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Marzuki AA, Banca P, Garofalo S, Degni LAE, Dalbagno D, Badioli M, Sule A, Kaser M, Conway-Morris A, Sahakian BJ, Robbins TW. Compulsive avoidance in youths and adults with OCD: an aversive pavlovian-to-instrumental transfer study. Transl Psychiatry 2024; 14:308. [PMID: 39060253 DOI: 10.1038/s41398-024-03028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Compulsive behaviour may often be triggered by Pavlovian cues. Assessing how Pavlovian cues drive instrumental behaviour in obsessive-compulsive disorder (OCD) is therefore crucial to understand how compulsions develop and are maintained. An aversive Pavlovian-to-Instrumental transfer (PIT) paradigm, particularly one involving avoidance/cancellation of negative outcomes, can enable such investigation and has not previously been studied in clinical-OCD. Forty-one participants diagnosed with OCD (21 adults; 20 youths) and 44 controls (21 adults; 23 youths) completed an aversive PIT task. Participants had to prevent the delivery of unpleasant noises by moving a joystick in the correct direction. They could infer these correct responses by learning appropriate response-outcome (instrumental) and stimulus-outcome (Pavlovian) associations. We then assessed whether Pavlovian cues elicited specific instrumental avoidance responses (specific PIT) and induced general instrumental avoidance (general PIT). We investigated whether task learning and confidence indices influenced PIT strength differentially between groups. There was no overall group difference in PIT performance, although youths with OCD showed weaker specific PIT than youth controls. However, urge to avoid unpleasant noises and preference for safe over unsafe stimuli influenced specific and general PIT respectively in OCD, while PIT in controls was more influenced by confidence in instrumental and Pavlovian learning. Thus, in OCD, implicit motivational factors, but not learnt knowledge, may contribute to the successful integration of aversive Pavlovian and instrumental cues. This implies that compulsive avoidance may be driven by these automatic processes. Youths with OCD show deficits in specific PIT, suggesting cue integration impairments are only apparent in adolescence. These findings may be clinically relevant as they emphasise the importance of targeting such implicit motivational processes when treating OCD.
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Affiliation(s)
- Aleya A Marzuki
- Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, UK.
- Department of Psychology, School of Medical and Life Sciences, Sunway University, Petaling Jaya, Selangor, Malaysia.
| | - Paula Banca
- Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, UK
| | - Sara Garofalo
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Luigi A E Degni
- Department of Psychology, University of Bologna, Bologna, Italy
| | | | - Marco Badioli
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Akeem Sule
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Muzaffer Kaser
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | | | - Barbara J Sahakian
- Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, UK
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Trevor W Robbins
- Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, UK.
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2
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Uhre CF, Ritter M, Jepsen JRM, Uhre VF, Lønfeldt NN, Müller AD, Plessen KJ, Vangkilde S, Blair RJ, Pagsberg AK. Atypical neurocognitive functioning in children and adolescents with obsessive-compulsive disorder (OCD). Eur Child Adolesc Psychiatry 2024; 33:2291-2300. [PMID: 37917157 PMCID: PMC11255040 DOI: 10.1007/s00787-023-02301-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/11/2023] [Indexed: 11/03/2023]
Abstract
Atypical neurocognitive functioning has been found in adult patients with obsessive-compulsive disorder (OCD). However, little work has been done in children and adolescents with OCD. In this study, we investigated neurocognitive functioning in a large and representative sample of newly diagnosed children and adolescents with OCD compared to non-psychiatric controls. Children and adolescents with OCD (n = 119) and non-psychiatric controls (n = 90) underwent psychopathological assessment, intelligence testing, and a neurocognitive test battery spanning cognitive flexibility, planning and decision-making, working memory, fluency, and processing speed. The MANOVA main effect revealed that children and adolescents with OCD performed significantly worse than the control group (p < .001, η p 2 = 0.256). Atypical patient performance was particularly found for indices of cognitive flexibility, decision-making, working memory, and processing speed. We found no evidence of differences in planning or fluency. Moreover, we found no significant associations between neurocognitive performance and OCD symptom severity or comorbidity status. Our results indicate that children and adolescents with OCD show selective atypical neurocognitive functioning. These difficulties do not appear to drive their OCD symptoms. However, they may contribute to lifespan difficulties and interfere with treatment efficacy, an objective of our research currently.
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Affiliation(s)
- Camilla Funch Uhre
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.
- Center for Clinical Neuropsychology, Children and Adolescents, Rigshospitalet, Copenhagen, Denmark.
| | - Melanie Ritter
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Jens Richardt Møllegaard Jepsen
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital - Mental Health Services CPH, Glostrup, Denmark
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Copenhagen University Hospital - Mental Health Services CPH, Glostrup, Denmark
| | - Valdemar Funch Uhre
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Nicole Nadine Lønfeldt
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Anne Dorothee Müller
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kerstin Jessica Plessen
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Signe Vangkilde
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Robert James Blair
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Katrine Pagsberg
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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3
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Nejati V, Peyvandi A, Nazari N, Dehghan M. Cognitive Correlates of Risky Decision-Making in Individuals with and without ADHD: A Meta-analysis. Neuropsychol Rev 2024:10.1007/s11065-024-09646-2. [PMID: 38902592 DOI: 10.1007/s11065-024-09646-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 05/27/2024] [Indexed: 06/22/2024]
Abstract
This meta-analytic study aims to investigate the cognitive correlates of risky decision-making in individuals with attention-deficit/hyperactivity disorder (ADHD) and typically developing (TD) individuals. A systematic analysis of existing literature was conducted, encompassing 38 studies (496 ADHD and 1493 TD). Findings revealed a consistent propensity for riskier decision-making in individuals with ADHD, supported by significant correlations with attention, cognitive flexibility, inhibitory control, time perception, and working memory. The study underscores the relevance of these cognitive functions in shaping decision-making tendencies, with nuanced patterns observed within the ADHD and TD subgroups. Individuals with ADHD often demonstrate altered patterns of correlation, reflecting the specific cognitive challenges characteristic of the disorder.
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Affiliation(s)
- Vahid Nejati
- Department of Psychology, Shahid Beheshti University, PO Box 1983969411, Tehran, Iran.
| | - Aida Peyvandi
- Department of Psychology, Shahid Beheshti University, PO Box 1983969411, Tehran, Iran
| | - Nasim Nazari
- Department of Psychology, Shahid Beheshti University, PO Box 1983969411, Tehran, Iran
| | - Mahshid Dehghan
- Department of Psychology, Shahid Beheshti University, PO Box 1983969411, Tehran, Iran
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Tang W, Shen T, Huang Y, Zhu W, You S, Zhu C, Zhang L, Ma J, Wang Y, Zhao J, Li T, Lai HY. Exploring structural and functional alterations in drug-naïve obsessive-compulsive disorder patients: An ultrahigh field multimodal MRI study. Asian J Psychiatr 2023; 81:103431. [PMID: 36610205 DOI: 10.1016/j.ajp.2022.103431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 12/08/2022] [Accepted: 12/26/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Brain structural and functional alterations have been reported in obsessive-compulsive disorder (OCD) patients; however, these findings were inconsistent across studies due to several limitations, including small sample sizes, different inclusion/exclusion criteria, varied demographic characteristics and symptom dimensions, comorbidity, and medication status. Prominent and replicable neuroimaging biomarkers remain to be discovered. METHODS This study explored the gray matter structure, neural activity, and white matter microstructure differences in 40 drug-naïve OCD patients and 57 matched healthy controls using ultrahigh field 7.0 T multimodal magnetic resonance imaging, which increased the spatial resolution and detection power. We also evaluated correlations among different modalities, imaging features and clinical symptoms. RESULTS Drug-naïve OCD patients exhibited significantly increased gray matter volume in the frontal cortex, especially in the orbitofrontal cortex, as well as volumetric reduction in the temporal lobe, occipital lobe and cerebellum. Increased neural activities were observed in the cingulate gyri and precuneus. Increased temporal-middle cingulate and posterior cingulate-precuneus functional connectivities and decreased frontal-middle cingulate connectivity were further detected. Decreased fractional anisotropy values were found in the cingulum-hippocampus gyrus and inferior fronto-occipital fascicle in OCD patients. Moreover, significantly altered imaging features were related to OCD symptom severity. Altered functional and structural neural connectivity might influence compulsive and obsessive features, respectively. CONCLUSIONS Altered structure and function of the classical cortico-striato-thalamo-cortical circuit, limbic system, default mode network, visual, language and sensorimotor networks play important roles in the neurophysiology of OCD.
