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Echizen K, Hirose D. Obsessive-compulsive disorder induced by donepezil in a patient with Alzheimer's disease. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2024; 3:e217. [PMID: 38887312 PMCID: PMC11180973 DOI: 10.1002/pcn5.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/14/2024] [Accepted: 06/02/2024] [Indexed: 06/20/2024]
Abstract
Background Donepezil, an acetylcholinesterase inhibitor commonly used to treat Alzheimer's disease (AD), is generally well tolerated. There have been no previous reports on donepezil-induced obsessive-compulsive disorder (OCD). Case Presentation The patient, a retired man in his 70s diagnosed with AD, displayed OCD symptoms following donepezil initiation, exacerbating post-stroke-specifically, a cerebral infarction in the right posterior limb of the internal capsule. Remarkably, the symptoms abated upon discontinuation of donepezil. Conclusion Caution should be exercised when using donepezil in patients with a history of stroke.
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Affiliation(s)
- Kohei Echizen
- Department of PsychiatryToranomon HospitalTokyoJapan
| | - Daisuke Hirose
- Department of Geriatric MedicineToranomon HospitalTokyoJapan
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2
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Yoshioka D, Yamanashi T, Hayashi T, Iwata M. Obsessive-compulsive disorder after traumatic injury to the right frontal and left temporal lobes: A case report. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2024; 3:e199. [PMID: 38883324 PMCID: PMC11177174 DOI: 10.1002/pcn5.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/10/2024] [Accepted: 04/24/2024] [Indexed: 06/18/2024]
Abstract
Background Obsessive-compulsive disorder (OCD) is a common neuropsychiatric disorder affecting many behaviors in daily life. Hyperactivity of the fronto-striato-thalamic circuit via the orbitofrontal cortex (OFC) is assumed to play a major role in the pathophysiology of OCD; however, its pathogenesis is not fully understood. Several reports have described the development of OCD after traumatic brain injury (TBI); however, the pathogenesis of post-TBI OCD remains unknown. Moreover, patients with TBI often have a variety of sequelae, including cognitive dysfunction and mood disorders, which make the diagnosis and treatment of OCD more complex. Case presentation We report the case of a 17-year-old Japanese male who developed OCD after traffic trauma. The patient developed a fear of contamination and checking compulsion after injuring his right OFC and left temporal lobe when he ran into a running truck during a suicide attempt. We believe that the patient's fear of contamination can be diagnosed as true post-TBI OCD. However, his memory impairment was significant, and we considered his checking compulsion to be strongly influenced by cognitive dysfunction due to TBI. We attempted behavioral therapy for OCD; however, sufficient results were not achieved because of the interference from the sequelae of TBI. Conclusion It is not rare for OCD symptoms to appear after TBI. Differentiating the OCD symptoms induced by brain injury or cognitive dysfunction associated with TBI is important to determine a treatment strategy.
