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Rinaldi LJ, Smees R, Ward J, Simner J. Poorer Well-Being in Children With Misophonia: Evidence From the Sussex Misophonia Scale for Adolescents. Front Psychol 2022; 13:808379. [PMID: 35465571 PMCID: PMC9019493 DOI: 10.3389/fpsyg.2022.808379] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/11/2022] [Indexed: 01/07/2023] Open
Abstract
Objective Misophonia is an unusually strong aversion to a specific class of sounds - most often human bodily sounds such as chewing, crunching, or breathing. A number of studies have emerged in the last 10 years examining misophonia in adults, but little is known about the impact of the condition in children. Here we set out to investigate the well-being profile of children with misophonia, while also presenting the first validated misophonia questionnaire for children. Materials and Methods We screened 142 children (10-14 years; Mean 11.72 SD 1.12; 65 female, 77 male) using our novel diagnostic [the Sussex Misophonia Scale for Adolescents (SMS-Adolescent)]. This allowed us to identify a group of children already manifesting misophonia at that age - the first population-sampled cohort of child misophonics examined to date. Children and their parents also completed measures of well-being (for convergent validation of our SMS-Adolescent) and creative self-construct (for discriminant validation). Results Data show that children with misophonia have significantly elevated levels of anxiety and obsessive compulsive traits. Additionally children with misophonia have significantly poorer life-satisfaction, and health-related quality of life. As predicted, they show no differences in creative self-construct. Conclusion Together our data suggest the first evidence in population sampling of poorer life outcomes for children with misophonia, and provide preliminary convergent and discriminant validation for our novel misophonia instrument. Our data suggest a need for greater recognition and therapeutic outlets for adolescents with misophonia.
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Affiliation(s)
- Louisa J. Rinaldi
- School of Psychology, University of Sussex, Brighton, United Kingdom
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2
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Jalal B, Chamberlain SR, Robbins TW, Sahakian BJ. Obsessive-compulsive disorder-contamination fears, features, and treatment: novel smartphone therapies in light of global mental health and pandemics (COVID-19). CNS Spectr 2022; 27:136-144. [PMID: 33081864 PMCID: PMC7691644 DOI: 10.1017/s1092852920001947] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/04/2020] [Indexed: 02/06/2023]
Abstract
This review aims to shed light on the symptoms of obsessive-compulsive disorder (OCD) with a focus on contamination fears. In addition, we will briefly review the current therapies for OCD and detail what their limitations are. A key focus will be on discussing how smartphone solutions may provide approaches to novel treatments, especially when considering global mental health and the challenges imposed by rural environments and limited resources; as well as restrictions imposed by world-wide pandemics such as COVID-19. In brief, research that questions this review will seek to address include: (1) What are the symptoms of contamination-related OCD? (2) How effective are current OCD therapies and what are their limitations? (3) How can novel technologies help mitigate challenges imposed by global mental health and pandemics/COVID-19.
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Affiliation(s)
- Baland Jalal
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
| | - Samuel R. Chamberlain
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Department of Psychiatry, Faculty of Medicine, University of Southampton; and Southern Health NHS Foundation Trust, Cambridgeshire & Peterborough NHS Foundation Trust, United Kingdom
| | - Trevor W. Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Barbara J. Sahakian
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
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3
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Olbrich H, Jahn I, Stengler K, Seifritz E, Colla M. Heart rate variability in obsessive compulsive disorder in comparison to healthy controls and as predictor of treatment response. Clin Neurophysiol 2022; 138:123-131. [PMID: 35390760 DOI: 10.1016/j.clinph.2022.02.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/04/2022] [Accepted: 02/27/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Obsessive compulsive disorder (OCD) has a large impact on the quality of life of patients. It often takes years to get the right diagnosis and to receive treatment. Therefore, biomarkers that could inform the diagnostic process and provide information on response or non-response for first line treatment approaches are urgently needed. The aim of this study was to analyze whether (1) heart rate (HR) and heart rate variability (HRV) markers of the autonomous nervous system could distinguish between healthy controls (HC) and patients suffering from OCD and (2) HRV parameters additionally yield useful information to separate therapy-responders from non-responders. METHODS A fifteen-minute resting state ECG (electrocardiogram) was recorded from 51 unmedicated OCD patients before treatment and 28 HC. The function of the autonomic nervous system was assessed by using parameters of the HRV. Clinical Global Impression (CGI) scores served as baseline and outcome parameters following three to six months of therapy (cognitive behavioral therapy n = 18, selective-serotonin-reuptake-inhibitor n = 11 or combination n = 22). Differences between patients and HC and responders and non-responders were identified using analysis of covariance (ANCOVAs). Predictive values were calculated following binary regression modelling and receiver operating characteristics (ROC). RESULTS OCD patients revealed a significantly higher HR in comparison to HC. Although patients were thus characterized by increased sympathetic and decreased parasympathetic tone, treatment responders exhibited a larger High Frequency Power as a marker for increased parasympathetic activity at baseline. ROC-curves for OCD vs HC and R vs NR showed clinically relevant areas under curve (83%, 88% respectively). CONCLUSIONS These results are in line with findings of increased sympathetic and decreased parasympathetic activity in OCD in comparison to healthy subjects. The findings further provide clinically useful information on treatment response in OCD. SIGNIFICANCE Results may facilitate the clinical use of electrophysiological markers in OCD.
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Affiliation(s)
- Hanife Olbrich
- Psychiatric University Hospital Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland.
| | - Ina Jahn
- Academic Educational Hospital of University of Leipzig, Department for Psychosomatics and Psychotherapy, Helios Park-Klinikum Leipzig, Leipzig, Germany
| | - Katarina Stengler
- Academic Educational Hospital of University of Leipzig, Department for Psychosomatics and Psychotherapy, Helios Park-Klinikum Leipzig, Leipzig, Germany
| | - Erich Seifritz
- Psychiatric University Hospital Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Michael Colla
- Psychiatric University Hospital Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
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4
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Jansen M, Overgaauw S, De Bruijn ERA. Social Cognition and Obsessive-Compulsive Disorder: A Review of Subdomains of Social Functioning. Front Psychiatry 2020; 11:118. [PMID: 32231594 PMCID: PMC7082418 DOI: 10.3389/fpsyt.2020.00118] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 02/10/2020] [Indexed: 12/12/2022] Open
Abstract
Disturbances in social cognitive processes such as the ability to infer others' mental states importantly contribute to social and functional impairments in psychiatric disorders. Yet, despite established social, emotional, and cognitive problems, the role of social cognition in obsessive-compulsive disorder is largely overlooked. The current review provides a first comprehensive overview of social (neuro)cognitive disturbances in adult patients with obsessive-compulsive disorder. Results of our review indicate various social cognitive alterations. Patients with obsessive-compulsive disorder show deficits in the recognition of affective social cues, specifically facial expressions of disgust, and more general deficits in theory of mind/mentalizing. Additionally, patients show heightened affective reactions and altered neural responding to emotions of self and others, as well as poor emotion regulation skills, which may contribute to poor social functioning of patients. However, the discrepancies in findings and scarcity of studies make it difficult to draw firm conclusions with regard to the specificity of social cognitive disturbances. The review offers directions for future research and highlights the need to investigate obsessive-compulsive disorder from an interactive social neurocognitive perspective in addition to the prevalent passive spectator perspective to advance our understanding of this intricate and burdensome disorder.
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Affiliation(s)
- Myrthe Jansen
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, Netherlands
| | - Sandy Overgaauw
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, Netherlands
| | - Ellen R A De Bruijn
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, Netherlands
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5
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Zhao XR, Chen ZF, Kang CY, Liu RX, Bai JY, Cao YP, Cheng YQ, Xu XF, Zhang YL. Mindfulness-based cognitive therapy is associated with distinct resting-state neural patterns in patients with generalized anxiety disorder. Asia Pac Psychiatry 2019; 11:e12368. [PMID: 31353828 DOI: 10.1111/appy.12368] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 06/13/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Mindfulness-based cognitive therapy (MBCT) may be effective for generalized anxiety disorder (GAD); however, the neural mechanism is poorly understood. In this study, we examined the potential neural mechanisms through which MBCT may reduce anxiety in patients with mild-to-moderate GAD. METHODS Eight weekly group MBCT sessions (2 h each) were conducted with 32 GAD patients. Resting-state functional magnetic resonance imaging (fMRI) was used, along with clinical and mindfulness profiles. A regional homogeneity (ReHo) approach was applied, and resting-state functional connectivity in the default mode network (DMN) using the posterior cingulate cortex (PCC) seed was examined. RESULTS MBCT reduced the anxiety and increased the mindfulness abilities of patients. After MBCT, patients had reduced ReHo in broad regions of the limbic system, along with increased DMN functional connectivity in the anterior cingulate cortex (ACC) and bilateral insula. Overlapping regions of reduced ReHo and increased DMN functional connectivity were observed in the mid-cingulate cortex (MCC) and bilateral insula. The increased PCC-ACC and PCC-insula functional connectivity following MBCT were related to anxiety improvements, suggesting a potential therapeutic mechanism for mindfulness-based therapies. DISCUSSION Group MBCT treatment appears to have effectively reduced anxiety symptoms in patients with mild-to-moderate GAD. Activation and functional connectivity appeared significantly different across some limbic regions after MBCT treatment. The salience network showed reduced ReHo and increased connectivity to the PCC. The DMN functional connectivity of the MCC may indicate reduced anxiety and improved mindfulness in GAD patients.