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Affiliation(s)
- Wenxin Tang
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ting Shen
- Department of Neurology of the Second Affiliated Hospital, Interdisciplinary Institute of Neuroscience and Technology, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Yueqi Huang
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenjing Zhu
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shujun You
- School of History, Zhejiang University, Hangzhou, China
| | - Cheng Zhu
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Luyue Zhang
- Zhejiang University School of Medicine, Hangzhou, China
| | - Jiehua Ma
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiquan Wang
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingping Zhao
- Department of Psychiatry and Mental Health Institute, The Second Xiangya Hospital of The Central South University, Changsha, Hunan, China
| | - Tao Li
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| | - Hsin-Yi Lai
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Neurology of the Second Affiliated Hospital, Interdisciplinary Institute of Neuroscience and Technology, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China; College of Biomedical Engineering and Instrument Science, Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China; MOE Frontier Science Center for Brain Science and Brain-Machine Integration, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, China.
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5
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Marzuki AA, Vaghi MM, Conway‐Morris A, Kaser M, Sule A, Apergis‐Schoute A, Sahakian BJ, Robbins TW. Atypical action updating in a dynamic environment associated with adolescent obsessive-compulsive disorder. J Child Psychol Psychiatry 2022; 63:1591-1601. [PMID: 35537441 PMCID: PMC9790358 DOI: 10.1111/jcpp.13628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Computational research had determined that adults with obsessive-compulsive disorder (OCD) display heightened action updating in response to noise in the environment and neglect metacognitive information (such as confidence) when making decisions. These features are proposed to underlie patients' compulsions despite the knowledge they are irrational. Nonetheless, it is unclear whether this extends to adolescents with OCD as research in this population is lacking. Thus, this study aimed to investigate the interplay between action and confidence in adolescents with OCD. METHODS Twenty-seven adolescents with OCD and 46 controls completed a predictive-inference task, designed to probe how subjects' actions and confidence ratings fluctuate in response to unexpected outcomes. We investigated how subjects update actions in response to prediction errors (indexing mismatches between expectations and outcomes) and used parameters from a Bayesian model to predict how confidence and action evolve over time. Confidence-action association strength was assessed using a regression model. We also investigated the effects of serotonergic medication. RESULTS Adolescents with OCD showed significantly increased learning rates, particularly following small prediction errors. Results were driven primarily by unmedicated patients. Confidence ratings appeared equivalent between groups, although model-based analysis revealed that patients' confidence was less affected by prediction errors compared to controls. Patients and controls did not differ in the extent to which they updated actions and confidence in tandem. CONCLUSIONS Adolescents with OCD showed enhanced action adjustments, especially in the face of small prediction errors, consistent with previous research establishing 'just-right' compulsions, enhanced error-related negativity, and greater decision uncertainty in paediatric-OCD. These tendencies were ameliorated in patients receiving serotonergic medication, emphasising the importance of early intervention in preventing disorder-related cognitive deficits. Confidence ratings were equivalent between young patients and controls, mirroring findings in adult OCD research.
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Affiliation(s)
- Aleya A. Marzuki
- Behavioural and Clinical Neuroscience InstituteDepartment of PsychologyUniversity of CambridgeCambridgeUK,Department of PsychologySchool of Medical and Life SciencesSunway UniversityPetaling JayaMalaysia
| | - Matilde M. Vaghi
- Department of PsychologySchool of Humanities and SciencesStanford UniversityStanfordCAUSA
| | | | - Muzaffer Kaser
- Cambridgeshire and Peterborough NHS Foundation TrustCambridgeUK,Department of PsychiatrySchool of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - Akeem Sule
- Department of PsychiatrySchool of Clinical MedicineUniversity of CambridgeCambridgeUK
| | | | - Barbara J. Sahakian
- Behavioural and Clinical Neuroscience InstituteDepartment of PsychologyUniversity of CambridgeCambridgeUK,Department of PsychiatrySchool of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - Trevor W. Robbins
- Behavioural and Clinical Neuroscience InstituteDepartment of PsychologyUniversity of CambridgeCambridgeUK
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6
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Zha R, Li P, Liu Y, Alarefi A, Zhang X, Li J. The orbitofrontal cortex represents advantageous choice in the Iowa gambling task. Hum Brain Mapp 2022; 43:3840-3856. [PMID: 35476367 PMCID: PMC9294296 DOI: 10.1002/hbm.25887] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/19/2022] [Accepted: 03/18/2022] [Indexed: 01/26/2023] Open
Abstract
A good‐based model, the central neurobiological model of economic decision‐making, proposes that the orbitofrontal cortex (OFC) represents binary choice outcome, that is, the chosen good. A good is defined by a group of determinants characterizing the conditions in which the commodity is offered, including commodity type, cost, risk, time delay, and ambiguity. Previous studies have found that the OFC represents the binary choice outcome in decision‐making tasks involving commodity type, cost, risk, and delay. Real‐life decisions are often complex and involve uncertainty, rewards, and penalties; however, whether the OFC represents binary choice outcomes in a complex decision‐making situation, for example, Iowa gambling task (IGT), remains unclear. Here, we propose that the OFC represents binary choice outcome, that is, advantageous choice versus disadvantageous choice, in the IGT. We propose two hypotheses: first, the activity pattern in the human OFC represents an advantageous choice; and second, choice induces an OFC‐related functional network. Using functional magnetic resonance imaging and advanced machine‐learning tools, we found that the OFC represented an advantageous choice in the IGT. The OFC representation of advantageous choice was related to decision‐making performance. Choice modulated the functional connectivity between the OFC and the superior medial gyrus. In conclusion, the OFC represents an advantageous choice during the IGT. In the framework of a good‐based model, the results extend the role of the OFC to complex decision‐making situation when making a binary choice.
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Affiliation(s)
- Rujing Zha
- Department of Radiology, the First Affiliated Hospital of USTC, Department of Psychology, School of Humanities & Social Science, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, Anhui, China
| | - Peng Li
- Department of Automation, School of Information Science and Technology, University of Science and Technology of China, Hefei, Anhui, China
| | - Ying Liu
- Department of Radiology, the First Affiliated Hospital of USTC, Department of Psychology, School of Humanities & Social Science, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, Anhui, China
| | - Abdulqawi Alarefi
- Department of Radiology, the First Affiliated Hospital of USTC, Department of Psychology, School of Humanities & Social Science, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, Anhui, China
| | - Xiaochu Zhang
- Department of Radiology, the First Affiliated Hospital of USTC, Department of Psychology, School of Humanities & Social Science, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, Anhui, China.,Application Technology Center of Physical Therapy to Brain Disorders, Institute of Advanced Technology, University of Science & Technology of China, Hefei, Anhui, China.,Hefei Medical Research Center on Alcohol Addiction, Affiliated Psychological Hospital of Anhui Medical University, Hefei Fourth People's Hospital, Anhui Mental Health Center, Hefei, Anhui, China.,Biomedical Sciences and Health Laboratory of Anhui Province, University of Science & Technology of China, Hefei, Anhui, China
| | - Jun Li
- Department of Automation, University of Science and Technology of China, Hefei, China
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7
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Du H, Xia J, Fan J, Gao F, Wang X, Han Y, Tan C, Zhu X. Spontaneous neural activity in the right fusiform gyrus and putamen is associated with consummatory anhedonia in obsessive compulsive disorder. Brain Imaging Behav 2022; 16:1708-1720. [DOI: 10.1007/s11682-021-00619-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
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8
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Hasuzawa S, Tomiyama H, Murayama K, Ohno A, Kang M, Mizobe T, Kato K, Matsuo A, Kikuchi K, Togao O, Nakao T. Inverse Association Between Resting-State Putamen Activity and Iowa Gambling Task Performance in Patients With Obsessive-Compulsive Disorder and Control Subjects. Front Psychiatry 2022; 13:836965. [PMID: 35633792 PMCID: PMC9136000 DOI: 10.3389/fpsyt.2022.836965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Symptoms of obsessive-compulsive disorder (OCD) have been conceptualized as manifestations of decision-making deficits. Patients with OCD exhibit impairment during the decision-making process, as assessed by the Iowa Gambling Task (IGT). This impairment is independent of clinical severity and disease progression. However, the association between the decision-making deficit and resting-state brain activity of patients with OCD has not been examined. METHODS Fifty unmedicated patients with OCD and 55 matched control subjects completed IGT. Resting-state brain activity was examined using the fractional amplitude of low-frequency fluctuations (fALFFs). fALFF analysis focused on the slow-4 and 5 bands. Group comparisons were performed to determine the association between IGT performance and fALFFs. RESULTS There was a significant group difference in the association between the IGT total net score and slow-4 fALFFs in the left putamen (voxel height threshold of p < 0.001; cluster size threshold of p < 0.05; family wise error-corrected). Higher putamen slow-4 fALFFs were correlated with lower IGT scores for OCD patients (r = -0.485; p < 0.0005) and higher IGT scores for control subjects (r = 0.402; p < 0.005). There was no group difference in the association between the IGT total net score and slow-5 fALFFs. CONCLUSIONS These findings in unmedicated patients demonstrate the importance of resting-state putamen activity for decision-making deficit associated with OCD, as measured by IGT. The inverse correlation may be explained by the hypersensitive response of the putamen in patients with OCD.
