1
|
Marzuki AA, Banca P, Garofalo S, Degni LAE, Dalbagno D, Badioli M, Sule A, Kaser M, Conway-Morris A, Sahakian BJ, Robbins TW. Compulsive avoidance in youths and adults with OCD: an aversive pavlovian-to-instrumental transfer study. Transl Psychiatry 2024; 14:308. [PMID: 39060253 PMCID: PMC11282188 DOI: 10.1038/s41398-024-03028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Compulsive behaviour may often be triggered by Pavlovian cues. Assessing how Pavlovian cues drive instrumental behaviour in obsessive-compulsive disorder (OCD) is therefore crucial to understand how compulsions develop and are maintained. An aversive Pavlovian-to-Instrumental transfer (PIT) paradigm, particularly one involving avoidance/cancellation of negative outcomes, can enable such investigation and has not previously been studied in clinical-OCD. Forty-one participants diagnosed with OCD (21 adults; 20 youths) and 44 controls (21 adults; 23 youths) completed an aversive PIT task. Participants had to prevent the delivery of unpleasant noises by moving a joystick in the correct direction. They could infer these correct responses by learning appropriate response-outcome (instrumental) and stimulus-outcome (Pavlovian) associations. We then assessed whether Pavlovian cues elicited specific instrumental avoidance responses (specific PIT) and induced general instrumental avoidance (general PIT). We investigated whether task learning and confidence indices influenced PIT strength differentially between groups. There was no overall group difference in PIT performance, although youths with OCD showed weaker specific PIT than youth controls. However, urge to avoid unpleasant noises and preference for safe over unsafe stimuli influenced specific and general PIT respectively in OCD, while PIT in controls was more influenced by confidence in instrumental and Pavlovian learning. Thus, in OCD, implicit motivational factors, but not learnt knowledge, may contribute to the successful integration of aversive Pavlovian and instrumental cues. This implies that compulsive avoidance may be driven by these automatic processes. Youths with OCD show deficits in specific PIT, suggesting cue integration impairments are only apparent in adolescence. These findings may be clinically relevant as they emphasise the importance of targeting such implicit motivational processes when treating OCD.
Collapse
Affiliation(s)
- Aleya A Marzuki
- Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, UK.
- Department of Psychology, School of Medical and Life Sciences, Sunway University, Petaling Jaya, Selangor, Malaysia.
| | - Paula Banca
- Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, UK
| | - Sara Garofalo
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Luigi A E Degni
- Department of Psychology, University of Bologna, Bologna, Italy
| | | | - Marco Badioli
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Akeem Sule
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Muzaffer Kaser
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | | | - Barbara J Sahakian
- Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, UK
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Trevor W Robbins
- Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, UK.
| |
Collapse
|
2
|
Uhre CF, Ritter M, Jepsen JRM, Uhre VF, Lønfeldt NN, Müller AD, Plessen KJ, Vangkilde S, Blair RJ, Pagsberg AK. Atypical neurocognitive functioning in children and adolescents with obsessive-compulsive disorder (OCD). Eur Child Adolesc Psychiatry 2024; 33:2291-2300. [PMID: 37917157 PMCID: PMC11255040 DOI: 10.1007/s00787-023-02301-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/11/2023] [Indexed: 11/03/2023]
Abstract
Atypical neurocognitive functioning has been found in adult patients with obsessive-compulsive disorder (OCD). However, little work has been done in children and adolescents with OCD. In this study, we investigated neurocognitive functioning in a large and representative sample of newly diagnosed children and adolescents with OCD compared to non-psychiatric controls. Children and adolescents with OCD (n = 119) and non-psychiatric controls (n = 90) underwent psychopathological assessment, intelligence testing, and a neurocognitive test battery spanning cognitive flexibility, planning and decision-making, working memory, fluency, and processing speed. The MANOVA main effect revealed that children and adolescents with OCD performed significantly worse than the control group (p < .001, η p 2 = 0.256). Atypical patient performance was particularly found for indices of cognitive flexibility, decision-making, working memory, and processing speed. We found no evidence of differences in planning or fluency. Moreover, we found no significant associations between neurocognitive performance and OCD symptom severity or comorbidity status. Our results indicate that children and adolescents with OCD show selective atypical neurocognitive functioning. These difficulties do not appear to drive their OCD symptoms. However, they may contribute to lifespan difficulties and interfere with treatment efficacy, an objective of our research currently.