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Affiliation(s)
- Daisuke Yoshioka
- Division of Neuropsychiatry Faculty of Medicine, Tottori University Yonago Japan
| | - Takehiko Yamanashi
- Division of Neuropsychiatry Faculty of Medicine, Tottori University Yonago Japan
| | - Teruaki Hayashi
- Division of Neuropsychiatry Faculty of Medicine, Tottori University Yonago Japan
| | - Masaaki Iwata
- Division of Neuropsychiatry Faculty of Medicine, Tottori University Yonago Japan
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Obsessive-compulsive symptoms associated with left temporal dysembryoplastic neuroepithelial tumor: A case report. THE EUROPEAN JOURNAL OF PSYCHIATRY 2022. [DOI: 10.1016/j.ejpsy.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Tanguy D, Batrancourt B, Estudillo-Romero A, Baxter JSH, Le Ber I, Bouzigues A, Godefroy V, Funkiewiez A, Chamayou C, Volle E, Saracino D, Rametti-Lacroux A, Morandi X, Jannin P, Levy R, Migliaccio R. An ecological approach to identify distinct neural correlates of disinhibition in frontotemporal dementia. Neuroimage Clin 2022; 35:103079. [PMID: 35700600 PMCID: PMC9194654 DOI: 10.1016/j.nicl.2022.103079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 05/24/2022] [Accepted: 06/03/2022] [Indexed: 11/27/2022]
Abstract
Disinhibition is a core symptom of many neurodegenerative diseases, particularly frontotemporal dementia, and is a major cause of stress for caregivers. While a distinction between behavioural and cognitive disinhibition is common, an operational definition of behavioural disinhibition is still missing. Furthermore, conventional assessment of behavioural disinhibition, based on questionnaires completed by the caregivers, often lacks ecological validity. Therefore, their neuroanatomical correlates are non-univocal. In the present work, we used an original behavioural approach in a semi-ecological situation to assess two specific dimensions of behavioural disinhibition: compulsivity and social disinhibition. First, we investigated disinhibition profile in patients compared to controls. Then, to validate our approach, compulsivity and social disinhibition scores were correlated with classic cognitive tests measuring disinhibition (Hayling Test) and social cognition (mini-Social cognition & Emotional Assessment). Finally, we disentangled the anatomical networks underlying these two subtypes of behavioural disinhibition, taking in account the grey (voxel-based morphometry) and white matter (diffusion tensor imaging tractography). We included 17 behavioural variant frontotemporal dementia patients and 18 healthy controls. We identified patients as more compulsive and socially disinhibited than controls. We found that behavioural metrics in the semi-ecological task were related to cognitive performance: compulsivity correlated with the Hayling test and both compulsivity and social disinhibition were associated with the emotion recognition test. Based on voxel-based morphometry and tractography, compulsivity correlated with atrophy in the bilateral orbitofrontal cortex, the right temporal region and subcortical structures, as well as with alterations of the bilateral cingulum and uncinate fasciculus, the right inferior longitudinal fasciculus and the right arcuate fasciculus. Thus, the network of regions related to compulsivity matched the "semantic appraisal" network. Social disinhibition was associated with bilateral frontal atrophy and impairments in the forceps minor, the bilateral cingulum and the left uncinate fasciculus, regions corresponding to the frontal component of the "salience" network. Summarizing, this study validates our semi-ecological approach, through the identification of two subtypes of behavioural disinhibition, and highlights different neural networks underlying compulsivity and social disinhibition. Taken together, these findings are promising for clinical practice by providing a better characterisation of inhibition disorders, promoting their detection and consequently a more adapted management of patients.
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Affiliation(s)
- Delphine Tanguy
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France; Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France.
| | - Bénédicte Batrancourt
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | | | - John S H Baxter
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Isabelle Le Ber
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, IM2A, Paris, France
| | - Arabella Bouzigues
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Valérie Godefroy
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Aurélie Funkiewiez
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, IM2A, Paris, France
| | - Céline Chamayou
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, IM2A, Paris, France
| | - Emmanuelle Volle
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Dario Saracino
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, IM2A, Paris, France
| | - Armelle Rametti-Lacroux
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Xavier Morandi
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Pierre Jannin
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Richard Levy
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, IM2A, Paris, France
| | - Raffaella Migliaccio
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, IM2A, Paris, France.