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Affiliation(s)
- Suguru Hasuzawa
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hirofumi Tomiyama
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keitaro Murayama
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Aikana Ohno
- Graduate School of Human Environment Studies, Kyushu University, Fukuoka, Japan
| | - Mingi Kang
- Graduate School of Human Environment Studies, Kyushu University, Fukuoka, Japan
| | - Taro Mizobe
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenta Kato
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Matsuo
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazufumi Kikuchi
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Osamu Togao
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomohiro Nakao
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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9
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Marzuki AA, Tomić I, Ip SHY, Gottwald J, Kanen JW, Kaser M, Sule A, Conway-Morris A, Sahakian BJ, Robbins TW. Association of Environmental Uncertainty With Altered Decision-making and Learning Mechanisms in Youths With Obsessive-Compulsive Disorder. JAMA Netw Open 2021; 4:e2136195. [PMID: 34842925 PMCID: PMC8630570 DOI: 10.1001/jamanetworkopen.2021.36195] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/01/2021] [Indexed: 02/05/2023] Open
Abstract
Importance Adults with obsessive-compulsive disorder (OCD) display perseverative behavior in stable environments but exhibit vacillating choice when payoffs are uncertain. These findings may be associated with intolerance of uncertainty and compulsive behaviors; however, little is known about the mechanisms underlying learning and decision-making in youths with OCD because research into this population has been limited. Objective To investigate cognitive mechanisms associated with decision-making in youths with OCD by using executive functioning tasks and computational modeling. Design, Setting, and Participants In this cross-sectional study, 50 youths with OCD (patients) and 53 healthy participants (controls) completed a probabilistic reversal learning (PRL) task between January 2014 and March 2020. A separate sample of 27 patients and 46 controls completed the Wisconsin Card Sorting Task (WCST) between January 2018 and November 2020. The study took place at the University of Cambridge in the UK. Main Outcomes and Measures Decision-making mechanisms were studied by fitting hierarchical bayesian reinforcement learning models to the 2 data sets and comparing model parameters between participant groups. Model parameters included reward and punishment learning rates (feedback sensitivity), reinforcement sensitivity and decision consistency (exploitation), and stickiness (perseveration). Associations of receipt of serotonergic medication with performance were assessed. Results In total, 50 patients (29 female patients [58%]; median age, 16.6 years [IQR, 15.3-18.0 years]) and 53 controls (30 female participants [57%]; median age, 16.4 years [IQR, 14.8-18.0 years]) completed the PRL task. A total of 27 patients (18 female patients [67%]; median age, 16.1 years [IQR, 15.2-17.2 years]) and 46 controls (28 female participants [61%]; median age, 17.2 [IQR, 16.3-17.6 years]) completed the WCST. During the reversal phase of the PRL task, patients made fewer correct responses (mean [SD] proportion: 0.83 [0.16] for controls and 0.61 [0.31] for patients; 95% CI, -1.31 to -0.64) and switched choices more often following false-negative feedback (mean [SD] proportion: 0.09 [0.16] for controls vs 0.27 [0.34] for patients; 95% CI, 0.60-1.26) and true-positive feedback (mean [SD] proportion: 0.93 [0.17] for controls vs 0.73 [0.34] for patients; 95% CI, -2.17 to -1.31). Computational modeling revealed that patients displayed enhanced reward learning rates (mean difference [MD], 0.21; 95% highest density interval [HDI], 0.04-0.38) but decreased punishment learning rates (MD, -0.29; 95% HDI, -0.39 to -0.18), reinforcement sensitivity (MD, -4.91; 95% HDI, -9.38 to -1.12), and stickiness (MD, -0.35; 95% HDI, -0.57 to -0.11) compared with controls. There were no group differences on standard WCST measures and computational model parameters. However, patients who received serotonergic medication showed slower response times (mean [SD], 1420.49 [279.71] milliseconds for controls, 1471.42 [212.81] milliseconds for patients who were unmedicated, and 1738.25 [349.23] milliseconds for patients who were medicated) (control vs medicated MD, -320.26 [95% CI, -547.00 to -88.68]) and increased unique errors (mean [SD] proportion: 0.001 [0.004] for controls, 0.002 [0.004] for patients who were unmedicated, and 0.008 [0.01] for patients who were medicated) (control vs medicated MD, -0.007 [95% CI, -3.14 to -0.36]) on the WCST. Conclusions and Relevance The results of this cross-sectional study indicated that youths with OCD showed atypical probabilistic reversal learning but were generally unimpaired on the deterministic WCST, although unexpected results were observed for patients receiving serotonergic medication. These findings have implications for reframing the understanding of early-onset OCD as a disorder in which decision-making is associated with uncertainty in the environment, a potential target for therapeutic treatment. These results provide continuity with findings in adults with OCD.
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Affiliation(s)
- Aleya A. Marzuki
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
- International University Malaya–Wales, Kuala Lumpur, Malaysia
| | - Ivan Tomić
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Samantha Hiu Yan Ip
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Julia Gottwald
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jonathan W. Kanen
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Muzaffer Kaser
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Akeem Sule
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Anna Conway-Morris
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Barbara J. Sahakian
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, 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
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10
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Qing X, Gu L, Li D. Abnormalities of Localized Connectivity in Obsessive-Compulsive Disorder: A Voxel-Wise Meta-Analysis. Front Hum Neurosci 2021; 15:739175. [PMID: 34602998 PMCID: PMC8481585 DOI: 10.3389/fnhum.2021.739175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 08/26/2021] [Indexed: 01/20/2023] Open
Abstract
Background: A large amount of resting-state functional magnetic resonance imaging (rs-fMRI) studies have revealed abnormalities of regional homogeneity (ReHo, an index of localized intraregional connectivity) in the obsessive-compulsive disorder (OCD) in the past few decades, However, the findings of these ReHo studies have remained inconsistent. Hence, we performed a meta-analysis to investigate the concurrence across ReHo studies for clarifying the most consistent localized connectivity underpinning this disorder. Methods: A systematic review of online databases was conducted for whole-brain rs-fMRI studies comparing ReHo between OCD patients and healthy control subjects (HCS). Anisotropic effect size version of the seed-based d mapping, a voxel-wise meta-analytic approach, was adopted to explore regions of abnormal ReHo alterations in OCD patients relative to HCS. Additionally, meta-regression analyses were conducted to explore the potential effects of clinical features on the reported ReHo abnormalities. Results: Ten datasets comprising 359 OCD patients and 361 HCS were included. Compared with HCS, patients with OCD showed higher ReHo in the bilateral inferior frontal gyri and orbitofrontal cortex (OFC). Meanwhile, lower ReHo was identified in the supplementary motor area (SMA) and bilateral cerebellum in OCD patients. Meta-regression analysis demonstrated that the ReHo in the OFC was negatively correlated with illness duration in OCD patients. Conclusions: Our meta-analysis gave a quantitative overview of ReHo findings in OCD and demonstrated that the most consistent localized connectivity abnormalities in individuals with OCD are in the prefrontal cortex. Meanwhile, our findings provided evidence that the hypo-activation of SMA and cerebellum might be associated with the pathophysiology of OCD.