Collapse
Affiliation(s)
- Camilla Funch Uhre
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.
- Center for Clinical Neuropsychology, Children and Adolescents, Rigshospitalet, Copenhagen, Denmark.
| | - Melanie Ritter
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Jens Richardt Møllegaard Jepsen
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital - Mental Health Services CPH, Glostrup, Denmark
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Copenhagen University Hospital - Mental Health Services CPH, Glostrup, Denmark
| | - Valdemar Funch Uhre
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Nicole Nadine Lønfeldt
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Anne Dorothee Müller
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kerstin Jessica Plessen
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Signe Vangkilde
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Robert James Blair
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Katrine Pagsberg
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
3
|
Kim T, Lee SW, Lho SK, Moon SY, Kim M, Kwon JS. Neurocomputational model of compulsivity: deviating from an uncertain goal-directed system. Brain 2024; 147:2230-2244. [PMID: 38584499 PMCID: PMC11146420 DOI: 10.1093/brain/awae102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/18/2024] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Despite a theory that an imbalance in goal-directed versus habitual systems serve as building blocks of compulsions, research has yet to delineate how this occurs during arbitration between the two systems in obsessive-compulsive disorder. Inspired by a brain model in which the inferior frontal cortex selectively gates the putamen to guide goal-directed or habitual actions, this study aimed to examine whether disruptions in the arbitration process via the fronto-striatal circuit would underlie imbalanced decision-making and compulsions in patients. Thirty patients with obsessive-compulsive disorder [mean (standard deviation) age = 26.93 (6.23) years, 12 females (40%)] and 30 healthy controls [mean (standard deviation) age = 24.97 (4.72) years, 17 females (57%)] underwent functional MRI scans while performing the two-step Markov decision task, which was designed to dissociate goal-directed behaviour from habitual behaviour. We employed a neurocomputational model to account for an uncertainty-based arbitration process, in which a prefrontal arbitrator (i.e. inferior frontal gyrus) allocates behavioural control to a more reliable strategy by selectively gating the putamen. We analysed group differences in the neural estimates of uncertainty of each strategy. We also compared the psychophysiological interaction effects of system preference (goal-directed versus habitual) on fronto-striatal coupling between groups. We examined the correlation between compulsivity score and the neural activity and connectivity involved in the arbitration process. The computational model captured the subjects' preferences between the strategies. Compared with healthy controls, patients had a stronger preference for the habitual system (t = -2.88, P = 0.006), which was attributed to a more uncertain goal-directed system (t = 2.72, P = 0.009). Before the allocation of controls, patients exhibited hypoactivity in the inferior frontal gyrus compared with healthy controls when this region tracked the inverse of uncertainty (i.e. reliability) of goal-directed behaviour (P = 0.001, family-wise error rate corrected). When reorienting behaviours to reach specific goals, patients exhibited weaker right ipsilateral ventrolateral prefronto-putamen coupling than healthy controls (P = 0.001, family-wise error rate corrected). This hypoconnectivity was correlated with more severe compulsivity (r = -0.57, P = 0.002). Our findings suggest that the attenuated top-down control of the putamen by the prefrontal arbitrator underlies compulsivity in obsessive-compulsive disorder. Enhancing fronto-striatal connectivity may be a potential neurotherapeutic approach for compulsivity and adaptive decision-making.
Collapse
Affiliation(s)
- Taekwan Kim
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul 08826, Republic of Korea
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
- Center for Neuroscience-inspired Artificial Intelligence, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Sang Wan Lee
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
- Center for Neuroscience-inspired Artificial Intelligence, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
- Kim Jaechul Graduate School of AI, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Silvia Kyungjin Lho
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Sun-Young Moon
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Jun Soo Kwon
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul 08826, Republic of Korea
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| |
Collapse
|
4
|
Banca P, Herrojo Ruiz M, Gonzalez-Zalba MF, Biria M, Marzuki AA, Piercy T, Sule A, Fineberg NA, Robbins TW. Action sequence learning, habits, and automaticity in obsessive-compulsive disorder. eLife 2024; 12:RP87346. [PMID: 38722306 PMCID: PMC11081634 DOI: 10.7554/elife.87346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
This study investigates the goal/habit imbalance theory of compulsion in obsessive-compulsive disorder (OCD), which postulates enhanced habit formation, increased automaticity, and impaired goal/habit arbitration. It directly tests these hypotheses using newly developed behavioral tasks. First, OCD patients and healthy participants were trained daily for a month using a smartphone app to perform chunked action sequences. Despite similar procedural learning and attainment of habitual performance (measured by an objective automaticity criterion) by both groups, OCD patients self-reported higher subjective habitual tendencies via a recently developed questionnaire. Subsequently, in a re-evaluation task assessing choices between established automatic and novel goal-directed actions, both groups were sensitive to re-evaluation based on monetary feedback. However, OCD patients, especially those with higher compulsive symptoms and habitual tendencies, showed a clear preference for trained/habitual sequences when choices were based on physical effort, possibly due to their higher attributed intrinsic value. These patients also used the habit-training app more extensively and reported symptom relief post-study. The tendency to attribute higher intrinsic value to familiar actions may be a potential mechanism leading to compulsions and an important addition to the goal/habit imbalance hypothesis in OCD. We also highlight the potential of smartphone app training as a habit reversal therapeutic tool.