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Affiliation(s)
- Xing-Rong Zhao
- Mental Health Institute, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Zhuang-Fei Chen
- Medical Faculty, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Chuan-Yuan Kang
- Department of Clinical Psychology, East Hospital Affiliated to Tongji University, Shanghai, China
| | - Rui-Xiang Liu
- Department of Clinical Psychology, The Second People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Jun-Yun Bai
- Department of Geriatrics, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yu-Ping Cao
- Mental Health Institute, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yu-Qi Cheng
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xiu-Feng Xu
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ya-Lin Zhang
- Mental Health Institute, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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Serrano MÁ, Rosell-Clari V, García-Soriano G. The Role of Perceived Control in the Psychophysiological Responses to Disgust of Subclinical OCD Women. SENSORS 2019; 19:s19194180. [PMID: 31561601 PMCID: PMC6806286 DOI: 10.3390/s19194180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/13/2019] [Accepted: 09/24/2019] [Indexed: 12/27/2022]
Abstract
Obsessive‒compulsive disorder (OCD), and especially contamination obsessions and washing compulsions, has been related to disgust. However, when its cardiovascular correlates have been studied, contradictory results have been found, including heart rate accelerations and decelerations. The aim of this study is to analyze emotional, cognitive, and cardiovascular responses in nonclinical (control) and subclinical participants with obsessive‒compulsive contamination/washing symptoms when confronted with a disgusting stimulus. Twenty-seven participants (14 subclinical OCD) completed a behavioral avoidance task with a contamination-based stimulus while their heart rate and subjective variables were measured. Results showed heart rate reductions in both samples, whereas subjective measures reflected higher disgust, anxiety, dirtiness, and emotional valence in the subclinical sample. However, at the same time, the sense of dominance was lower in the control group. In conclusion, our results support a heart rate deceleration during exposure to a disgusting stimulus dissociated from the subjective experience.
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Affiliation(s)
- Miguel Ángel Serrano
- Departamento de Psicobiología, Facultad de Psicología, Universitat de València, 46010 Valencia, Spain.
| | - Vicent Rosell-Clari
- Departamento de Psicología Básica, Facultad de Psicología, Universitat de València, 46010 Valencia, Spain.
| | - Gemma García-Soriano
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, Universitat de València, 46010 Valencia, Spain.
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Brown C, Shahab R, Collins K, Fleysher L, Goodman WK, Burdick KE, Stern ER. Functional neural mechanisms of sensory phenomena in obsessive-compulsive disorder. J Psychiatr Res 2019; 109:68-75. [PMID: 30508745 PMCID: PMC6347462 DOI: 10.1016/j.jpsychires.2018.11.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 11/02/2018] [Accepted: 11/20/2018] [Indexed: 11/24/2022]
Abstract
Sensory phenomena (SP) are aversive or uncomfortable sensations that accompany and/or drive repetitive behaviors in obsessive-compulsive disorder (OCD). Although SP are associated with significant distress and may respond less well to standard treatments than harm-related obsessions, little is known about their underlying neurobiology. The present study used functional magnetic resonance imaging (fMRI) to measure brain functioning related to severity of SP during a "body-focused" videos task designed to elicit activation in sensorimotor brain regions. Regression analysis examined the relationship between severity of SP and activation during task using permutation analysis, cluster-level corrected for multiple comparisons (family-wise error rate p < 0.05). The distribution of SP severity was not significantly different from normal, with both high- and low-severity scores represented in the OCD sample. Severity of SP was not correlated with other clinical symptoms in OCD including general anxiety, depression, or harm avoidance. When viewing body-focused videos, patients with greater severity of SP showed increased activity in the mid-posterior insula, a relationship that remained significant when controlling for other clinical symptoms, medication status, and comorbidities. At uncorrected thresholds, SP severity was also positively related to somatosensory, mid orbitofrontal, and lateral prefrontal cortical activity. These data suggest that SP in OCD are dissociable from other symptoms in the disorder and related to hyperactivation of the insula. Future work examining neural mechanisms of SP across different disorders (tics, trichotillomania) as well as with other imaging modalities will be needed to further understand the neurobiology of these impairing symptoms.
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Affiliation(s)
- Carina Brown
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA; Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Rebbia Shahab
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA; Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Katherine Collins
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lazar Fleysher
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Wayne K Goodman
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | | | - Emily R Stern
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA; Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA.
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8
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Fontenelle LF, Frydman I, Hoefle S, Oliveira-Souza R, Vigne P, Bortolini TS, Suo C, Yücel M, Mattos P, Moll J. Decoding moral emotions in obsessive-compulsive disorder. Neuroimage Clin 2018; 19:82-89. [PMID: 30035005 PMCID: PMC6051311 DOI: 10.1016/j.nicl.2018.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/07/2018] [Accepted: 04/01/2018] [Indexed: 11/20/2022]
Abstract
Background Patients with obsessive-compulsive disorder (OCD) exhibit abnormal neural responses when they experience particular emotions or when they evaluate stimuli with emotional value. Whether these brain responses are sufficiently distinctive to discriminate between OCD patients and healthy controls is unknown. The present study is the first to investigate the discriminative power of multivariate pattern analysis of regional fMRI responses to moral and non-moral emotions. Method To accomplish this goal, we performed a searchlight-based multivariate pattern analysis to unveil brain regions that could discriminate 18 OCD patients from 18 matched healthy controls during provoked guilt, disgust, compassion, and anger. We also investigated the existence of distinctive neural patterns while combining those four emotions (herein termed multiemotion analysis). Results We found that different frontostriatal regions discriminated OCD patients from controls based on individual emotional experiences. Most notably, the left nucleus accumbens (NAcc) discriminated OCD patients from controls during both disgust and the multiemotion analysis. Among other regions, the angular gyrus responses to anger and the lingual and the middle temporal gyri in the multi-emotion analysis were highly discriminant between samples. Additional BOLD analyses supported the directionality of these findings. Conclusions In line with previous studies, differential activity in regions beyond the frontostriatal circuitry differentiates OCD from healthy volunteers. The finding that the response of the left NAcc to different basic and moral emotions is highly discriminative for a diagnosis of OCD confirms current pathophysiological models and points to new venues of research.
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Affiliation(s)
- Leonardo F Fontenelle
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil; Brain & Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia; Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil.
| | - Ilana Frydman
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil; Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Sebastian Hoefle
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | | | - Paula Vigne
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil; Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Tiago S Bortolini
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Chao Suo
- Brain & Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia
| | - Murat Yücel
- Brain & Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia
| | - Paulo Mattos
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Jorge Moll
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
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Bhikram T, Abi-Jaoude E, Sandor P. OCD: obsessive-compulsive … disgust? The role of disgust in obsessive-compulsive disorder. J Psychiatry Neurosci 2017; 42:300-306. [PMID: 28375077 PMCID: PMC5573572 DOI: 10.1503/jpn.160079] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Recent research has identified the important role of disgust in the symptomatology of obsessive-compulsive disorder (OCD). Exaggerated and inappropriate disgust reactions may drive some of the symptoms of OCD, and in some cases, may even eclipse feelings of anxiety. This paper reviews behavioural and neuroimaging research that recognizes the prominent role of disgust in contributing to OCD symptoms, especially contamination-based symptoms. We discuss how elevated behavioural and biological markers of disgust reported in OCD populations support the need for alternative clinical treatment strategies and theoretical models of OCD.