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Affiliation(s)
- Xiuli Qing
- Department of Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children in Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Li Gu
- Department of Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children in Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Dehua Li
- Nursing Department, West China Second University Hospital, Sichuan University, Chengdu, China
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11
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Shephard E, Stern ER, van den Heuvel OA, Costa DL, Batistuzzo MC, Godoy PB, Lopes AC, Brunoni AR, Hoexter MQ, Shavitt RG, Reddy JY, Lochner C, Stein DJ, Simpson HB, Miguel EC. Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder. Mol Psychiatry 2021; 26:4583-4604. [PMID: 33414496 PMCID: PMC8260628 DOI: 10.1038/s41380-020-01007-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022]
Abstract
An important challenge in mental health research is to translate findings from cognitive neuroscience and neuroimaging research into effective treatments that target the neurobiological alterations involved in psychiatric symptoms. To address this challenge, in this review we propose a heuristic neurocircuit-based taxonomy to guide the treatment of obsessive-compulsive disorder (OCD). We do this by integrating information from several sources. First, we provide case vignettes in which patients with OCD describe their symptoms and discuss different clinical profiles in the phenotypic expression of the condition. Second, we link variations in these clinical profiles to underlying neurocircuit dysfunctions, drawing on findings from neuropsychological and neuroimaging studies in OCD. Third, we consider behavioral, pharmacological, and neuromodulatory treatments that could target those specific neurocircuit dysfunctions. Finally, we suggest methods of testing this neurocircuit-based taxonomy as well as important limitations to this approach that should be considered in future research.
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Affiliation(s)
- Elizabeth Shephard
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. .,Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.
| | - Emily R. Stern
- Department of Psychiatry, The New York University School of Medicine, New York, USA.,Nathan Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Odile A. van den Heuvel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Daniel L.C. Costa
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo C. Batistuzzo
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Priscilla B.G. Godoy
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Antonio C. Lopes
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Andre R. Brunoni
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo Q. Hoexter
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Roseli G. Shavitt
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Janardhan Y.C Reddy
- Department of Psychiatry OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Christine Lochner
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Dan J. Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - H. Blair Simpson
- Center for OCD and Related Disorders, New York State Psychiatric Institute and the Department of Psychiatry, Columbia University Irving Medical Center, New York New York
| | - Euripedes C. Miguel
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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12
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Poppi LA, Ho-Nguyen KT, Shi A, Daut CT, Tischfield MA. Recurrent Implication of Striatal Cholinergic Interneurons in a Range of Neurodevelopmental, Neurodegenerative, and Neuropsychiatric Disorders. Cells 2021; 10:907. [PMID: 33920757 PMCID: PMC8071147 DOI: 10.3390/cells10040907] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/03/2021] [Accepted: 04/12/2021] [Indexed: 12/17/2022] Open
Abstract
Cholinergic interneurons are "gatekeepers" for striatal circuitry and play pivotal roles in attention, goal-directed actions, habit formation, and behavioral flexibility. Accordingly, perturbations to striatal cholinergic interneurons have been associated with many neurodevelopmental, neurodegenerative, and neuropsychiatric disorders. The role of acetylcholine in many of these disorders is well known, but the use of drugs targeting cholinergic systems fell out of favor due to adverse side effects and the introduction of other broadly acting compounds. However, in response to recent findings, re-examining the mechanisms of cholinergic interneuron dysfunction may reveal key insights into underlying pathogeneses. Here, we provide an update on striatal cholinergic interneuron function, connectivity, and their putative involvement in several disorders. In doing so, we aim to spotlight recurring physiological themes, circuits, and mechanisms that can be investigated in future studies using new tools and approaches.
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Affiliation(s)
- Lauren A. Poppi
- Human Genetics Institute of New Jersey, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA;
- Child Health Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; (K.T.H.-N.); (A.S.); (C.T.D.)
- Tourette International Collaborative (TIC) Genetics Study, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
| | - Khue Tu Ho-Nguyen
- Child Health Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; (K.T.H.-N.); (A.S.); (C.T.D.)
- Department of Cell Biology and Neuroscience, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
| | - Anna Shi
- Child Health Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; (K.T.H.-N.); (A.S.); (C.T.D.)
- Department of Cell Biology and Neuroscience, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
| | - Cynthia T. Daut
- Child Health Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; (K.T.H.-N.); (A.S.); (C.T.D.)
- Department of Cell Biology and Neuroscience, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
| | - Max A. Tischfield
- Child Health Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; (K.T.H.-N.); (A.S.); (C.T.D.)
- Tourette International Collaborative (TIC) Genetics Study, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
- Department of Cell Biology and Neuroscience, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
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13
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Pagliaccio D, Durham K, Fitzgerald KD, Marsh R. Obsessive-Compulsive Symptoms Among Children in the Adolescent Brain and Cognitive Development Study: Clinical, Cognitive, and Brain Connectivity Correlates. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:399-409. [PMID: 33495121 PMCID: PMC8035161 DOI: 10.1016/j.bpsc.2020.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/01/2020] [Accepted: 10/27/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Childhood obsessive-compulsive symptoms (OCSs) are common and can be an early risk marker for obsessive-compulsive disorder. The Adolescent Brain and Cognitive Development (ABCD) Study provides a unique opportunity to characterize OCSs in a large normative sample of school-age children and to explore corticostriatal and task-control circuits implicated in pediatric obsessive-compulsive disorder. METHODS The ABCD Study acquired data from 9- and 10-year-olds (N = 11,876). Linear mixed-effects models probed associations between OCSs (Child Behavior Checklist) and cognition (NIH Toolbox), brain structure (subcortical volume, cortical thickness), white matter (diffusion tensor imaging), and resting-state functional connectivity. RESULTS OCS scores showed good psychometric properties and high prevalence, and they were related to familial/parental factors, including family conflict. Higher OCS scores related to better cognitive performance (β = .06, t9966.60 = 6.28, p < .001, ηp2= .01), particularly verbal, when controlling for attention-deficit/hyperactivity disorder, which related to worse performance. OCSs did not significantly relate to brain structure but did relate to lower superior corticostriatal tract fractional anisotropy (β = -.03, t = -3.07, p = .002, ηp2= .02). Higher OCS scores were related to altered functional connectivity, including weaker connectivity within the dorsal attention network (β = -.04, t7262.87 = -3.71, p < .001, ηp2= .002) and weaker dorsal attention-default mode anticorrelation (β = .04, t7251.95 = 3.94, p < .001, ηp2 = .002). Dorsal attention-default mode connectivity predicted OCS scores at 1 year (β = -.04, t2407.61 = -2.23, p = .03, ηp2 = .03). CONCLUSIONS OCSs are common and may persist throughout childhood. Corticostriatal connectivity and attention network connectivity are likely mechanisms in the subclinical-to-clinical spectrum of OCSs. Understanding correlates and mechanisms of OCSs may elucidate their role in childhood psychiatric risk and suggest potential utility of neuroimaging, e.g., dorsal attention-default mode connectivity, for identifying children at increased risk for obsessive-compulsive disorder.