Collapse
Affiliation(s)
- Paula Banca
- Department of Psychology, University of CambridgeCambridgeUnited Kingdom
- Behavioural and Clinical Neuroscience Institute, University of CambridgeCambridgeUnited Kingdom
| | - Maria Herrojo Ruiz
- Department of Psychology, Goldsmiths University of LondonLondonUnited Kingdom
| | | | - Marjan Biria
- Department of Psychology, University of CambridgeCambridgeUnited Kingdom
- Behavioural and Clinical Neuroscience Institute, University of CambridgeCambridgeUnited Kingdom
| | - Aleya A Marzuki
- Department of Psychology, University of CambridgeCambridgeUnited Kingdom
- Behavioural and Clinical Neuroscience Institute, University of CambridgeCambridgeUnited Kingdom
| | - Thomas Piercy
- Department of Psychiatry, School of Clinical Medicine, University of CambridgeCambridgeUnited Kingdom
| | - Akeem Sule
- Department of Psychiatry, School of Clinical Medicine, University of CambridgeCambridgeUnited Kingdom
| | - Naomi A Fineberg
- Hertfordshire Partnership University NHS Foundation TrustWelwyn Garden CityUnited Kingdom
- University of HertfordshireHatfieldUnited Kingdom
| | - Trevor W Robbins
- Department of Psychology, University of CambridgeCambridgeUnited Kingdom
- Behavioural and Clinical Neuroscience Institute, University of CambridgeCambridgeUnited Kingdom
| |
Collapse
|
5
|
Jones JA, Belin-Rauscent A, Jupp B, Fouyssac M, Sawiak SJ, Zuhlsdorff K, Zhukovsky P, Hebdon L, Velazquez Sanchez C, Robbins TW, Everitt BJ, Belin D, Dalley JW. Neurobehavioral Precursors of Compulsive Cocaine Seeking in Dual Frontostriatal Circuits. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:194-202. [PMID: 38298793 PMCID: PMC10829640 DOI: 10.1016/j.bpsgos.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/04/2023] [Accepted: 06/09/2023] [Indexed: 02/02/2024] Open
Abstract
Background Only some individuals who use drugs recreationally eventually develop a substance use disorder, characterized in part by the rigid engagement in drug foraging behavior (drug seeking), which is often maintained in the face of adverse consequences (i.e., is compulsive). The neurobehavioral determinants of this individual vulnerability have not been fully elucidated. Methods Using a prospective longitudinal study involving 39 male rats, we combined multidimensional characterization of behavioral traits of vulnerability to stimulant use disorder (impulsivity and stickiness) and resilience (sign tracking and sensation seeking/locomotor reactivity to novelty) with magnetic resonance imaging to identify the structural and functional brain correlates of the later emergence of compulsive drug seeking in drug-naïve subjects. We developed a novel behavioral procedure to investigate the individual tendency to persist in drug-seeking behavior in the face of punishment in a drug-free state in subjects with a prolonged history of cocaine seeking under the control of the conditioned reinforcing properties of a drug-paired Pavlovian conditioned stimulus. Results In drug-naïve rats, the tendency to develop compulsive cocaine seeking was characterized by behavioral stickiness-related functional hypoconnectivity between the prefrontal cortex and posterior dorsomedial striatum in combination with impulsivity-related structural alterations in the infralimbic cortex, anterior insula, and nucleus accumbens. Conclusions These findings show that the vulnerability to developing compulsive cocaine-seeking behavior stems from preexisting structural or functional changes in two distinct corticostriatal systems that underlie deficits in impulse control and goal-directed behavior.
