction in cognitive inflexibility in psychiatric disorders, such as OCD.
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Affiliation(s)
- Marianne Klanker
- Netherlands Institute for Neuroscience, Institute of the Royal Netherlands Academy of Arts and Sciences Amsterdam, Netherlands ; Department of Psychiatry, Academic Medical Center, University of Amsterdam Amsterdam, Netherlands
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Kodaira M, Iwadare Y, Ushijima H, Oiji A, Kato M, Sugiyama N, Sasayama D, Usami M, Watanabe K, Saito K. Poor performance on the Iowa gambling task in children with obsessive-compulsive disorder. Ann Gen Psychiatry 2012; 11:25. [PMID: 23062199 PMCID: PMC3508952 DOI: 10.1186/1744-859x-11-25] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 10/08/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Several lines of evidence implicate orbitofrontal cortex dysfunction in the pathophysiology of obsessive-compulsive disorder (OCD). The purpose of this study was to investigate neuropsychological dysfunction of the orbitofrontal cortex in children with OCD. METHODS The Iowa Gambling Task (IGT), which reflects orbitofrontal cortex function, and the Wisconsin Card Sorting Test (WCST), which is associated with functioning of the dorsolateral prefrontal cortex, were administered to 22 children with OCD and 22 healthy controls matched for gender, age, and intelligence. RESULTS OCD patients displayed poor performance on the IGT. In contrast, performance on the WCST was not impaired in OCD patients compared to controls. CONCLUSIONS These findings are in line with previous studies demonstrating that OCD in childhood is associated with a dysfunction of orbitofrontal-striatal-thalamic circuitry.
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Affiliation(s)
- Masaki Kodaira
- Department of Child and Adolescent Psychiatry, National Center for Global Health and Medicine, Kohnodai Hospital, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-0836, Japan.
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27
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Rao NP. Pathogenetic and therapeutic perspectives on neurocognitive models in psychiatry: A synthesis of behavioral, brain imaging, and biological studies. Indian J Psychiatry 2012; 54:217-22. [PMID: 23226843 PMCID: PMC3512356 DOI: 10.4103/0019-5545.102410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Neurocognitive assessments are useful to determine the locus of insult as well as functional capacities of patients on treatment. In psychiatry, neurocognitive assessment is useful in the identification of brain lesions, evaluation of cognitive deterioration over time, and advancement of theories regarding the neuroanatomical localization of symptoms. Neurocognitive models provide a bridging link between brain pathology and phenomenology. They provide a useful framework to understand the pathogenesis of psychiatric disorders, bringing together isolated findings in behavioral, neuroimaging, and other neurobiological studies. This review will discuss neurocognitive model of three disorders - schizophrenia, bipolar disorder, and obsessive compulsive disorder - by incorporating findings from neurocognitive, neuroimaging, and other biological studies.
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Affiliation(s)
- Naren P. Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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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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den Braber A, van 't Ent D, Cath DC, Wagner J, Boomsma DI, de Geus EJC. Brain activation during cognitive planning in twins discordant or concordant for obsessive-compulsive symptoms. Brain 2010; 133:3123-40. [PMID: 20823085 PMCID: PMC2947427 DOI: 10.1093/brain/awq229] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Neuroimaging studies have indicated abnormalities in cortico-striatal-thalamo-cortical circuits in patients with obsessive–compulsive disorder compared with controls. However, there are inconsistencies between studies regarding the exact set of brain structures involved and the direction of anatomical and functional changes. These inconsistencies may reflect the differential impact of environmental and genetic risk factors for obsessive–compulsive disorder on different parts of the brain. To distinguish between functional brain changes underlying environmentally and genetically mediated obsessive–compulsive disorder, we compared task performance and brain activation during a Tower of London planning paradigm in monozygotic twins discordant (n = 38) or concordant (n = 100) for obsessive–compulsive symptoms. Twins who score high on obsessive–compulsive symptoms can be considered at high risk for obsessive–compulsive disorder. We found that subjects at high risk for obsessive–compulsive disorder did not differ from the low-risk subjects behaviourally, but we obtained evidence that the high-risk subjects differed from the low-risk subjects in the patterns of brain activation accompanying task execution. These regions can be separated into those that were affected by mainly environmental risk (dorsolateral prefrontal cortex and lingual cortex), genetic risk (frontopolar cortex, inferior frontal cortex, globus pallidus and caudate nucleus) and regions affected by both environmental and genetic risk factors (cingulate cortex, premotor cortex and parts of the parietal cortex). Our results suggest that neurobiological changes related to obsessive–compulsive symptoms induced by environmental factors involve primarily the dorsolateral prefrontal cortex, whereas neurobiological changes induced by genetic factors involve orbitofrontal–basal ganglia structures. Regions showing similar changes in high-risk twins from discordant and concordant pairs may be part of compensatory networks that keep planning performance intact, in spite of cortico-striatal-thalamo-cortical deficits.