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Affiliation(s)
- David Pagliaccio
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York.
| | - Katherine Durham
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Kate D Fitzgerald
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Rachel Marsh
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
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14
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Zarka D, Cebolla AM, Cevallos C, Palmero-Soler E, Dan B, Cheron G. Caudate and cerebellar involvement in altered P2 and P3 components of GO/NoGO evoked potentials in children with attention-deficit/hyperactivity disorder. Eur J Neurosci 2021; 53:3447-3462. [PMID: 33759261 DOI: 10.1111/ejn.15198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/08/2021] [Accepted: 03/14/2021] [Indexed: 01/10/2023]
Abstract
Previous studies showed reduced activity of the anterior cingulate cortex (ACC) and supplementary motor area during inhibition in children with attention-deficit/hyperactivity disorder (ADHD). This study aimed to investigate deep brain generators underlying alterations of evoked potential components triggered by visual GO/NoGO tasks in children with ADHD compared with typically developing children (TDC). Standardized weighted low-resolution electromagnetic tomography (swLORETA) source analysis showed that lower GO-P3 component in children with ADHD was explained not only by a reduced contribution of the frontal areas but also by a stronger contribution of the anterior part of the caudate nucleus in these children compared with TDC. While the reduction of the NoGO-P3 component in children with ADHD was essentially explained by a reduced contribution of the dorsal ACC, the higher NoGO-P2 amplitude in these children was concomitant to the reduced contribution of the dorsolateral prefrontal cortex, the insula, and the cerebellum. These data corroborate previous findings showed by fMRI studies and offered insight relative to the precise time-related contribution of the caudate nucleus and the cerebellum during the automatic feature of inhibition processes in children with ADHD. These results were discussed regarding the involvement of the fronto-basal ganglia and fronto-cerebellum networks in inhibition and attention alterations in ADHD.
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Affiliation(s)
- David Zarka
- Laboratory of Neurophysiology and Movement Biomechanics, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium.,Faculty of Motor Sciences, Research Unit in Sciences of Osteopathy, Université Libre de Bruxelles, Brussels, Belgium
| | - Anna Maria Cebolla
- Laboratory of Neurophysiology and Movement Biomechanics, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Carlos Cevallos
- Laboratory of Neurophysiology and Movement Biomechanics, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium.,Departamento de Ingeniería Mecánica, Facultad de Ingeniería Mecánica, Escuela Politécnica Nacional, Quito, Ecuador
| | - Ernesto Palmero-Soler
- Laboratory of Neurophysiology and Movement Biomechanics, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Bernard Dan
- Medical and Rehabilitation Departments, Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium
| | - Guy Cheron
- Laboratory of Neurophysiology and Movement Biomechanics, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium.,Laboratory of Electrophysiology, Université de Mons, Mons, Belgium
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15
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Nisticò V, De Angelis A, Erro R, Demartini B, Ricciardi L. Obsessive-Compulsive Disorder and Decision Making under Ambiguity: A Systematic Review with Meta-Analysis. Brain Sci 2021; 11:brainsci11020143. [PMID: 33499211 PMCID: PMC7912249 DOI: 10.3390/brainsci11020143] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 12/11/2022] Open
Abstract
In the last decade, decision-making has been proposed to have a central role in obsessive-compulsive disorder (OCD) aetiology, since patients show pathological doubt and an apparent inability to make decisions. Here, we aimed to comprehensively review decision making under ambiguity, as measured by the Iowa Gambling Task (IGT), in OCD, using a meta-analytic approach. According to PRISMA Guidelines, we selected 26 studies for a systematic review and, amongst them, 16 studies were included in a meta-analysis, comprising a total of 846 OCD patients and 763 healthy controls (HC). Our results show that OCD patients perform significantly lower than HC at the IGT, pointing towards the direction of a decision making impairment. In particular, this deficit seems to emerge mainly in the last three blocks of the IGT. IGT scores in OCD patients under the age of 18 were still significantly lower than in HC. Finally, no difference emerged between medicated and unmedicated patients, since they both scored significantly lower at the IGT compared to HC. In conclusion, our results are in line with the hypothesis according to which decision making impairment might represent a potential endophenotype lying between the clinical manifestation of OCD and its neurobiological aetiology.
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Affiliation(s)
- Veronica Nisticò
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milano, Italy; (V.N.); (B.D.)
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, 20142 Milano, Italy
| | - Andrea De Angelis
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, London SW17 0RE, UK;
- Department of Neuropsychiatry, St George’s Hospital, South West London and St George’s Mental Health NHS Trust, London SW17 0RE, UK
| | - Roberto Erro
- Dipartimento di Medicina, Chirurgia e Odontoiatria “Scuola Medica Salernitana”, Università di Salerno, 84018 Baronissi, Salerno, Italy;
| | - Benedetta Demartini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milano, Italy; (V.N.); (B.D.)
- Aldo Ravelli Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, 20142 Milano, Italy
- Unità di Psichiatria II, Presidio San Paolo, ASST Santi Paolo e Carlo, 20142 Milano, Italy
| | - Lucia Ricciardi
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, London SW17 0RE, UK;
- Correspondence:
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16
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Oh S, Jung WH, Kim T, Shim G, Kwon JS. Brain Activation of Patients With Obsessive-Compulsive Disorder During a Mental Rotation Task: A Functional MRI Study. Front Psychiatry 2021; 12:659121. [PMID: 34025482 PMCID: PMC8138312 DOI: 10.3389/fpsyt.2021.659121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/06/2021] [Indexed: 01/01/2023] Open
Abstract
Functional neuroimaging studies have implicated alterations in frontostriatal and frontoparietal circuits in obsessive-compulsive disorder (OCD) during various tasks. To date, however, brain activation for visuospatial function in conjunction with symptoms in OCD has not been comprehensively evaluated. To elucidate the relationship between neural activity, cognitive function, and obsessive-compulsive symptoms, we investigated regional brain activation during the performance of a visuospatial task in patients with OCD using functional magnetic resonance imaging (fMRI). Seventeen medication-free patients with OCD and 21 age-, sex-, and IQ-matched healthy controls participated in this study. Functional magnetic resonance imaging data were obtained while the subjects performed a mental rotation (MR) task. Brain activation during the task was compared between the two groups using a two-sample t-test. Voxel-wise whole-brain multiple regression analyses were also performed to examine the relationship between obsessive-compulsive symptom severity and neural activity during the task. The two groups did not differ in MR task performance. Both groups also showed similar task-related activation patterns in frontoparietal regions with no significant differences. Activation in the right dorsolateral prefrontal cortex in patients with OCD during the MR task was positively associated with their total Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores. This study identified the specific brain areas associated with the interaction between symptom severity and visuospatial cognitive function during an MR task in medication-free patients with OCD. These findings may serve as potential neuromodulation targets for OCD treatment.
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Affiliation(s)
- Sanghoon Oh
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea.,Department of Psychiatry, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Gyeonggi-do, South Korea
| | - Wi Hoon Jung
- Department of Psychology, Daegu University, Gyeongsan, South Korea
| | - Taekwan Kim
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, South Korea
| | - Geumsook Shim
- KAIST Clinic Pappalardo Center, KAIST, Daejeon, South Korea
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea.,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, South Korea.,Institute of Human Behavioral Medicine, SNU-MRC, Seoul, South Korea
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17
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Abstract
OCD most often arises before adulthood with adolescence being a particularly vulnerable period. This is also a time when both brain and cognition undergo fundamental developmental change and reorganisation. However, the neurocognitive mechanisms that drive the emergence of OCD during development are still largely unknown. In this chapter, I review the relatively sparse literature on the developmental aspects of OCD and I discuss the symptomatic, cognitive and neural patterns in OCD and the developing mind. I highlight how we need to understand the emergence of cognitive impairments and neural alteration in a developmental context if we want to understand more about the mechanisms that give rise to OCD. Moreover, I outline how we best approach this challenge to overcome the current limitations in research.
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Affiliation(s)
- T U Hauser
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, London, UK. .,Wellcome Centre for Human Neuroimaging, University College London, London, UK.