Collapse
Affiliation(s)
- Jolyon A. Jones
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Downing Site, Cambridge, United Kingdom
| | - Aude Belin-Rauscent
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Downing Site, Cambridge, United Kingdom
| | - Bianca Jupp
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Maxime Fouyssac
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Downing Site, Cambridge, United Kingdom
| | - Stephen J. Sawiak
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Downing Site, Cambridge, United Kingdom
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Katharina Zuhlsdorff
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Downing Site, Cambridge, United Kingdom
| | - Peter Zhukovsky
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lara Hebdon
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Downing Site, Cambridge, United Kingdom
| | - Clara Velazquez Sanchez
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Downing Site, Cambridge, United Kingdom
| | - Trevor W. Robbins
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Downing Site, Cambridge, United Kingdom
| | - Barry J. Everitt
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Downing Site, Cambridge, United Kingdom
| | - David Belin
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Downing Site, Cambridge, United Kingdom
| | - Jeffrey W. Dalley
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Downing Site, Cambridge, United Kingdom
- Department of Psychiatry, Herschel Smith Building for Brain and Mind Sciences, Forvie Site, Cambridge, United Kingdom
| |
Collapse
|
6
|
Sato R, Shimomura K, Morita K. Opponent learning with different representations in the cortico-basal ganglia pathways can develop obsession-compulsion cycle. PLoS Comput Biol 2023; 19:e1011206. [PMID: 37319256 PMCID: PMC10306209 DOI: 10.1371/journal.pcbi.1011206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) has been suggested to be associated with impairment of model-based behavioral control. Meanwhile, recent work suggested shorter memory trace for negative than positive prediction errors (PEs) in OCD. We explored relations between these two suggestions through computational modeling. Based on the properties of cortico-basal ganglia pathways, we modeled human as an agent having a combination of successor representation (SR)-based system that enables model-based-like control and individual representation (IR)-based system that only hosts model-free control, with the two systems potentially learning from positive and negative PEs in different rates. We simulated the agent's behavior in the environmental model used in the recent work that describes potential development of obsession-compulsion cycle. We found that the dual-system agent could develop enhanced obsession-compulsion cycle, similarly to the agent having memory trace imbalance in the recent work, if the SR- and IR-based systems learned mainly from positive and negative PEs, respectively. We then simulated the behavior of such an opponent SR+IR agent in the two-stage decision task, in comparison with the agent having only SR-based control. Fitting of the agents' behavior by the model weighing model-based and model-free control developed in the original two-stage task study resulted in smaller weights of model-based control for the opponent SR+IR agent than for the SR-only agent. These results reconcile the previous suggestions about OCD, i.e., impaired model-based control and memory trace imbalance, raising a novel possibility that opponent learning in model(SR)-based and model-free controllers underlies obsession-compulsion. Our model cannot explain the behavior of OCD patients in punishment, rather than reward, contexts, but it could be resolved if opponent SR+IR learning operates also in the recently revealed non-canonical cortico-basal ganglia-dopamine circuit for threat/aversiveness, rather than reward, reinforcement learning, and the aversive SR + appetitive IR agent could actually develop obsession-compulsion if the environment is modeled differently.
Collapse
Affiliation(s)
- Reo Sato
- Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Kanji Shimomura
- Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Kenji Morita
- Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan
- International Research Center for Neurointelligence (WPI-IRCN), The University of Tokyo, Tokyo, Japan
| |
Collapse
|
7
|
Suzuki S, Zhang X, Dezfouli A, Braganza L, Fulcher BD, Parkes L, Fontenelle LF, Harrison BJ, Murawski C, Yücel M, Suo C. Individuals with problem gambling and obsessive-compulsive disorder learn through distinct reinforcement mechanisms. PLoS Biol 2023; 21:e3002031. [PMID: 36917567 PMCID: PMC10013903 DOI: 10.1371/journal.pbio.3002031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 02/08/2023] [Indexed: 03/16/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) and pathological gambling (PG) are accompanied by deficits in behavioural flexibility. In reinforcement learning, this inflexibility can reflect asymmetric learning from outcomes above and below expectations. In alternative frameworks, it reflects perseveration independent of learning. Here, we examine evidence for asymmetric reward-learning in OCD and PG by leveraging model-based functional magnetic resonance imaging (fMRI). Compared with healthy controls (HC), OCD patients exhibited a lower learning rate for worse-than-expected outcomes, which was associated with the attenuated encoding of negative reward prediction errors in the dorsomedial prefrontal cortex and the dorsal striatum. PG patients showed higher and lower learning rates for better- and worse-than-expected outcomes, respectively, accompanied by higher encoding of positive reward prediction errors in the anterior insula than HC. Perseveration did not differ considerably between the patient groups and HC. These findings elucidate the neural computations of reward-learning that are altered in OCD and PG, providing a potential account of behavioural inflexibility in those mental disorders.