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Affiliation(s)
- Tracy Bhikram
- Correspondence to: T. Bhikram, University Health Network, Tourette Syndrome Neurodevelopmental Clinic, 399 Bathurst St, Toronto, ON M5T 2S8;
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10
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Olatunji BO, Armstrong T, Elwood L. Is Disgust Proneness Associated With Anxiety and Related Disorders? A Qualitative Review and Meta-Analysis of Group Comparison and Correlational Studies. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2017. [DOI: 10.1177/1745691616688879] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Research suggests that disgust may be linked to the etiology of some anxiety-related disorders. The present investigation reviews this literature and employs separate meta-analyses of clinical group comparison and correlational studies to examine the association between disgust proneness and anxiety-related disorder symptoms. Meta-analysis of 43 group comparison studies revealed those high in anxiety disorder symptoms reported significantly more disgust proneness than those low in anxiety symptoms. Although this effect was not moderated by clinical versus analogue studies or type of disorder, larger group differences were observed for those high in anxiety symptoms associated with contagion concerns compared to those high in anxiety symptoms not associated with contagion concerns. Similarly, meta-analysis of correlational data across 83 samples revealed moderate associations between disgust proneness and anxiety-related disorder symptoms. Moderator analysis revealed that the association between disgust proneness and anxiety-related disorder symptoms was especially robust for anxiety symptoms associated with contagion concerns. After controlling for measures of negative affect, disgust proneness continued to be moderately correlated with anxiety-related disorder symptoms. However, negative affect was no longer significantly associated with symptoms of anxiety-related disorders when controlling for disgust proneness. The implications of these findings are discussed in the context of a novel transdiagnostic model.
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11
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Core, social and moral disgust are bounded: A review on behavioral and neural bases of repugnance in clinical disorders. Neurosci Biobehav Rev 2017; 80:185-200. [PMID: 28506923 DOI: 10.1016/j.neubiorev.2017.05.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 04/19/2017] [Accepted: 05/09/2017] [Indexed: 12/12/2022]
Abstract
Disgust is a multifaceted experience that might affect several aspects of life. Here, we reviewed research on neurological and psychiatric disorders that are characterized by abnormal disgust processing to test the hypothesis of a shared neurocognitive architecture in the representation of three disgust domains: i) personal experience of 'core disgust'; ii) social disgust, i.e., sensitivity to others' expressions of disgust; iii) moral disgust, i.e., sensitivity to ethical violations. Our review provides some support to the shared neurocognitive hypothesis and suggests that the insula might be the "hub" structure linking the three domains of disgust sensitivity, while other brain regions may subserve specific facets of the multidimensional experience. Our review also suggests a role of serotonin core and moral disgust, supporting "neo-sentimentalist" theories of morality, which posit a causal role of affect in moral judgment.
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12
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Berlin HA, Stern ER, Ng J, Zhang S, Rosenthal D, Turetzky R, Tang C, Goodman W. Altered olfactory processing and increased insula activity in patients with obsessive-compulsive disorder: An fMRI study. Psychiatry Res 2017; 262:15-24. [PMID: 28208068 PMCID: PMC5373557 DOI: 10.1016/j.pscychresns.2017.01.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 01/14/2017] [Accepted: 01/18/2017] [Indexed: 12/19/2022]
Abstract
Obsessive-compulsive disorder (OCD) patients show increased insula activation to disgust-inducing images compared to healthy controls (HC). We explored whether this disgust reactivity was also present in the olfactory domain by conducting the first fMRI study of olfaction in OCD. Neural activation in response to pleasant and unpleasant odors (vs. unscented air) was investigated in 15 OCD and 15 HC participants using fMRI. OCD participants (vs. HC) had increased left anterior insula activation to unpleasant odors (vs. unscented air), which positively correlated with their disgust sensitivity and ratings of the unpleasantness and intensity of those odors. OCD participants (vs. HC) showed increased activation of caudate nucleus and left anterior and posterior insula to pleasant odors (vs. unscented air), which positively correlated with their OCD symptom severity, trait anxiety, frequency of feeling disgust, and odor intensity ratings. OCD participants had increased anterior insula activation to both pleasant and unpleasant odors, which correlated with their OCD symptoms, anxiety, disgust sensitivity, and frequency of feeling disgust. OCD patients might have a negative cognitive bias and experience all stimuli, regardless of valence, as being more unpleasant than healthy people. These findings further elucidate the neural underpinnings of OCD and may contribute to more effective treatments.
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Affiliation(s)
- Heather A Berlin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Emily R Stern
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Johnny Ng
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sam Zhang
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Rosenthal
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Turetzky
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cheuk Tang
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Wayne Goodman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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13
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Gibson WS, Cho S, Abulseoud OA, Gorny KR, Felmlee JP, Welker KM, Klassen BT, Min HK, Lee KH. The Impact of Mirth-Inducing Ventral Striatal Deep Brain Stimulation on Functional and Effective Connectivity. Cereb Cortex 2017; 27:2183-2194. [PMID: 27001680 DOI: 10.1093/cercor/bhw074] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) is an investigational therapy for treatment-resistant obsessive-compulsive disorder. The ability of VC/VS DBS to evoke spontaneous mirth in patients, often accompanied by smiling and laughter, is clinically well documented. However, the neural correlates of DBS-evoked mirth remain poorly characterized. Patients undergoing VC/VS DBS surgery underwent intraoperative evaluation in which mirth-inducing and non-mirth-inducing stimulation localizations were identified. Using dynamic causal modeling (DCM) for fMRI, the effect of mirth-inducing DBS on functional and effective connectivity among established nodes in limbic cortico-striato-thalamo-cortical (CSTC) circuitry was investigated. Both mirth-inducing and non-mirth-inducing VC/VS DBS consistently resulted (conjunction, global null, family-wise error-corrected P < 0.05) in activation of amygdala, ventral striatum, and mediodorsal thalamus. However, only mirth-inducing DBS resulted in functional inhibition of anterior cingulate cortex. Dynamic causal modeling revealed that mirth-inducing DBS enhanced effective connectivity from anterior cingulate to ventral striatum, while attenuating connectivity from thalamus to ventral striatum relative to non-mirth-inducing stimulation. These results suggest that DBS-evoked mood elevation is accompanied by distinct patterns of limbic thalamocortical connectivity. Using the novel combination of DBS-evoked mood alteration and functional MRI in human subjects, we provide new insights into the network-level mechanisms that influence affect.
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Affiliation(s)
| | | | - Osama A Abulseoud
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55906, USA.,National Institute on Drug Abuse, Baltimore, MD 21224, USA
| | | | | | | | | | - Hoon-Ki Min
- Department of Neurologic Surgery.,Department of Radiology.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Kendall H Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, US.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
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14
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Brooks SJ, Stein DJ. A systematic review of the neural bases of psychotherapy for anxiety and related disorders. DIALOGUES IN CLINICAL NEUROSCIENCE 2016. [PMID: 26487807 PMCID: PMC4610611 DOI: 10.31887/dcns.2015.17.3/sbrooks] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Brain imaging studies over two decades have delineated the neural circuitry of anxiety and related disorders, particularly regions involved in fear processing and in obsessive-compulsive symptoms. The neural circuitry of fear processing involves the amygdala, anterior cingulate, and insular cortex, while cortico-striatal-thalamic circuitry plays a key role in obsessive-compulsive disorder. More recently, neuroimaging studies have examined how psychotherapy for anxiety and related disorders impacts on these neural circuits. Here we conduct a systematic review of the findings of such work, which yielded 19 functional magnetic resonance imaging studies examining the neural bases of cognitive-behavioral therapy (CBT) in 509 patients with anxiety and related disorders. We conclude that, although each of these related disorders is mediated by somewhat different neural circuitry, CBT may act in a similar way to increase prefrontal control of subcortical structures. These findings are consistent with an emphasis in cognitive-affective neuroscience on the potential therapeutic value of enhancing emotional regulation in various psychiatric conditions.
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Affiliation(s)
- Samantha J Brooks
- UCT Department of Psychiatry and Mental Health, Grotte Schuur Hospital, Observatory, Cape Town, South Africa
| | - Dan J Stein
- UCT Department of Psychiatry and Mental Health, Grotte Schuur Hospital, Observatory, Cape Town, South Africa; MRC Unit on Anxiety & Stress Disorders, Cape Town, South Africa
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15
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Widen SC, Olatunji BO. A Developmental Perspective on Disgust: Implications for Obsessive-Compulsive Disorder. Curr Behav Neurosci Rep 2016. [DOI: 10.1007/s40473-016-0087-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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16
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Duncko R, Veale D. Changes in disgust and heart rate during exposure for Obsessive Compulsive Disorder: A case series. J Behav Ther Exp Psychiatry 2016; 51:92-9. [PMID: 26803230 DOI: 10.1016/j.jbtep.2016.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/26/2015] [Accepted: 01/10/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND OBJECTIVES The emotion of disgust has been suggested as a factor contributing to a poor response to Cognitive Behaviour Therapy (CBT) in the treatment of Obsessive Compulsive Disorder (OCD). However, only limited information is available about the phenomenology of disgust in clinical OCD and the physiological mechanisms involved. This case series was designed to explore the phenomenology of OCD and the physiological activity associated with the emotion of disgust. METHODS State disgust and heart rate was measured in eleven participants attending treatment for OCD during exposure relevant to their individual formulation. RESULTS All participants with contamination and most patients with blood and injury related fears experienced a prominent increase in state disgust during exposure. These participants also had absent heart rate acceleration during exposure. Disgust response correlated with heart rate response (r = -0.63, p < 0.01) and Root Mean Square of Successive Differences (RMSSD) (r = 0.52, p < 0.01). LIMITATIONS The design using ecologically valid stimuli and the limited number of participants did not allow between subject comparisons or more detailed analysis of relationship between trait and state disgust and between disgust and severity of OCD. CONCLUSIONS Our findings show that a large proportion of our case series with OCD experience prominent disgust with signs of increased vagal tonus during their exposure. Such experiences differ from the concept of adrenergic activation used for psychoeducation in CBT and appraisals of harm and this may result in poorer therapeutic outcome.