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18
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McNorgan C, Judson C, Handzlik D, Holden JG. Linking ADHD and Behavioral Assessment Through Identification of Shared Diagnostic Task-Based Functional Connections. Front Physiol 2020; 11:583005. [PMID: 33391011 PMCID: PMC7773605 DOI: 10.3389/fphys.2020.583005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022] Open
Abstract
A mixed literature implicates atypical connectivity involving attentional, reward and task inhibition networks in ADHD. The neural mechanisms underlying the utility of behavioral tasks in ADHD diagnosis are likewise underexplored. We hypothesized that a machine-learning classifier may use task-based functional connectivity to compute a joint probability function that identifies connectivity signatures that accurately predict ADHD diagnosis and performance on a clinically-relevant behavioral task, providing an explicit neural mechanism linking behavioral phenotype to diagnosis. We analyzed archival MRI and behavioral data of 80 participants (64 male) who had completed the go/no-go task from the longitudinal follow-up of the Multimodal Treatment Study of ADHD (MTA 168) (mean age = 24 years). Cross-mutual information within a functionally-defined mask measured functional connectivity for each task run. Multilayer feedforward classifier models identified the subset of functional connections that predicted clinical diagnosis (ADHD vs. Control) and split-half performance on the Iowa Gambling Task (IGT). A sample of random models trained on functional connectivity profiles predicted validation set clinical diagnosis and IGT performance with 0.91 accuracy and d' > 2.9, indicating very high sensitivity and specificity. We identified the most diagnostic functional connections between visual and ventral attentional networks and the anterior default mode network. Our results show that task-based functional connectivity is a biomarker of ADHD. Our analytic framework provides a template approach that explicitly ties behavioral assessment measures to both clinical diagnosis, and functional connectivity. This may differentiate otherwise similar diagnoses, and promote more efficacious intervention strategies.
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Affiliation(s)
- Chris McNorgan
- Department of Psychology, University at Buffalo – SUNY, Buffalo, NY, United States
| | - Cary Judson
- Department of Psychology, University at Buffalo – SUNY, Buffalo, NY, United States
| | - Dakota Handzlik
- Department of Computer Science, University at Buffalo – SUNY, Buffalo, NY, United States
| | - John G. Holden
- Department of Psychology, University of Cincinnati, Cincinnati, OH, United States
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19
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Jeong H, Yim HW, Lee SY, Lee HK, Potenza MN, Jo SJ, Son HJ, Kim G. Low self-control and aggression exert serial mediation between inattention/hyperactivity problems and severity of internet gaming disorder features longitudinally among adolescents. J Behav Addict 2020; 9:401-409. [PMID: 32634112 PMCID: PMC8939404 DOI: 10.1556/2006.2020.00039] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/29/2020] [Accepted: 05/24/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES We examined serial mediating roles of low self-control and aggression in explaining relationships between levels of inattention and hyperactivity problems (IHPs) and severity of Internet gaming disorder (IGD) features when exposed to online games among adolescents without Attention deficit hyperactivity disorder (ADHD) stratified by gender using three-wave longitudinal study. METHOD The sample comprised a total of 1,732 family dyads from a study that was conducted among seventh graders without diagnoses of ADHD at baseline. Levels of IHPs were assessed by the parent reported Korean version of the ADHD rating scale at baseline (wave1). Severity of IGD features was assessed by the Internet Game Use-Elicited Symptom Screen (IGUESS) at wave3. Both levels of self-control (wave1) and aggression (wave2) were assessed by self-report. The mediating role of low self-control and aggression in the relationships between level of IHPs and severity of IGD were evaluated using serial mediation analysis separately for each gender. RESULTS Levels of IHPs were related directly to severity of IGD features in both genders. The indirect effects via low self-control were also significant in both genders, however, the indirect effects via aggression was significant only in women. The serial mediation effect via low self-control and aggression between levels of IHPs and IGD features was significant in both genders (men, coefficient:0.009, 95%CI 0.005-0.019; women, coefficient:0.010, 95%CI:0.005-0.026). CONCLUSION We revealed a possible mechanism underlying a serial mediation chain from low self-control to aggression explaining the effects of IHPs on severity of IGD features. However, this conclusion should be taken with a caution, because the effect sizes were very low.
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Affiliation(s)
- Hyunsuk Jeong
- Department of Preventive Medicine, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Hyeon Woo Yim
- Department of Preventive Medicine, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Seung-Yup Lee
- Department of Psychiatry, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Hae Kook Lee
- Department of Psychiatry, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Marc N. Potenza
- Departments of Psychiatry and Neuroscience and Child Study Center, Yale University, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - Sun-Jin Jo
- Department of Preventive Medicine, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Hye Jung Son
- Department of Preventive Medicine, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Gyeogmin Kim
- Department of Preventive Medicine, College of Medicine, Catholic University of Korea, Seoul, Korea
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Moreira PS, Macoveanu J, Marques P, Coelho A, Magalhães R, Siebner HR, Soares JM, Sousa N, Morgado P. Altered response to risky decisions and reward in patients with obsessive–compulsive disorder. J Psychiatry Neurosci 2020; 45:98-107. [PMID: 31509362 PMCID: PMC7828903 DOI: 10.1503/jpn.180226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Patients with obsessive–compulsive disorder (OCD) employ ritualistic behaviours to reduce or even neutralize the anxiety provoked by their obsessions. The presence of excessive rumination and indecision has motivated the view of OCD as a disorder of decision-making. Most studies have focused on the “cold,” cognitive aspects of decision-making. This study expands current understanding of OCD by characterizing the abnormalities associated with affective, or “hot” decision-making. METHODS We performed a functional MRI study in a sample of 34 patients with OCD and 33 sex- and age-matched healthy controls, during which participants made 2-choice gambles taking varying levels of risk. RESULTS During risky decisions, patients showed significantly reduced task-related activation in the posterior cingulum, lingual gyrus and anterior cingulate cortex. We identified significant group × risk interactions in the calcarine cortex, precuneus, amygdala and anterior cingulate cortex. During the outcome phase, patients with OCD showed stronger activation of the orbitofrontal cortex, anterior cingulate cortex and putamen in response to unexpected losses. LIMITATIONS The group of patients not receiving medication was very small (n = 5), which precluded us from assessing the effect of medication on risk-taking behaviour in these patients. CONCLUSION Obsessive–compulsive disorder is associated with abnormal brain activity patterns during risky decision-making in a set of brain regions that have been consistently implicated in the processing of reward prediction errors. Alterations in affective “hot” processes implicated in decision-making may contribute to increased indecisiveness and intolerance to uncertainty in patients with OCD.
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Affiliation(s)
- Pedro Silva Moreira
- From the Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the ICVS/3Bs, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the Clinical Academic Centre, Braga, 4710-057 Braga, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (Macoveanu); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Denmark (Macoveanu, Siebner); the Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 København, Denmark (Siebner); and the Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark (Siebner)
| | - Julian Macoveanu
- From the Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the ICVS/3Bs, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the Clinical Academic Centre, Braga, 4710-057 Braga, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (Macoveanu); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Denmark (Macoveanu, Siebner); the Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 København, Denmark (Siebner); and the Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark (Siebner)
| | - Paulo Marques
- From the Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the ICVS/3Bs, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the Clinical Academic Centre, Braga, 4710-057 Braga, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (Macoveanu); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Denmark (Macoveanu, Siebner); the Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 København, Denmark (Siebner); and the Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark (Siebner)
| | - Ana Coelho
- From the Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the ICVS/3Bs, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the Clinical Academic Centre, Braga, 4710-057 Braga, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (Macoveanu); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Denmark (Macoveanu, Siebner); the Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 København, Denmark (Siebner); and the Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark (Siebner)
| | - Ricardo Magalhães
- From the Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the ICVS/3Bs, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the Clinical Academic Centre, Braga, 4710-057 Braga, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (Macoveanu); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Denmark (Macoveanu, Siebner); the Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 København, Denmark (Siebner); and the Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark (Siebner)
| | - Hartwig R. Siebner
- From the Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the ICVS/3Bs, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the Clinical Academic Centre, Braga, 4710-057 Braga, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (Macoveanu); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Denmark (Macoveanu, Siebner); the Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 København, Denmark (Siebner); and the Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark (Siebner)
| | - José Miguel Soares
- From the Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the ICVS/3Bs, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the Clinical Academic Centre, Braga, 4710-057 Braga, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (Macoveanu); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Denmark (Macoveanu, Siebner); the Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 København, Denmark (Siebner); and the Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark (Siebner)
| | - Nuno Sousa
- From the Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the ICVS/3Bs, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the Clinical Academic Centre, Braga, 4710-057 Braga, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (Macoveanu); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Denmark (Macoveanu, Siebner); the Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 København, Denmark (Siebner); and the Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark (Siebner)
| | - Pedro Morgado
- From the Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the ICVS/3Bs, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the Clinical Academic Centre, Braga, 4710-057 Braga, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (Macoveanu); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Denmark (Macoveanu, Siebner); the Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 København, Denmark (Siebner); and the Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark (Siebner)
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Marzuki AA, Pereira de Souza AMFL, Sahakian BJ, Robbins TW. Are candidate neurocognitive endophenotypes of OCD present in paediatric patients? A systematic review. Neurosci Biobehav Rev 2019; 108:617-645. [PMID: 31821834 DOI: 10.1016/j.neubiorev.2019.12.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/01/2019] [Accepted: 12/06/2019] [Indexed: 01/03/2023]
Abstract
To-date it has been difficult to ascertain the exact cognitive profile of childhood OCD as studies report variable results. Adult OCD research lately utilises the endophenotype approach; studying cognitive traits that are present in both patients and their unaffected first-degree relatives, and are thought to lie closer to the genotype than the full-blown disorder. By observing whether candidate endopenotypes of adult OCD are present in child patients, we can determine whether the two subtypes show cognitive overlap. We conducted a systematic review of the paediatric OCD literature focussing on proposed neurocognitive endophenotypes of OCD: cognitive flexibility, response inhibition, memory, planning, decision-making, action monitoring, and reversal learning. We found that paediatric patients present robust increases in brain error related negativity associated with abnormal action monitoring, impaired decision-making under uncertainty, planning, and visual working memory, but there is less evidence for deficits in other cognitive domains. This implies that children with OCD show some cognitive similarities with adult patients, but other dysfunctions may only manifest later in the disorder trajectory.