Collapse
Affiliation(s)
- Shinsuke Suzuki
- Centre for Brain, Mind and Markets, The University of Melbourne, Carlton, Australia
- Center for the Promotion of Social Data Science Education and Research, Hitotsubashi University, Tokyo, Japan
- * E-mail:
| | - Xiaoliu Zhang
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences, and Monash Biomedical Imaging Facility, Monash University, Clayton, Australia
| | - Amir Dezfouli
- Data61, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Sydney, Australia
| | - Leah Braganza
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences, and Monash Biomedical Imaging Facility, Monash University, Clayton, Australia
| | - Ben D. Fulcher
- School of Physics, The University of Sydney, Sydney, Australia
| | - Linden Parkes
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences, and Monash Biomedical Imaging Facility, Monash University, Clayton, Australia
- Department of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Leonardo F. Fontenelle
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences, and Monash Biomedical Imaging Facility, Monash University, Clayton, Australia
| | - Ben J. Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Carlton, Australia
| | - Carsten Murawski
- Centre for Brain, Mind and Markets, The University of Melbourne, Carlton, Australia
| | - Murat Yücel
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences, and Monash Biomedical Imaging Facility, Monash University, Clayton, Australia
| | - Chao Suo
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences, and Monash Biomedical Imaging Facility, Monash University, Clayton, Australia
| |
Collapse
|
8
|
Chronic escitalopram in healthy volunteers has specific effects on reinforcement sensitivity: a double-blind, placebo-controlled semi-randomised study. Neuropsychopharmacology 2023; 48:664-670. [PMID: 36683090 PMCID: PMC9938113 DOI: 10.1038/s41386-022-01523-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 01/24/2023]
Abstract
Several studies of the effects on cognition of selective serotonin reuptake inhibitors (SSRI), administered either acutely or sub-chronically in healthy volunteers, have found changes in learning and reinforcement outcomes. In contrast, to our knowledge, there have been no studies of chronic effects of escitalopram on cognition in healthy volunteers. This is important in view of its clinical use in major depressive disorder (MDD) and obsessive-compulsive disorder (OCD). Consequently, we aimed to investigate the chronic effect of the SSRI, escitalopram, on measures of 'cold' cognition (including inhibition, cognitive flexibility, memory) and 'hot cognition' including decision-making and particularly reinforcement learning. The study, conducted at the University of Copenhagen between May 2020 and October 2021, used a double-blind placebo-controlled design with 66 healthy volunteers, semi-randomised to receive either 20 mg of escitalopram (n = 32) or placebo (n = 34), balanced for age, sex and intelligence quotient (IQ) for at least 21 days. Questionnaires, neuropsychological tests and serum escitalopram measures were taken. We analysed group differences on the cognitive measures using linear regression models as well as innovative hierarchical Bayesian modelling of the Probabilistic Reversal Learning (PRL) task. The novel and important finding was that escitalopram reduced reinforcement sensitivity compared to placebo on both the Sequential Model-Based/Model-Free task and the PRL task. We found no other significant group differences on 'cold' or 'hot' cognition. These findings demonstrate that serotonin reuptake inhibition is involved in reinforcement learning in healthy individuals. Lower reinforcement sensitivity in response to chronic SSRI administration may reflect the 'blunting' effect often reported by patients with MDD treated with SSRIs. Trial Registration: NCT04239339 .