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Affiliation(s)
- Roman Duncko
- South London and Maudsley NHS Foundation Trust, UK; Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK.
| | - David Veale
- South London and Maudsley NHS Foundation Trust, UK; Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
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17
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Stein DJ, Hermesh H, Eilam D, Segalas C, Zohar J, Menchon J, Nesse RM. Human compulsivity: A perspective from evolutionary medicine. Eur Neuropsychopharmacol 2016; 26:869-76. [PMID: 26723168 DOI: 10.1016/j.euroneuro.2015.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 10/25/2015] [Accepted: 12/01/2015] [Indexed: 01/15/2023]
Abstract
Biological explanations address not only proximal mechanisms (for example, the underlying neurobiology of obsessive-compulsive disorder), but also distal mechanisms (that is, a consideration of how particular neurobiological mechanisms evolved). Evolutionary medicine has emphasized a series of explanations for vulnerability to disease, including constraints, mismatch, and tradeoffs. The current paper will consider compulsive symptoms in obsessive-compulsive and related disorders and behavioral addictions from this evolutionary perspective. It will argue that while obsessive-compulsive disorder (OCD) is typically best conceptualized as a dysfunction, it is theoretically and clinically valuable to understand some symptoms of obsessive-compulsive and related disorders in terms of useful defenses. The symptoms of behavioral addictions can also be conceptualized in evolutionary terms (for example, mismatch), which in turn provides a sound foundation for approaching assessment and intervention.
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Affiliation(s)
- Dan J Stein
- Department of Psychiatry, University of Cape Town, South Africa.
| | | | - David Eilam
- Department of Zoology, Tel-Aviv University, Israel
| | - Cosi Segalas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Cibersam, University of Barcelona, Spain
| | - Joseph Zohar
- Department of Psychiatry, Chaim Sheba Medical Centre, Israel
| | - Jose Menchon
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Cibersam, University of Barcelona, Spain
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18
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Wood J, Ahmari SE. A Framework for Understanding the Emerging Role of Corticolimbic-Ventral Striatal Networks in OCD-Associated Repetitive Behaviors. Front Syst Neurosci 2015; 9:171. [PMID: 26733823 PMCID: PMC4681810 DOI: 10.3389/fnsys.2015.00171] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/23/2015] [Indexed: 11/13/2022] Open
Abstract
Significant interest in the mechanistic underpinnings of obsessive-compulsive disorder (OCD) has fueled research on the neural origins of compulsive behaviors. Converging clinical and preclinical evidence suggests that abnormal repetitive behaviors are driven by dysfunction in cortico-striatal-thalamic-cortical (CSTC) circuits. These findings suggest that compulsive behaviors arise, in part, from aberrant communication between lateral orbitofrontal cortex (OFC) and dorsal striatum. An important body of work focused on the role of this network in OCD has been instrumental to progress in the field. Disease models focused primarily on these regions, however, fail to capture an important aspect of the disorder: affective dysregulation. High levels of anxiety are extremely prevalent in OCD, as is comorbidity with major depressive disorder. Furthermore, deficits in processing rewards and abnormalities in processing emotional stimuli are suggestive of aberrant encoding of affective information. Accordingly, OCD can be partially characterized as a disease in which behavioral selection is corrupted by exaggerated or dysregulated emotional states. This suggests that the networks producing OCD symptoms likely expand beyond traditional lateral OFC and dorsal striatum circuit models, and highlights the need to cast a wider net in our investigation of the circuits involved in generating and sustaining OCD symptoms. Here, we address the emerging role of medial OFC, amygdala, and ventral tegmental area projections to the ventral striatum (VS) in OCD pathophysiology. The VS receives strong innervation from these affect and reward processing regions, and is therefore poised to integrate information crucial to the generation of compulsive behaviors. Though it complements functions of dorsal striatum and lateral OFC, this corticolimbic-VS network is less commonly explored as a potential source of the pathology underlying OCD. In this review, we discuss this network's potential role as a locus of OCD pathology and effective treatment.
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Affiliation(s)
- Jesse Wood
- Translational Neuroscience Program, Department of Psychiatry, University of PittsburghPittsburgh, PA, USA
- Center for Neuroscience, University of PittsburghPittsburgh, PA, USA
| | - Susanne E. Ahmari
- Translational Neuroscience Program, Department of Psychiatry, University of PittsburghPittsburgh, PA, USA
- Center for Neuroscience, University of PittsburghPittsburgh, PA, USA
- Center for the Neural Basis of Cognition, University of PittsburghPittsburgh, PA, USA
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19
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Berlin HA, Schulz KP, Zhang S, Turetzky R, Rosenthal D, Goodman W. Neural correlates of emotional response inhibition in obsessive-compulsive disorder: A preliminary study. Psychiatry Res 2015; 234:259-64. [PMID: 26456416 DOI: 10.1016/j.pscychresns.2015.09.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 09/27/2015] [Accepted: 09/27/2015] [Indexed: 10/23/2022]
Abstract
Failure to inhibit recurrent anxiety-provoking thoughts is a central symptom of obsessive-compulsive disorder (OCD). Neuroimaging studies suggest inhibitory control and disgust processing abnormalities in patients with OCD. However, the emotional modulation of response inhibition deficits in OCD and their neural correlates remain to be elucidated. For this preliminary study we administered an adapted affective response inhibition paradigm, an emotional go/no-go task, during fMRI to characterize the neural systems underlying disgust-related and fear-related inhibition in nine adults with contamination-type OCD compared to ten matched healthy controls. Participants with OCD had significantly greater anterior insula cortex activation when inhibiting responses to both disgusting (bilateral), and fearful (right-sided) images, compared to healthy controls. They also had increased activation in several frontal, temporal, and parietal regions, but there was no evidence of amygdala activation in OCD or healthy participants and no significant between-group differences in performance on the emotion go/no-go task. The anterior insula appears to play a central role in the emotional modulation of response inhibition in contamination-type OCD to both fearful and disgusting images. The insula may serve as a potential treatment target for contamination-type OCD.
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Affiliation(s)
- Heather A Berlin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Kurt P Schulz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sam Zhang
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Turetzky
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Rosenthal
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Wayne Goodman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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20
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Buyukturkoglu K, Roettgers H, Sommer J, Rana M, Dietzsch L, Arikan EB, Veit R, Malekshahi R, Kircher T, Birbaumer N, Sitaram R, Ruiz S. Self-Regulation of Anterior Insula with Real-Time fMRI and Its Behavioral Effects in Obsessive-Compulsive Disorder: A Feasibility Study. PLoS One 2015; 10:e0135872. [PMID: 26301829 PMCID: PMC4547706 DOI: 10.1371/journal.pone.0135872] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 07/27/2015] [Indexed: 11/27/2022] Open
Abstract
Introduction Obsessive-compulsive disorder (OCD) is a common and chronic condition that can have disabling effects throughout the patient's lifespan. Frequent symptoms among OCD patients include fear of contamination and washing compulsions. Several studies have shown a link between contamination fears, disgust over-reactivity, and insula activation in OCD. In concordance with the role of insula in disgust processing, new neural models based on neuroimaging studies suggest that abnormally high activations of insula could be implicated in OCD psychopathology, at least in the subgroup of patients with contamination fears and washing compulsions. Methods In the current study, we used a Brain Computer Interface (BCI) based on real-time functional magnetic resonance imaging (rtfMRI) to aid OCD patients to achieve down-regulation of the Blood Oxygenation Level Dependent (BOLD) signal in anterior insula. Our first aim was to investigate whether patients with contamination obsessions and washing compulsions can learn to volitionally decrease (down-regulate) activity in the insula in the presence of disgust/anxiety provoking stimuli. Our second aim was to evaluate the effect of down-regulation on clinical, behavioural and physiological changes pertaining to OCD symptoms. Hence, several pre- and post-training measures were performed, i.e., confronting the patient with a disgust/anxiety inducing real-world object (Ecological Disgust Test), and subjective rating and physiological responses (heart rate, skin conductance level) of disgust towards provoking pictures. Results Results of this pilot study, performed in 3 patients (2 females), show that OCD patients can gain self-control of the BOLD activity of insula, albeit to different degrees. In two patients positive changes in behaviour in the EDT were observed following the rtfMRI trainings. Behavioural changes were also confirmed by reductions in the negative valence and in the subjective perception of disgust towards symptom provoking images. Conclusion Although preliminary, results of this study confirmed that insula down-regulation is possible in patients suffering from OCD, and that volitional decreases of insula activation could be used for symptom alleviation in this disorder.