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Affiliation(s)
- Anouk den Braber
- Department of Biological Psychology, VU University, van der Boechorststraat 1, Amsterdam, The Netherlands.
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Britton JC, Rauch SL, Rosso IM, Killgore WD, Price LM, Ragan J, Chosak A, Hezel DM, Pine DS, Leibenluft E, Pauls DL, Jenike MA, Stewart SE. Cognitive inflexibility and frontal-cortical activation in pediatric obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry 2010; 49:944-53. [PMID: 20732630 PMCID: PMC4196669 DOI: 10.1016/j.jaac.2010.05.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 05/03/2010] [Accepted: 05/14/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Deficits in cognitive flexibility and response inhibition have been linked to perturbations in cortico-striatal-thalamic circuitry in adult obsessive-compulsive disorder (OCD). Although similar cognitive deficits have been identified in pediatric OCD, few neuroimaging studies have been conducted to examine its neural correlates in the developing brain. In this study, we tested hypotheses regarding group differences in the behavioral and neural correlates of cognitive flexibility in a pediatric OCD and a healthy comparison (HC) sample. METHOD In this functional magnetic resonance imaging (fMRI) study, a pediatric sample of 10- to 17-year-old subjects, 15 with OCD and 20 HC, completed a set-shifting task. The task, requiring an extradimensional shift to identify a target, examines cognitive flexibility. Within each block, the dimension (color or shape) that identified the target either alternated (i.e., mixed) or remained unchanged (i.e., repeated). RESULTS Compared with the HC group, the OCD group tended to be slower to respond to trials within mixed blocks. Compared with the HC group, the OCD group exhibited less left inferior frontal gyrus/BA47 activation in the set-shifting contrast (i.e., HC > OCD, mixed versus repeated); only the HC group exhibited significant activation in this region. The correlation between set shifting-induced right caudate activation and shift cost (i.e., reaction time differential in response to mixed versus repeated trials) was significantly different between HC and OCD groups, in that we found a positive correlation in HC and a negative correlation in OCD. CONCLUSIONS In pediatric OCD, less fronto-striatal activation may explain previously identified deficits in shifting cognitive sets.
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Menzies L, Chamberlain SR, Laird AR, Thelen SM, Sahakian BJ, Bullmore ET. Integrating evidence from neuroimaging and neuropsychological studies of obsessive-compulsive disorder: the orbitofronto-striatal model revisited. Neurosci Biobehav Rev 2007; 32:525-49. [PMID: 18061263 DOI: 10.1016/j.neubiorev.2007.09.005] [Citation(s) in RCA: 819] [Impact Index Per Article: 48.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Revised: 09/24/2007] [Accepted: 09/28/2007] [Indexed: 12/16/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a common, heritable and disabling neuropsychiatric disorder. Theoretical models suggest that OCD is underpinned by functional and structural abnormalities in orbitofronto-striatal circuits. Evidence from cognitive and neuroimaging studies (functional and structural magnetic resonance imaging (MRI) and positron emission tomography (PET)) have generally been taken to be supportive of these theoretical models; however, results from these studies have not been entirely congruent with each other. With the advent of whole brain-based structural imaging techniques, such as voxel-based morphometry and multivoxel analyses, we consider it timely to assess neuroimaging findings to date, and to examine their compatibility with cognitive studies and orbitofronto-striatal models. As part of this assessment, we performed a quantitative, voxel-level meta-analysis of functional MRI findings, which revealed consistent abnormalities in orbitofronto-striatal and other additional areas in OCD. This review also considers the evidence for involvement of other brain areas outside orbitofronto-striatal regions in OCD, the limitations of current imaging techniques, and how future developments in imaging may aid our understanding of OCD.
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Affiliation(s)
- Lara Menzies
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK.
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