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Liu J, Bu X, Hu X, Li H, Cao L, Gao Y, Liang K, Zhang L, Lu L, Hu X, Wang Y, Gong Q, Huang X. Temporal variability of regional intrinsic neural activity in drug-naïve patients with obsessive-compulsive disorder. Hum Brain Mapp 2021; 42:3792-3803. [PMID: 33949731 PMCID: PMC8288087 DOI: 10.1002/hbm.25465] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/08/2021] [Accepted: 04/26/2021] [Indexed: 02/05/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) displays alterations in regional brain activity represented by the amplitude of low-frequency fluctuation (ALFF), but the time-varying characteristics of this local neural activity remain to be clarified. We aimed to investigate the dynamic changes of intrinsic brain activity in a relatively large sample of drug-naïve OCD patients using univariate and multivariate analyses. We applied a sliding-window approach to calculate the dynamic ALFF (dALFF) and compared the difference between 73 OCD patients and age- and sex-matched healthy controls (HCs). We also utilized multivariate pattern analysis to determine whether dALFF could differentiate OCD patients from HCs at the individual level. Compared with HCs, OCD patients exhibited increased dALFF mainly within regions of the cortical-striatal-thalamic-cortical (CSTC) circuit, including the bilateral dorsal anterior cingulate cortex, medial prefrontal cortex and striatum, and right dorsolateral prefrontal cortex (dlPFC). Decreased dALFF was identified in the bilateral inferior parietal lobule (IPL), posterior cingulate cortex, insula, fusiform gyrus, and cerebellum. Moreover, we found negative correlations between illness duration and dALFF values in the right IPL and between dALFF values in the left cerebellum and Hamilton Depression Scale scores. Furthermore, dALFF can distinguish OCD patients from HCs with the most discriminative regions located in the IPL, dlPFC, middle occipital gyrus, and cuneus. Taken together, in the current study, we demonstrated a characteristic pattern of higher variability of regional brain activity within the CSTC circuits and lower variability in regions outside the CSTC circuits in drug-naïve OCD patients.
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Affiliation(s)
- Jing Liu
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of RadiologyWest China Hospital, Sichuan UniversityChengduChina
- Psychoradiology Research Unit of the Chinese Academy of Medical SciencesWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Xuan Bu
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of RadiologyWest China Hospital, Sichuan UniversityChengduChina
- Psychoradiology Research Unit of the Chinese Academy of Medical SciencesWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Xinyu Hu
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of RadiologyWest China Hospital, Sichuan UniversityChengduChina
- Psychoradiology Research Unit of the Chinese Academy of Medical SciencesWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Hailong Li
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of RadiologyWest China Hospital, Sichuan UniversityChengduChina
- Psychoradiology Research Unit of the Chinese Academy of Medical SciencesWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Lingxiao Cao
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of RadiologyWest China Hospital, Sichuan UniversityChengduChina
- Psychoradiology Research Unit of the Chinese Academy of Medical SciencesWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Yingxue Gao
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of RadiologyWest China Hospital, Sichuan UniversityChengduChina
- Psychoradiology Research Unit of the Chinese Academy of Medical SciencesWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Kaili Liang
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of RadiologyWest China Hospital, Sichuan UniversityChengduChina
- Psychoradiology Research Unit of the Chinese Academy of Medical SciencesWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Lianqing Zhang
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of RadiologyWest China Hospital, Sichuan UniversityChengduChina
- Psychoradiology Research Unit of the Chinese Academy of Medical SciencesWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Lu Lu
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of RadiologyWest China Hospital, Sichuan UniversityChengduChina
- Psychoradiology Research Unit of the Chinese Academy of Medical SciencesWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Xinyue Hu
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of RadiologyWest China Hospital, Sichuan UniversityChengduChina
- Psychoradiology Research Unit of the Chinese Academy of Medical SciencesWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Yanlin Wang
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of RadiologyWest China Hospital, Sichuan UniversityChengduChina
- Psychoradiology Research Unit of the Chinese Academy of Medical SciencesWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of RadiologyWest China Hospital, Sichuan UniversityChengduChina
- Psychoradiology Research Unit of the Chinese Academy of Medical SciencesWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Xiaoqi Huang
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of RadiologyWest China Hospital, Sichuan UniversityChengduChina
- Psychoradiology Research Unit of the Chinese Academy of Medical SciencesWest China Hospital of Sichuan UniversityChengduSichuanChina
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Manarte L, Andrade AR, do Rosário L, Sampaio D, Figueira ML, Morgado P, Sahakian BJ. Executive functions and insight in OCD: a comparative study. BMC Psychiatry 2021; 21:216. [PMID: 33926404 PMCID: PMC8082868 DOI: 10.1186/s12888-021-03227-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/19/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Around 25 to 30% of patients with obsessive-compulsive disorder (OCD) do not respond to treatment. These patients have the longest duration of disease and the worst prognosis. Following years of research on this topic, insight has emerged as a potential explanation for this therapeutic resistance. Therefore, it has become important to characterize OCD patients with poor insight. Few studies have focused on the neuropsychological and cognitive characteristics of these patients. METHODS To help fill this gap, we divided 57 patients into two groups, one with good insight and the other with poor insight, assessed their neuropsychological functions-through a Rey's figure test, a California verbal learning test, a Toulouse-Piéron test and a Wisconsin Card Sorting Test (WCST)-and compared the results with those of a paired control group. RESULTS The statistical analysis, with a significance level of 95%, revealed differences in the executive function tests, and particularly in the WCST (p ≤ 0.001) and trail-making-test (TMT A/B) (p = 0.002). CONCLUSIONS These differences suggest that the neuropsychological profile of poor-insight patients is different from their good-insight counterparts, emphasize the role played by the executive functions in insight and highlights the need for more accurate neurocognitive research and treatment.