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Affiliation(s)
- Korhan Buyukturkoglu
- Graduate School of Neural & Behavioural Sciences, International Max Planck Research School, University of Tübingen, Tuebingen, Germany
- Institute for Medical Psychology and Behavioural Neurobiology, University of Tuebingen, Tuebingen, Germany
| | - Hans Roettgers
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Jens Sommer
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Mohit Rana
- Graduate School of Neural & Behavioural Sciences, International Max Planck Research School, University of Tübingen, Tuebingen, Germany
- Institute for Medical Psychology and Behavioural Neurobiology, University of Tuebingen, Tuebingen, Germany
- Department of Biomedical Engineering, University of Florida, Gainesville, Florida, United States of America
| | - Leonie Dietzsch
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Ezgi Belkis Arikan
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Ralf Veit
- Institute for Medical Psychology and Behavioural Neurobiology, University of Tuebingen, Tuebingen, Germany
| | - Rahim Malekshahi
- Graduate School of Neural & Behavioural Sciences, International Max Planck Research School, University of Tübingen, Tuebingen, Germany
- Institute for Medical Psychology and Behavioural Neurobiology, University of Tuebingen, Tuebingen, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Niels Birbaumer
- Institute for Medical Psychology and Behavioural Neurobiology, University of Tuebingen, Tuebingen, Germany
- Ospedale San Camillo, Istituto di Ricovero e Cura a Carattere Scientifico, Venezia, Italy
| | - Ranganatha Sitaram
- Institute for Medical Psychology and Behavioural Neurobiology, University of Tuebingen, Tuebingen, Germany
- Department of Biomedical Engineering, University of Florida, Gainesville, Florida, United States of America
- * E-mail: (SR); (RS)
| | - Sergio Ruiz
- Institute for Medical Psychology and Behavioural Neurobiology, University of Tuebingen, Tuebingen, Germany
- Departamento de Psiquiatría, Escuela de Medicina, Centro Interdisciplinario de Neurociencia, Pontificia Universidad Católica de Chile, Santiago, Chile
- * E-mail: (SR); (RS)
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21
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Ludvik D, Boschen MJ, Neumann DL. Effective behavioural strategies for reducing disgust in contamination-related OCD: A review. Clin Psychol Rev 2015; 42:116-29. [PMID: 26190372 DOI: 10.1016/j.cpr.2015.07.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 05/19/2015] [Accepted: 07/01/2015] [Indexed: 11/29/2022]
Abstract
Disgust is an understudied but important emotion in various psychological disorders. Over the last decade, increasing evidence suggests that disgust is also present in various subtypes of obsessive-compulsive disorder (OCD), especially in contamination-related OCD (C-OCD). The treatment of choice for C-OCD is exposure with response prevention, originally designed to reduce fear-associated emotions thought to be acquired through Pavlovian conditioning (PC). However, disgust has been proposed to be acquired through evaluative conditioning (EC) and according to the referential model of this form of learning, there are functional differences between PC and EC that need to be considered in the treatment of disgust-related responses. Alternative strategies suggested by EC-based models include counterconditioning (contingent presentation of the CS with a US of opposite valence) and US revaluation (contingent presentation of the US with US of opposite valence). Drawing on the referential model, this paper reviews evidence for the effectiveness of each strategy to identify the most theoretically sound and empirically valid intervention to reduce disgust in C-OCD.
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Affiliation(s)
- Dominika Ludvik
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Gold Coast 4222, Australia.
| | - Mark J Boschen
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Gold Coast 4222, Australia.
| | - David L Neumann
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Gold Coast 4222, Australia.
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22
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Abstract
Despite the effort on DSM-5 and ICD-11, few appear satisfied with these classification systems. We suggest that the core reason for dissatisfaction is expecting too much from them; they do not provide discrete categories that map to specific causes of disease, they describe clinical syndromes intended to guide treatment choices. Here we review work on anxiety and anxiety disorders to argue that while clinicians draw a pragmatic distinction between normal and abnormal emotions based on considerations such as severity and duration, understanding the evolutionary origins and utility of the emotions, including the adaptive value of adverse emotions, is key for formulating comprehensive assessments of an individual patient’s symptoms and for providing a conceptual foundation for pharmacotherapy, psychotherapy, and public health.
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Affiliation(s)
- Dan J. Stein
- Department of Psychiatry and MRC Unit on Anxiety & Stress Disorders, University of Cape Town, South Africa
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23
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Williams NR, Taylor JJ, Lamb K, Hanlon CA, Short EB, George MS. Role of functional imaging in the development and refinement of invasive neuromodulation for psychiatric disorders. World J Radiol 2014; 6:756-778. [PMID: 25349661 PMCID: PMC4209423 DOI: 10.4329/wjr.v6.i10.756] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/17/2014] [Accepted: 08/31/2014] [Indexed: 02/07/2023] Open
Abstract
Deep brain stimulation (DBS) is emerging as a powerful tool for the alleviation of targeted symptoms in treatment-resistant neuropsychiatric disorders. Despite the expanding use of neuropsychiatric DBS, the mechanisms responsible for its effects are only starting to be elucidated. Several modalities such as quantitative electroencephalography as well a intraoperative recordings have been utilized to attempt to understand the underpinnings of this new treatment modality, but functional imaging appears to offer several unique advantages. Functional imaging techniques like positron emission tomography, single photon emission computed tomography and functional magnetic resonance imaging have been used to examine the effects of focal DBS on activity in a distributed neural network. These investigations are critical for advancing the field of invasive neuromodulation in a safe and effective manner, particularly in terms of defining the neuroanatomical targets and refining the stimulation protocols. The purpose of this review is to summarize the current functional neuroimaging findings from neuropsychiatric DBS implantation for three disorders: treatment-resistant depression, obsessive-compulsive disorder, and Tourette syndrome. All of the major targets will be discussed (Nucleus accumbens, anterior limb of internal capsule, subcallosal cingulate, Subthalamic nucleus, Centromedial nucleus of the thalamus-Parafasicular complex, frontal pole, and dorsolateral prefrontal cortex). We will also address some apparent inconsistencies within this literature, and suggest potential future directions for this promising area.
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Stern ER. Neural Circuitry of Interoception: New Insights into Anxiety and Obsessive-Compulsive Disorders. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2014; 1:235-247. [PMID: 33344105 PMCID: PMC7747958 DOI: 10.1007/s40501-014-0019-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Over the past century, much research has investigated how the brain processes signals from the body (interoception) and how this processing may be disturbed in patients with psychiatric disorders. In this paper, I discuss the literature examining the relationship between interoceptive awareness and emotional and cognitive processes, and review the evidence suggesting that anxiety and obsessive-compulsive disorder (OCD) are characterized by abnormal interoception. A network of cortical and subcortical brain regions centered on the insula has repeatedly been implicated in interoception and is abnormal in anxiety and OCD. The investigation of interoception provides a framework for understanding behavioral and neural mechanisms of anxiety and OCD, although additional research is needed to directly link insula functioning to aberrant interoception in these disorders. Future work targeting interoception may be useful for the development of novel treatments.
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Affiliation(s)
- Emily R. Stern
- Department of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place( Box 1230, New York, NY 11105, USA
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25
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Olbrich S, Olbrich H, Adamaszek M, Jahn I, Hegerl U, Stengler K. Altered EEG lagged coherence during rest in obsessive-compulsive disorder. Clin Neurophysiol 2013; 124:2421-30. [PMID: 23968842 DOI: 10.1016/j.clinph.2013.05.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 05/01/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Functional magnetic resonance imaging (fMRI) studies found alterations of functional connectivity in obsessive compulsive disorder (OCD). However, there is little knowledge about region of interest (ROI) based electroencephalogram (EEG) connectivity, i.e. lagged non-linear and linear coherence in OCD. Goal of this study was to compare these EEG measures during rest and at different vigilance stages between patients and healthy controls (HC). METHODS A 15 min resting-state EEG was recorded in 30 unmedicated patients and 30 matched HC. Intracortical lagged non-linear coherence of the main EEG-frequency bands within a set of frontal ROIs and within the default mode network (DMN) were computed and compared using intracortical exact low resolution electromagnetic tomography (eLORETA) software. RESULTS Lagged non-linear but not linear coherence was significantly decreased for patients in comparison to HC for the beta 2 frequency between frontal brain areas but not within the DMN. When analysing separate EEG-vigilance stages, only high vigilance stages yielded decreased frontal phase synchronisation at beta and theta frequencies. CONCLUSIONS The results underline an altered neuronal communication within frontal brain areas during rest in OCD. SIGNIFICANCE These findings encourage further research on connectivity measures as possible biomarkers for physiological homogeneous subgroups.