Collapse
|
9
|
Marzuki AA, Vaghi MM, Conway‐Morris A, Kaser M, Sule A, Apergis‐Schoute A, Sahakian BJ, Robbins TW. Atypical action updating in a dynamic environment associated with adolescent obsessive-compulsive disorder. J Child Psychol Psychiatry 2022; 63:1591-1601. [PMID: 35537441 PMCID: PMC9790358 DOI: 10.1111/jcpp.13628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Computational research had determined that adults with obsessive-compulsive disorder (OCD) display heightened action updating in response to noise in the environment and neglect metacognitive information (such as confidence) when making decisions. These features are proposed to underlie patients' compulsions despite the knowledge they are irrational. Nonetheless, it is unclear whether this extends to adolescents with OCD as research in this population is lacking. Thus, this study aimed to investigate the interplay between action and confidence in adolescents with OCD. METHODS Twenty-seven adolescents with OCD and 46 controls completed a predictive-inference task, designed to probe how subjects' actions and confidence ratings fluctuate in response to unexpected outcomes. We investigated how subjects update actions in response to prediction errors (indexing mismatches between expectations and outcomes) and used parameters from a Bayesian model to predict how confidence and action evolve over time. Confidence-action association strength was assessed using a regression model. We also investigated the effects of serotonergic medication. RESULTS Adolescents with OCD showed significantly increased learning rates, particularly following small prediction errors. Results were driven primarily by unmedicated patients. Confidence ratings appeared equivalent between groups, although model-based analysis revealed that patients' confidence was less affected by prediction errors compared to controls. Patients and controls did not differ in the extent to which they updated actions and confidence in tandem. CONCLUSIONS Adolescents with OCD showed enhanced action adjustments, especially in the face of small prediction errors, consistent with previous research establishing 'just-right' compulsions, enhanced error-related negativity, and greater decision uncertainty in paediatric-OCD. These tendencies were ameliorated in patients receiving serotonergic medication, emphasising the importance of early intervention in preventing disorder-related cognitive deficits. Confidence ratings were equivalent between young patients and controls, mirroring findings in adult OCD research.
Collapse
Affiliation(s)
- Aleya A. Marzuki
- Behavioural and Clinical Neuroscience InstituteDepartment of PsychologyUniversity of CambridgeCambridgeUK,Department of PsychologySchool of Medical and Life SciencesSunway UniversityPetaling JayaMalaysia
| | - Matilde M. Vaghi
- Department of PsychologySchool of Humanities and SciencesStanford UniversityStanfordCAUSA
| | | | - Muzaffer Kaser
- Cambridgeshire and Peterborough NHS Foundation TrustCambridgeUK,Department of PsychiatrySchool of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - Akeem Sule
- Department of PsychiatrySchool of Clinical MedicineUniversity of CambridgeCambridgeUK
| | | | - Barbara J. Sahakian
- Behavioural and Clinical Neuroscience InstituteDepartment of PsychologyUniversity of CambridgeCambridgeUK,Department of PsychiatrySchool of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - Trevor W. Robbins
- Behavioural and Clinical Neuroscience InstituteDepartment of PsychologyUniversity of CambridgeCambridgeUK
| |
Collapse
|
10
|
Kozunova G, Novikov A, Stroganova T, Chernyshev B. Intolerance of Uncertainty and Challenges in Decision-making in Adults with High-Functioning Autism. КЛИНИЧЕСКАЯ И СПЕЦИАЛЬНАЯ ПСИХОЛОГИЯ 2022. [DOI: 10.17759/cpse.2022110402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
<p style="text-align: justify;">Individuals with high-functioning autism have difficulties in decision-making in face of incomplete or ambiguous information, particularly in the context of social interaction. Tasks demanding an immediate response or deviation from the usual behavior make them feel excessive anxiety which restricts their social and professional activity. Attempts to camouflage their conservatism to others are one of the risk factors for comorbid depression. Therefore, they avoid new and non-routine situations, thus restricting their own social activity and professional development. On the other hand, insisting on sameness and clarity may give individuals with autism an advantage in long-lasting monotonous tasks. The aim of this review is to consider these symptoms from the perspective of predictive coding. A range of experimental studies has shown that most of the subjects with autism have difficulty in predicting the outcomes based on the cumulative history of interacting with the environment, as well as updating expectations as new evidence becomes available. These peculiarities of the analysis and pragmatic weighting of information may cause the trait intolerance of uncertainty and novelty avoidance of most people with autism.</p>
Collapse
|
11
|
Error in Byline. JAMA Netw Open 2021; 4:e2145564. [PMID: 34964858 PMCID: PMC8717097 DOI: 10.1001/jamanetworkopen.2021.45564] [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: 11/14/2022] Open
|