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Affiliation(s)
- Lucas Manarte
- Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal.
| | - António R Andrade
- IDMEC. Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais 1, 1049-001, Lisbon, Portugal
| | - Linete do Rosário
- Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Daniel Sampaio
- Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Maria Luísa Figueira
- Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Pedro Morgado
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, R. da Universidade, 4710-057, Braga, Portugal
| | - Barbara J Sahakian
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
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7
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Sacchi L, Rotondo E, Pozzoli S, Fiorentini A, Schinco G, Mandelli C, Coppola C, Fumagalli GG, Carandini T, Pietroboni AM, Galimberti D, Triulzi F, Marotta G, Scarpini E, Cesari M, Brambilla P, Arighi A. Diogenes syndrome in dementia: a case report. BJPsych Open 2021; 7:e43. [PMID: 33526159 PMCID: PMC8058863 DOI: 10.1192/bjo.2020.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Diogenes syndrome is a neurobehavioural syndrome characterised by domestic squalor, hoarding and lack of insight. It is an uncommon but high-mortality condition, often associated with dementia. AIMS To describe the clinical features and treatment of Diogenes syndrome secondary to behavioural variant frontotemporal dementia (bvFTD). METHOD We describe a case of bvFTD in a 77-year-old man presenting with Diogenes syndrome. RESULTS The patient's medical and psychiatric histories were unremarkable, but in recent years he had begun packing his flat with 'art pieces'. Mental state examination revealed confabulation and more structured delusions. Neuropsychological evaluation outlined an impairment in selective attention and letter verbal fluency, but no semantic impairment, in the context of an overall preserved mental functioning. Brain magnetic resonance imaging and positron emission tomography (PET) with fluorodeoxyglucose showed mild bilateral temporo-insular atrophy and hypometabolism in the left-superior temporal gyrus respectively. An amyloid PET scan and genetic analysis covering the dementia spectrum were normal. A diagnosis of bvFTD was made. CONCLUSIONS The clinical framing of behavioural symptoms of dementia such as hoarding poses a diagnostic challenge. This case illustrates the importance of a deeper understanding of Diogenes syndrome, leading to timelier diagnosis and effective therapeutic strategies.