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Affiliation(s)
- Sebastian Olbrich
- Clinic for Psychiatry and Psychotherapy, University Hospital Leipzig, Germany; LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Germany.
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Broderick J, Grisham JR, Weidemann G. Disgust and fear responding in contamination-based obsessive-compulsive disorder during pictorial exposure. Behav Ther 2013; 44:27-38. [PMID: 23312424 DOI: 10.1016/j.beth.2012.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 04/12/2012] [Accepted: 05/30/2012] [Indexed: 11/15/2022]
Abstract
The emotion of disgust has been implicated in the development and maintenance of contamination-based obsessive-compulsive disorder (OCD). In the present study nonclinical participants with high (n=26) and low (n=28) levels of OCD contamination symptoms were exposed to 2 categories of disgust stimuli (blood injury and body waste) across 4 blocks using standardized disgust images. Self-report disgust and fear were recorded, as well as cardiovascular heart rate. In both groups, an initial primary disgust reaction was observed. Self-report disgust and fear, but not heart rate deceleration, was greater in the high symptom group. The high symptom group showed reductions in heart rate deceleration, whereas the low symptom group did not. Significant differences in self-report changes across time were observed between the groups, with fear increasing to a greater extent for high contamination fearful individuals when viewing body waste images. The implications of these findings for theoretical models and clinical treatment of OCD with prominent contamination symptoms are discussed.
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Affiliation(s)
- Joshua Broderick
- School of Psychology, University of New South Wales, Sydney, NSW 2052 Australia.
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Kang JI, Kim SJ, Cho HJ, Jhung K, Lee SY, Lee E, An SK. Psychometric analysis of the Korean version of the Disgust Scale-Revised. Compr Psychiatry 2012; 53:648-55. [PMID: 21831367 DOI: 10.1016/j.comppsych.2011.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 06/13/2011] [Accepted: 06/18/2011] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Disgust is a basic emotion associated with feelings of revulsion and withdrawal behaviors from dangerous situations. The aim of this study was to examine the psychometric properties of the Disgust Scale--Revised (DS-R), a tool designed to measure individuals' responses to various disgust-provoking situations, among Korean populations. METHODS A sample of 1117 healthy volunteers completed self-report questionnaires containing the 27-item DS-R. A subsample (n = 231) completed the Temperament and Character Inventory (TCI), Eysenck Personality Questionnaire (EPQ), and State-Trait Anxiety Inventory (STAI). Principal component analysis using a varimax rotation was conducted. Construct validity was assessed using Pearson correlation analysis for the TCI, EPQ, and STAI. To examine differences in responses on the DS-R among populations, patients with obsessive-compulsive disorder were compared with healthy subjects who were matched with respect to age and sex. RESULTS The Cronbach α estimates for total items and the 3 original subscales of the DS-R, including: core disgust, animal reminder disgust, and contamination-based disgust, were 0.86, 0.77, 0.80, and 0.55, respectively. Principal component analysis identified 5 factors, which accounted for 48% of the total variance of the scale. The 5 newly developed dimensions were labeled as core disgust-touch, core disgust-dirt, contamination-based disgust, animal reminder disgust, and social intolerance disgust. The Cronbach α coefficients were 0.79, 0.64, 0.46, 0.77, and 0.34, respectively, for these subscales. The DS-R was correlated positively with harm avoidance from the TCI, neuroticism from the EPQ, and the anxiety scores of STAI. Furthermore, the contamination-based disgust scores for patients with obsessive-compulsive disorder were higher than those of normal controls. CONCLUSION The DS-R may be a reliable, valid, and acceptable tool to measure disgust sensitivity among Korean populations. The psychometric properties of the Korean version of the DS-R and the original DS-R are discussed.
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Affiliation(s)
- Jee In Kang
- Department of Psychiatry, Ilsan Hospital, National Health Insurance Corporation, Goyang, 410-719 South Korea
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Rector NA, Daros AR, Bradbury CL, Richter MA. Disgust recognition in obsessive-compulsive disorder: diagnostic comparisons and posttreatment effects. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:177-83. [PMID: 22398004 DOI: 10.1177/070674371205700307] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine whether disgust recognition deficits are present and specific to obsessive-compulsive disorder (OCD), and the extent to which this deficit, if present, can be reduced in cognitive-behavioural therapy (CBT). METHOD Responses to the Pictures of Facial Affect (POFA) were examined in patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosed OCD (n = 20), panic disorder with agoraphobia (PDA; n = 15), and generalized social phobia (GSP; n = 15) and a second, independent OCD sample of treatment responders to CBT (n = 11). RESULTS There were significant and statistically large disgust recognition differences between the OCD group and comparison PDA and GSP groups. However, patients with OCD treated with CBT showed disgust recognition scores that were equivalent to the PDA and GSP groups, significantly better than the untreated OCD sample, and equivalent to scores from the original POFA nonaffected standardization sample. CONCLUSIONS These results provide support for the presence of disgust recognition impairment in OCD, and provide preliminary evidence that disgust recognition impairments may improve with treatment.
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Affiliation(s)
- Neil A Rector
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario.
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Benetti S, McCrory E, Arulanantham S, De Sanctis T, McGuire P, Mechelli A. Attachment style, affective loss and gray matter volume: a voxel-based morphometry study. Hum Brain Mapp 2011; 31:1482-9. [PMID: 20127871 DOI: 10.1002/hbm.20954] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Early patterns of infant attachment have been shown to be an important influence on adult social behavior. Animal studies suggest that patterns of early attachment influence brain development, contributing to permanent alterations in neural structure; however, there are no previous studies investigating whether differences in attachment style are associated with differences in brain structure in humans. In this study, we used Magnetic Resonance Imaging (MRI) and voxel-based morphometry (VBM) to examine for the first time the association between attachment style, affective loss (for example, death of a loved one) and gray matter volume in a healthy sample of adults (n = 32). Attachment style was assessed on two dimensions (anxious and avoidant) using the ECR-Revised questionnaire. High attachment-related anxiety was associated with decreased gray matter in the anterior temporal pole and increased gray matter in the left lateral orbital gyrus. A greater number of affective losses was associated with increased gray matter volume in the cerebellum; in this region, however, the impact of affective losses was significantly moderated by the level of attachment-related avoidance. These findings indicate that differences in attachment style are associated with differences in the neural structure of regions implicated in emotion regulation. It is hypothesized that early attachment experience may contribute to structural brain differences associated with attachment style in adulthood; furthermore, these findings point to a neuronal mechanism through which attachment style may mediate individual differences in responses to affective loss.
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Affiliation(s)
- Stefania Benetti
- Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, London SE5 8AF, United Kingdom
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Stein DJ, Nesse RM. Threat detection, precautionary responses, and anxiety disorders. Neurosci Biobehav Rev 2010; 35:1075-9. [PMID: 21147162 DOI: 10.1016/j.neubiorev.2010.11.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 11/27/2010] [Accepted: 11/29/2010] [Indexed: 11/29/2022]
Abstract
Study of the anxiety disorders may be a particularly useful vehicle for demonstrating how foundational sciences (e.g. cognitive-affective neuroscience, evolutionary psychology) can advance psychiatric theory and research. Here we consider important potential advances and remaining future challenges when basic research on threat detection and precautionary responses is used to address the anxiety disorders. We emphasize the potential value of a model of threat detection and precautionary responses that integrates cognitive-affective neuroscience and evolutionary approaches for understanding the anxiety disorders. However, we also suggest that substantial additional work is needed in order to link systematically the psychobiological mechanisms posited by basic work on threat detection and precautionary responses to the complex phenomena seen in the clinic.
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Affiliation(s)
- Dan J Stein
- University of Cape Town, Cape Town, South Africa.