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Affiliation(s)
- Aleya A Marzuki
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, CB2 3EL, Cambridge, UK; Department of Psychology, Downing Site, University of Cambridge, CB2 3EB, Cambridge, UK.
| | - Ana Maria Frota Lisboa Pereira de Souza
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, CB2 3EL, Cambridge, UK; Department of Psychology, Downing Site, University of Cambridge, CB2 3EB, Cambridge, UK.
| | - Barbara J Sahakian
- Herchel Smith Building, Department of Psychiatry, University of Cambridge, CB2 0SZ, Cambridge, UK.
| | - Trevor W Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, CB2 3EL, Cambridge, UK; Department of Psychology, Downing Site, University of Cambridge, CB2 3EB, Cambridge, UK.
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22
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Mitelman SA. Transdiagnostic neuroimaging in psychiatry: A review. Psychiatry Res 2019; 277:23-38. [PMID: 30639090 DOI: 10.1016/j.psychres.2019.01.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 01/10/2023]
Abstract
Transdiagnostic approach has a long history in neuroimaging, predating its recent ascendance as a paradigm for new psychiatric nosology. Various psychiatric disorders have been compared for commonalities and differences in neuroanatomical features and activation patterns, with different aims and rationales. This review covers both structural and functional neuroimaging publications with direct comparison of different psychiatric disorders, including schizophrenia, bipolar disorder, major depressive disorder, autism spectrum disorder, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, conduct disorder, anorexia nervosa, and bulimia nervosa. Major findings are systematically presented along with specific rationales for each comparison.
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Affiliation(s)
- Serge A Mitelman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; Department of Psychiatry, Division of Child and Adolescent Psychiatry, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY 11373, USA.
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23
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Hu X, Zhang L, Bu X, Li H, Li B, Tang W, Lu L, Hu X, Tang S, Gao Y, Yang Y, Roberts N, Gong Q, Huang X. Localized Connectivity in Obsessive-Compulsive Disorder: An Investigation Combining Univariate and Multivariate Pattern Analyses. Front Behav Neurosci 2019; 13:122. [PMID: 31249515 PMCID: PMC6584748 DOI: 10.3389/fnbeh.2019.00122] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 05/20/2019] [Indexed: 02/05/2023] Open
Abstract
Recent developments in psychoradiological researches have highlighted the disrupted organization of large-scale functional brain networks in obsessive-compulsive disorder (OCD). However, whether abnormal activation of localized brain areas would affect network dysfunction remains to be fully characterized. We applied both univariate analysis and multivariate pattern analysis (MVPA) approaches to investigate the abnormalities of regional homogeneity (ReHo), an index to measure the localized connectivity, in 88 medication-free patients with OCD and 88 healthy control subjects (HCS). Resting-state functional magnetic resonance imaging (RS-fMRI) data of all the participants were acquired in a 3.0-T scanner. First, we adopted a traditional univariate analysis to explore ReHo alterations between the patient group and the control group. Subsequently, we utilized a support vector machine (SVM) to examine whether ReHo could be further used to differentiate patients with OCD from HCS at the individual level. Relative to HCS, OCD patients showed lower ReHo in the bilateral cerebellum and higher ReHo in the bilateral superior frontal gyri (SFG), right inferior parietal gyrus (IPG), and precuneus [P < 0.05, family-wise error (FWE) correction]. ReHo value in the left SFG positively correlated with Yale-Brown Obsessive Compulsive Scale (Y-BOCS) total score (r = 0 0.241, P = 0.024) and obsessive subscale (r = 0.224, P = 0.036). The SVM classification regarding ReHo yielded an accuracy of 78.98% (sensitivity = 78.41%, specificity = 79.55%) with P < 0.001 after permutation testing. The most discriminative regions contributing to the SVM classification were mainly located in the frontal, temporal, and parietal regions as well as in the cerebellum while the right orbital frontal cortex was identified with the highest discriminative power. Our findings not only suggested that the localized activation disequilibrium between the prefrontal cortex (PFC) and the cerebellum appeared to be associated with the pathophysiology of OCD but also indicated the translational role of the localized connectivity as a potential discriminative pattern to detect OCD at the individual level.
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Affiliation(s)
- Xinyu Hu
- Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Lianqing Zhang
- Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Xuan Bu
- Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Hailong Li
- Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Bin Li
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Wanjie Tang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Lu Lu
- Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Xiaoxiao Hu
- Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Shi Tang
- Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Yingxue Gao
- Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Yanchun Yang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Neil Roberts
- Clinical Research Imaging Centre (CRIC), The Queen's Medical Research Institute (QMRI), University of Edinburgh, Edinburgh, United Kingdom
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Xiaoqi Huang
- Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
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24
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Norman LJ, Taylor SF, Liu Y, Radua J, Chye Y, De Wit SJ, Huyser C, Karahanoglu FI, Luks T, Manoach D, Mathews C, Rubia K, Suo C, van den Heuvel OA, Yücel M, Fitzgerald K. Error Processing and Inhibitory Control in Obsessive-Compulsive Disorder: A Meta-analysis Using Statistical Parametric Maps. Biol Psychiatry 2019; 85:713-725. [PMID: 30595231 PMCID: PMC6474799 DOI: 10.1016/j.biopsych.2018.11.010] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/26/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Error processing and inhibitory control enable the adjustment of behaviors to meet task demands. Functional magnetic resonance imaging studies report brain activation abnormalities in patients with obsessive-compulsive disorder (OCD) during both processes. However, conclusions are limited by inconsistencies in the literature and small sample sizes. Therefore, the aim here was to perform a meta-analysis of the existing literature using unthresholded statistical maps from previous studies. METHODS A voxelwise seed-based d mapping meta-analysis was performed using t-maps from studies comparing patients with OCD and healthy control subjects (HCs) during error processing and inhibitory control. For the error processing analysis, 239 patients with OCD (120 male; 79 medicated) and 229 HCs (129 male) were included, while the inhibitory control analysis included 245 patients with OCD (120 male; 91 medicated) and 239 HCs (135 male). RESULTS Patients with OCD, relative to HCs, showed longer inhibitory control reaction time (standardized mean difference = 0.20, p = .03, 95% confidence interval = 0.016, 0.393) and more inhibitory control errors (standardized mean difference = 0.22, p = .02, 95% confidence interval = 0.039, 0.399). In the brain, patients showed hyperactivation in the bilateral dorsal anterior cingulate cortex, supplementary motor area, and pre-supplementary motor area as well as right anterior insula/frontal operculum and anterior lateral prefrontal cortex during error processing but showed hypoactivation during inhibitory control in the rostral and ventral anterior cingulate cortices and bilateral thalamus/caudate, as well as the right anterior insula/frontal operculum, supramarginal gyrus, and medial orbitofrontal cortex (all seed-based d mapping z value >2, p < .001). CONCLUSIONS A hyperactive error processing mechanism in conjunction with impairments in implementing inhibitory control may underlie deficits in stopping unwanted compulsive behaviors in the disorder.