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Wobrock T, Gruber O, McIntosh AM, Kraft S, Klinghardt A, Scherk H, Reith W, Schneider-Axmann T, Lawrie SM, Falkai P, Moorhead TW. Reduced prefrontal gyrification in obsessive-compulsive disorder. Eur Arch Psychiatry Clin Neurosci 2010; 260:455-64. [PMID: 20112027 PMCID: PMC2940041 DOI: 10.1007/s00406-009-0096-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 12/23/2009] [Indexed: 12/01/2022]
Abstract
Structural magnetic resonance imaging (MRI) studies reveal evidence for brain abnormalities in obsessive-compulsive disorder (OCD), for instance, reduction of gray matter volume in the prefrontal cortex. Disturbances of gyrification in the prefrontal cortex have been described several times in schizophrenia pointing to a neurodevelopmental etiology, while gyrification has not been studied so far in OCD patients. In 26 OCD patients and 38 healthy control subjects MR-imaging was performed. Prefrontal cortical folding (gyrification) was measured bilaterally by an automated version of the automated-gyrification index (A-GI), a ratio reflecting the extent of folding, from the slice containing the inner genu of the corpus callosum up to the frontal pole. Analysis of covariance (ANCOVA, independent factor diagnosis, covariates age, duration of education) demonstrated that compared with control subjects, patients with OCD displayed a significantly reduced A-GI in the left hemisphere (p = 0.021) and a trend for a decreased A-GI in the right hemisphere (p = 0.076). Significant correlations between prefrontal lobe volume and A-GI were only observed in controls, but not in OCD patients. In conclusion, prefrontal hypogyrification in OCD patients may be a structural correlate of the impairment in executive function of this patient group and may point to a neurodevelopmental origin of this disease.
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Affiliation(s)
- Thomas Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University, Von-Siebold-Str. 5, 37075, Göttingen, Germany.
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Britton JC, Stewart SE, Killgore WDS, Rosso IM, Price LM, Gold AL, Pine DS, Wilhelm S, Jenike MA, Rauch SL. Amygdala activation in response to facial expressions in pediatric obsessive-compulsive disorder. Depress Anxiety 2010; 27:643-51. [PMID: 20602430 PMCID: PMC2951127 DOI: 10.1002/da.20718] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Exaggerated amygdala activation to threatening faces has been detected in adults and children with anxiety disorders, compared to healthy comparison (HC) subjects. However, the profile of amygdala activation in response to facial expressions in obsessive-compulsive disorder (OCD) may be a distinguishing feature; a prior study found that compared with healthy adults, adults with OCD exhibited less amygdala activation to emotional and neutral faces, relative to fixation [Cannistraro et al. (2004). Biological Psychiatry 56:916-920]. METHODS In the current event-related functional magnetic resonance imaging (fMRI) study, a pediatric OCD sample (N=12) and a HC sample (N=17) performed a gender discrimination task while viewing emotional faces (happy, fearful, disgusted) and neutral faces. RESULTS Compared to the HC group, the OCD group showed less amygdala/hippocampus activation in all emotion and neutral conditions relative to fixation. CONCLUSIONS Like previous reports in adult OCD, pediatric OCD may have a distinct neural profile from other anxiety disorders, with respect to amygdala activation in response to emotional stimuli that are not disorder specific.
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Affiliation(s)
- Jennifer C Britton
- Mood and Anxiety Disorders Program, National Institute of Mental Health, Bethesda, Maryland 20892, USA
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Stein DJ, Fineberg NA, Bienvenu OJ, Denys D, Lochner C, Nestadt G, Leckman JF, Rauch SL, Phillips KA. Should OCD be classified as an anxiety disorder in DSM-V? Depress Anxiety 2010; 27:495-506. [PMID: 20533366 DOI: 10.1002/da.20699] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
In DSM-III, DSM-III-R, and DSM-IV, obsessive-compulsive disorder (OCD) was classified as an anxiety disorder. In ICD-10, OCD is classified separately from the anxiety disorders, although within the same larger category as anxiety disorders (as one of the "neurotic, stress-related, and somatoform disorders"). Ongoing advances in our understanding of OCD and other anxiety disorders have raised the question of whether OCD should continue to be classified with the anxiety disorders in DSM-V. This review presents a number of options and preliminary recommendations to be considered for DSM-V. Evidence is reviewed for retaining OCD in the category of anxiety disorders, and for moving OCD to a separate category of obsessive-compulsive (OC)-spectrum disorders, if such a category is included in DSM-V. Our preliminary recommendation is that OCD be retained in the category of anxiety disorders but that this category also includes OC-spectrum disorders along with OCD. If this change is made, the name of this category should be changed to reflect this proposed change.
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Affiliation(s)
- Dan J Stein
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa.
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Matsumoto R, Ichise M, Ito H, Ando T, Takahashi H, Ikoma Y, Kosaka J, Arakawa R, Fujimura Y, Ota M, Takano A, Fukui K, Nakayama K, Suhara T. Reduced serotonin transporter binding in the insular cortex in patients with obsessive-compulsive disorder: a [11C]DASB PET study. Neuroimage 2009; 49:121-6. [PMID: 19660554 DOI: 10.1016/j.neuroimage.2009.07.069] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Revised: 07/25/2009] [Accepted: 07/29/2009] [Indexed: 11/26/2022] Open
Abstract
The serotonin transporter (5-HTT) and other markers of the serotonergic system have been of interest in the pathophysiology of obsessive-compulsive disorder (OCD). Previous studies using single photon emission computed tomography (SPECT) with [(123)I]beta-CIT or positron emission tomography (PET) with [(11)C]McN5652 have not shown consistent findings about 5-HTT in OCD patients. The aim of the present study was to investigate 5-HTT binding using [(11)C]DASB, which has higher selectivity or specific binding-to-nonspecific binding ratios for 5-HTT compared to the aforementioned radioligands. Four drug-naive and 6 drug-free patients with OCD who were free of comorbid depression and 18 gender and age-matched healthy subjects underwent PET scans with [(11)C]DASB. The severity of OCD was assessed by Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) (mean+/-SD: 22+/-7.6, range: 7-32). The binding potential (BP(ND)) of [(11)C]DASB was calculated using a two-parameter multilinear reference tissue model (MRTM2). The parametric images of BP(ND) were analyzed using a statistical parametric mapping system. Significant reductions of BP(ND) were observed in the right posterior and left anterior insular cortices in patients with OCD compared to controls. Region-of-interest analysis has also confirmed significant reduction of BP(ND) in the insular cortex. Although significantly reduced BP(ND) in the orbitofrontal cortex was also observed in patients with OCD compared to controls, this finding should be considered with caution because of the very low 5-HTT binding in the region. On the other hand, no significant correlation was observed between the Y-BOCS score and BP(ND). The change in [(11)C]DASB binding in the insular cortex suggests that dysfunction of the serotonergic system in the limbic area might be involved in the pathophysiology of OCD.
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Affiliation(s)
- Ryohei Matsumoto
- Molecular Neuroimaging Group, Molecular Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-ku, Chiba, Japan.
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Sehlmeyer C, Schöning S, Zwitserlood P, Pfleiderer B, Kircher T, Arolt V, Konrad C. Human fear conditioning and extinction in neuroimaging: a systematic review. PLoS One 2009; 4:e5865. [PMID: 19517024 PMCID: PMC2692002 DOI: 10.1371/journal.pone.0005865] [Citation(s) in RCA: 393] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 03/25/2009] [Indexed: 12/22/2022] Open
Abstract
Fear conditioning and extinction are basic forms of associative learning that have gained considerable clinical relevance in enhancing our understanding of anxiety disorders and facilitating their treatment. Modern neuroimaging techniques have significantly aided the identification of anatomical structures and networks involved in fear conditioning. On closer inspection, there is considerable variation in methodology and results between studies. This systematic review provides an overview of the current neuroimaging literature on fear conditioning and extinction on healthy subjects, taking into account methodological issues such as the conditioning paradigm. A Pubmed search, as of December 2008, was performed and supplemented by manual searches of bibliographies of key articles. Two independent reviewers made the final study selection and data extraction. A total of 46 studies on cued fear conditioning and/or extinction on healthy volunteers using positron emission tomography or functional magnetic resonance imaging were reviewed. The influence of specific experimental factors, such as contingency and timing parameters, assessment of conditioned responses, and characteristics of conditioned and unconditioned stimuli, on cerebral activation patterns was examined. Results were summarized descriptively. A network consisting of fear-related brain areas, such as amygdala, insula, and anterior cingulate cortex, is activated independently of design parameters. However, some neuroimaging studies do not report these findings in the presence of methodological heterogeneities. Furthermore, other brain areas are differentially activated, depending on specific design parameters. These include stronger hippocampal activation in trace conditioning and tactile stimulation. Furthermore, tactile unconditioned stimuli enhance activation of pain related, motor, and somatosensory areas. Differences concerning experimental factors may partly explain the variance between neuroimaging investigations on human fear conditioning and extinction and should, therefore, be taken into serious consideration in the planning and the interpretation of research projects.
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Affiliation(s)
- Christina Sehlmeyer
- Department of Psychiatry, University of Muenster, Muenster, Germany
- Interdisciplinary Center for Clinical Research (IZKF), University of Muenster, Muenster, Germany
| | - Sonja Schöning
- Department of Psychiatry, University of Muenster, Muenster, Germany
- Interdisciplinary Center for Clinical Research (IZKF), University of Muenster, Muenster, Germany
| | | | - Bettina Pfleiderer
- Department of Clinical Radiology, University of Muenster, Muenster, Germany
| | - Tilo Kircher
- Department of Psychiatry und Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Volker Arolt
- Department of Psychiatry, University of Muenster, Muenster, Germany
| | - Carsten Konrad
- Department of Psychiatry, University of Muenster, Muenster, Germany
- Interdisciplinary Center for Clinical Research (IZKF), University of Muenster, Muenster, Germany
- Department of Psychiatry und Psychotherapy, Philipps-University Marburg, Marburg, Germany
- * E-mail:
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Abstract
INTRODUCTION Cerebral perfusion imaging using magnetic resonance imaging (MRI) is widely used in the research and clinical fields to assess the profound changes in blood flow related to ischemic events such as acute stroke, chronic steno-occlusive disease, vasospasm, and abnormal vessel formations from congenital conditions or tumoral neovascularity. With continuing improvements in the precision of MRI-based perfusion techniques, it is increasingly feasible to use this tool in the study of the subtle brain perfusion changes occurring in psychiatric illnesses. This article aims to review the existing literature on applications of perfusion MRI in psychiatric disorder and substance abuse research. The article also provides a brief introductory overview of dynamic susceptibility contrast MRI and arterial spin labeling techniques. An outlook of necessary steps to bring perfusion MRI into the realm of clinical psychiatry as a diagnostic tool is brought forth. Opportunities for research in unexplored disorders and with higher field strengths are briefly examined. METHODS PubMed, ISI Web of Knowledge & Scopus were used to search the literature and cross reference several neuropsychiatric disorders with a search term construct, including "magnetic resonance imaging," "dynamic susceptibility contrast," "arterial spin labeling," perfusion or "cerebral blood flow" or "cerebral blood volume" or "mean transit time." The list of disorders used in the search included schizophrenia, depression and bipolar disorder, dementia and Alzheimer's disease, Parkinson's disease, posttraumatic stress disorder, autism, Asperger disease, attention deficit, Tourette syndrome, obsessive-compulsive disorder, Huntington's disease, bulimia nervosa, anorexia nervosa, and substance abuse. For each disorder for which perfusion MRI studies were found, a brief overview of the disorder symptoms, treatment, prevalence, and existing models is provided, and previous findings from nuclear medicine-based perfusion imaging are overviewed. Findings of perfusion MRI studies are then summarized, and overlap of findings are discussed. Overarching conclusions are made, or an outlook for future work in the area is offered, where appropriate. RESULTS Despite the now fairly broad availability of perfusion MRI, only a limited number of studies were found using this technology. The search produced 13 studies of schizophrenia, 7 studies in major depression, 12 studies in Alzheimer's disease, and 2 studies in Parkinson's disease. Drug abuse and other disorders have mainly been studied with nuclear medicine-based perfusion imaging. The literature concerning the use of perfusion imaging in psychiatry has not been reviewed in the last 5 years or more. The use of MRI for perfusion measurements in psychiatry has not been reviewed in 10 years. CONCLUSIONS Although MRI-based perfusion imaging in psychiatry has mainly been used as a research tool, a path is progressively being cleared for its application in clinical diagnostic and treatment monitoring. The precision of perfusion MRI methods now rivals that of nuclear medicine-based perfusion imaging techniques. Because of their noninvasive nature, arterial spin labeling methods have gained popularity in studies of neuropsychiatric disorders such as schizophrenia, depression, Alzheimer's, and Parkinson's diseases. Perfusion imaging measurements have yet to be included within the diagnostic criteria of neuropsychiatric disorders despite having shown to have great discriminant power in specific disorders. As this young methodology continues to improve and research studies demonstrate the correlation of measured perfusion abnormalities to microcirculatory abnormalities and neuropsychiatric symptomatology, the idea of including such a test within diagnostic criteria for certain mental illnesses becomes increasingly plausible.
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Wang Y, Samuels JF, Chang YC, Grados MA, Greenberg BD, Knowles JA, McCracken JT, Rauch SL, Murphy DL, Rasmussen SA, Cullen B, Hoehn-Saric R, Pinto A, Fyer AJ, Piacentini J, Pauls DL, Bienvenu OJ, Riddle M, Shugart YY, Liang KY, Nestadt G. Gender differences in genetic linkage and association on 11p15 in obsessive-compulsive disorder families. Am J Med Genet B Neuropsychiatr Genet 2009; 150B:33-40. [PMID: 18425788 DOI: 10.1002/ajmg.b.30760] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Several clinical and genetic studies have reported gender differences in obsessive-compulsive disorder (OCD). Previously, we conducted a linkage genome scan using multipoint allele-sharing methods to test for linkage in 219 families participating in the OCD Collaborative Genetics Study. When these families were stratified by proband's gender, suggestive linkage to chromosome 11p15 at marker D11S2362 (KAC(all) = 2.92, P = 0.00012) was detected in families with male probands, but not in the ones with female probands. We have since conducted fine mapping with a denser microsatellite marker panel in the region of 11p15, and detected a significant linkage signal at D11S4146 (KAC(all) = 5.08, P < 0.00001) in the families of male probands. Subsequently, 632 SNPs were genotyped spanning a 4.0 Mb region of the 1 LOD unit interval surrounding the linkage peak in the original families and an additional 165 families. Six SNPs were associated with OCD (P < 0.001): two SNPs were identified when all the families were included, and four SNPs only in male proband families. No SNP showed significant association with the OCD phenotype only in the families with a female proband. The results suggest a possible gender effect in the etiology of OCD.
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Affiliation(s)
- Y Wang
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
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Abstract
Obsessive-compulsive disorder is currently classified as an anxiety disorder. However, there is growing interest in the concept of an obsessive-compulsive spectrum of disorders (OCSDs). The relationship between anxiety disorders and OCSDs has been questioned. The psychobiology of anxiety disorders and OCSDs is briefly reviewed in this article. While there appear to be several distinct contrasts in the underlying psychobiology of these conditions, there is also evidence of overlapping mechanisms. In addition, there are crucial gaps in our current database, confounding nosological decision-making. Conceptualizing various anxiety disorders and putative OCSDs as lying within a broader spectrum of emotional disorders may be useful. However, clinicians must also recognize that individual anxiety and obsessive-compulsive spectrum conditions, including disorders characterized by body-focused repetitive behaviors, have distinct psychobiological underpinnings and require different treatment approaches.
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Perlis RH, Holt DJ, Smoller JW, Blood AJ, Lee S, Kim BW, Lee MJ, Sun M, Makris N, Kennedy DK, Rooney K, Dougherty DD, Hoge R, Rosenbaum JF, Fava M, Gusella J, Gasic GP, Breiter HC. Association of a polymorphism near CREB1 with differential aversion processing in the insula of healthy participants. ACTA ACUST UNITED AC 2008; 65:882-92. [PMID: 18678793 DOI: 10.1001/archgenpsychiatry.2008.3] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Previous functional neuroimaging studies have identified a network of brain regions that process aversive stimuli, including anger. A polymorphism near the cyclic adenosine monophosphate response element binding protein gene (CREB1) has recently been associated with greater self-reported effort at anger control as well as risk for antidepressant treatment-emergent suicidality in men with major depressive disorder, but its functional effects have not been studied. OBJECTIVE To determine whether this genetic variant is associated with altered brain processing of and behavioral avoidance responses to angry facial expressions. DESIGN AND PARTICIPANTS A total of 28 white participants (mean age, 29.2 years; 13 women) were screened using the Structured Clinical Interview for DSM-IV to exclude any lifetime Axis I psychiatric disorder and were genotyped for rs4675690, a single-nucleotide polymorphism near CREB1. MAIN OUTCOME MEASURES Blood oxygenation level-dependent signal by functional magnetic resonance imaging in the amygdala, insula, anterior cingulate, and orbitofrontal cortex during passive viewing of photographs of faces with emotional expressions. To measure approach and avoidance responses to anger, an off-line key-press task that traded effort for viewing time assessed valuation of angry faces compared with other expressions. RESULTS The CREB1-linked single-nucleotide polymorphism was associated with significant differential activation in an extended neural network responding to angry and other facial expressions. The CREB1-associated insular activation was coincident with activation associated with behavioral avoidance of angry faces. CONCLUSIONS A polymorphism near CREB1 is associated with responsiveness to angry faces in a brain network implicated in processing aversion. Coincident activation in the left insula is further associated with behavioral avoidance of these stimuli.
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Affiliation(s)
- Roy H Perlis
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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