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Affiliation(s)
- Luke J. Norman
- Department of Psychiatry, Medical School, University of Michigan, Ann Arbor, USA,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Stephan F. Taylor
- Department of Psychiatry, Medical School, University of Michigan, Ann Arbor, USA
| | - Yanni Liu
- Department of Psychiatry, Medical School, University of Michigan, Ann Arbor, USA
| | - Joaquim Radua
- Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Mental Health Research Networking Center (CIBERSAM), Barcelona, Spain,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Yann Chye
- Brain and Mental Health Research Hub, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Stella J. De Wit
- Amsterdam University Medical Centers, Vrije Universiteit, Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam, The Netherlands,GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Chaim Huyser
- Bascule, Academic Centre for Children and Adolescent Psychiatry, Amsterdam, Netherlands
| | - F. Isik Karahanoglu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Tracy Luks
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | - Dara Manoach
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, USA
| | - Carol Mathews
- Department of Psychiatry and Center for OCD, Anxiety and Related Disorders, University of Florida, Gainesville, Florida, USA
| | - Katya Rubia
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Chao Suo
- Brain and Mental Health Research Hub, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Odile A. van den Heuvel
- Amsterdam University Medical Centers, Vrije Universiteit, Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam, The Netherlands,OCD-Team, Haukeland University Hospital, Bergen, Norway
| | - Murat Yücel
- Brain and Mental Health Research Hub, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia,Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Kate Fitzgerald
- Department of Psychiatry, Medical School, University of Michigan, Ann Arbor, USA
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25
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The impact of successful learning of self-regulation on reward processing in children with ADHD using fMRI. ATTENTION DEFICIT AND HYPERACTIVITY DISORDERS 2019; 11:31-45. [PMID: 30225805 DOI: 10.1007/s12402-018-0269-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/10/2018] [Indexed: 12/24/2022]
Abstract
Neurofeedback (NF) is a non-pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD) that is targeting self-regulation, is efficacious when standard protocols are used and induces partly specific neurophysiological changes in the inhibitory network. However, its effects on reward processing, which is also considered an important aspect of ADHD and has been linked to neurophysiological deficits, remain unknown. Children with ADHD (N = 15, mean age 11.8, SD 1.52) were randomly assigned to either slow cortical potential NF (n = 8) or EMG biofeedback control training (n = 7) and received 20 sessions of training under comparable conditions. Learning was defined as the slope of successful training runs across all transfer sessions. Whole brain analysis, region-of-interest analysis of anticipatory ventral striatal (VS) activation, and analysis of behavioral data were performed. Clinically, the NF group improved more than the EMG group. Whole brain analysis indicated increased activation in the left superior frontal gyrus in the control group only, and in medial prefrontal cortex and dorsolateral prefrontal gyrus (DLPFC) after treatment across all groups. Only successful learners of self-regulation (n = 8) showed increased left inferior frontal gyrus and DLPFC activation after treatment. Left VS activation was increased after treatment and showed a significant time*medication-status interaction. Specific treatment effects were found in left frontal regions for the control treatment and successful learners. Also, unmedicated participants, irrespective of treatment type or successful learning, showed treatment-induced improvement in reward processing. The results suggest no prominent specific effect of NF on reward processing. However, cautious interpretation is warranted due to the small sample.
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26
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Deng K, Qi T, Xu J, Jiang L, Zhang F, Dai N, Cheng Y, Xu X. Reduced Interhemispheric Functional Connectivity in Obsessive-Compulsive Disorder Patients. Front Psychiatry 2019; 10:418. [PMID: 31249539 PMCID: PMC6584782 DOI: 10.3389/fpsyt.2019.00418] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/24/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Neuroimaging studies have shown that the high synchrony of spontaneous neural activity in the homotopic regions between hemispheres is an important functional structural feature of normal human brains, and this feature is abnormal in the patients with various mental disorders. However, little is known about this feature in obsessive-compulsive disorder (OCD). This study aimed to further analyze the underlying neural mechanisms of OCD and to explore whether clinical characteristics are correlated with the alerted homotopic connectivity in patients with OCD. Methods: Using voxel-mirrored homotopic connectivity (VMHC) during resting state, we compared 46 OCD patients and 46 healthy controls (HCs) matched for age, gender, and education level. A partial correlation analysis was used to investigate the relationship between altered VMHC and clinical characteristics in patients with OCD. Results: Patients with OCD showed lower VMHC than HCs in fusiform gyrus/inferior occipital gyrus, lingual gyrus, postcentral gyrus/precentral gyrus, putamen, and orbital frontal gyrus. A significant positive correlation was observed between altered VMHC in the angular gyrus/middle occipital gyrus and illness duration in patients. Conclusions: Interhemispheric functional imbalance may be an essential aspect of the pathophysiological mechanism of OCD, which is reflected not only in the cortico-striato-thalamo-cortical (CSTC) loop but also elsewhere in the brain.
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Affiliation(s)
- Ke Deng
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Tianfu Qi
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jian Xu
- Department of Rheumatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Linlin Jiang
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China.,Yunan Key Laboratory of Laboratory Medicine, Kunming, China
| | - Fengrui Zhang
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Nan Dai
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yuqi Cheng
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiufeng Xu
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
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27
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Cabarkapa S, King JA, Dowling N, Ng CH. Co-Morbid Obsessive-Compulsive Disorder and Attention Deficit Hyperactivity Disorder: Neurobiological Commonalities and Treatment Implications. Front Psychiatry 2019; 10:557. [PMID: 31456703 PMCID: PMC6700219 DOI: 10.3389/fpsyt.2019.00557] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/16/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sonja Cabarkapa
- The Melbourne Clinic, Richmond, VIC, Australia.,St Vincent's Health, Melbourne, VIC, Australia
| | - Joel A King
- The Melbourne Clinic, Richmond, VIC, Australia.,The University of Melbourne, Melbourne, VIC, Australia
| | - Nathan Dowling
- The Melbourne Clinic, Richmond, VIC, Australia.,The University of Melbourne, Melbourne, VIC, Australia
| | - Chee H Ng
- The Melbourne Clinic, Richmond, VIC, Australia.,The University of Melbourne, Melbourne, VIC, Australia
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28
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Jiang X, Liu L, Ji H, Zhu Y. Association of Affected Neurocircuitry With Deficit of Response Inhibition and Delayed Gratification in Attention Deficit Hyperactivity Disorder: A Narrative Review. Front Hum Neurosci 2018; 12:506. [PMID: 30618685 PMCID: PMC6305413 DOI: 10.3389/fnhum.2018.00506] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 12/05/2018] [Indexed: 12/11/2022] Open
Abstract
The neural networks that constitute corticostriatothalamocortical circuits between prefrontal cortex and subcortical structure provide a heuristic framework for bridging gaps between neurocircuitry and executive dysfunction in attention deficit hyperactivity disorder (ADHD). “Cool” and “Hot” executive functional theory and the models of dual pathway are supposed to be applied within the neuropsychology of ADHD. The theoretical model elaborated response inhibition and delayed gratification in ADHD. We aimed to review and summarize the literature about the circuits on ADHD and ADHD-related comorbidities, as well as the effects of neurocircuitry on the executive dysfunction in ADHD.
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Affiliation(s)
- Xixi Jiang
- Shanghai Changning Mental Health Center, Affiliated Greenland Hospital of Bio-X Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Li Liu
- Shanghai Changning Mental Health Center, Affiliated Greenland Hospital of Bio-X Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Haifeng Ji
- Shanghai Changning Mental Health Center, Affiliated Greenland Hospital of Bio-X Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Yuncheng Zhu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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