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Affiliation(s)
- Luca Sacchi
- Dino Ferrari Center, University of Milan, Italy
| | - Emanuela Rotondo
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Pozzoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessio Fiorentini
- Department of Neurosciences and Mental Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppina Schinco
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Clara Mandelli
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlotta Coppola
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio G Fumagalli
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tiziana Carandini
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna M Pietroboni
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Galimberti
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; and Dino Ferrari Center, University of Milan, Italy
| | - Fabio Triulzi
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Marotta
- Nuclear Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elio Scarpini
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; and Dino Ferrari Center, University of Milan, Italy
| | - Matteo Cesari
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, University of Milan, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; and Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Andrea Arighi
- Neurodegenerative Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Increased cerebellar-default-mode network connectivity at rest in obsessive-compulsive disorder. Eur Arch Psychiatry Clin Neurosci 2020; 270:1015-1024. [PMID: 31570980 DOI: 10.1007/s00406-019-01070-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/18/2019] [Indexed: 12/20/2022]
Abstract
Abnormalities of the cerebellum and default-mode network (DMN) in patients with obsessive-compulsive disorder (OCD) have been widely reported. However, alterations of reciprocal functional connections between the cerebellum and DMN at rest in OCD remain unclear. Forty patients with OCD and 38 gender-, age-, and education-matched healthy controls (HCs) underwent resting-state functional magnetic resonance imaging scan. Seed-based functional connectivity (FC) and support vector machine (SVM) were applied to analyze the imaging data. Compared with HCs, patients with OCD exhibited increased FCs between the left Crus I-left superior medial prefrontal cortex (MPFC) and between the right Crus I-left superior MPFC, left middle MPFC, and left middle temporal gyrus (MTG). A significantly negative correlation was observed between the right Crus I-left MTG connectivity and the Yale-Brown Obsessive-Compulsive Scale compulsion subscale scores in the OCD group (r = - 0.476, p = 0.002, Bonferroni corrected). SVM classification analysis indicated that a combination of the left Crus I-left superior MPFC connectivity and the right Crus I-left middle MPFC connectivity can be used to discriminate patients with OCD from HCs with a sensitivity of 85.00%, specificity of 68.42%, and accuracy of 76.92%. Our study highlights the contribution of the cerebellar-DMN connectivity in OCD pathophysiology and provides new findings to OCD research.
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Szechtman H, Harvey BH, Woody EZ, Hoffman KL. The Psychopharmacology of Obsessive-Compulsive Disorder: A Preclinical Roadmap. Pharmacol Rev 2020; 72:80-151. [PMID: 31826934 DOI: 10.1124/pr.119.017772] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This review evaluates current knowledge about obsessive-compulsive disorder (OCD), with the goal of providing a roadmap for future directions in research on the psychopharmacology of the disorder. It first addresses issues in the description and diagnosis of OCD, including the structure, measurement, and appropriate description of the disorder and issues of differential diagnosis. Current pharmacotherapies for OCD are then reviewed, including monotherapy with serotonin reuptake inhibitors and augmentation with antipsychotic medication and with psychologic treatment. Neuromodulatory therapies for OCD are also described, including psychosurgery, deep brain stimulation, and noninvasive brain stimulation. Psychotherapies for OCD are then reviewed, focusing on behavior therapy, including exposure and response prevention and cognitive therapy, and the efficacy of these interventions is discussed, touching on issues such as the timing of sessions, the adjunctive role of pharmacotherapy, and the underlying mechanisms. Next, current research on the neurobiology of OCD is examined, including work probing the role of various neurotransmitters and other endogenous processes and etiology as clues to the neurobiological fault that may underlie OCD. A new perspective on preclinical research is advanced, using the Research Domain Criteria to propose an adaptationist viewpoint that regards OCD as the dysfunction of a normal motivational system. A systems-design approach introduces the security motivation system (SMS) theory of OCD as a framework for research. Finally, a new perspective on psychopharmacological research for OCD is advanced, exploring three approaches: boosting infrastructure facilities of the brain, facilitating psychotherapeutic relearning, and targeting specific pathways of the SMS network to fix deficient SMS shut-down processes. SIGNIFICANCE STATEMENT: A significant proportion of patients with obsessive-compulsive disorder (OCD) do not achieve remission with current treatments, indicating the need for innovations in psychopharmacology for the disorder. OCD may be conceptualized as the dysfunction of a normal, special motivation system that evolved to manage the prospect of potential danger. This perspective, together with a wide-ranging review of the literature, suggests novel directions for psychopharmacological research, including boosting support systems of the brain, facilitating relearning that occurs in psychotherapy, and targeting specific pathways in the brain that provide deficient stopping processes in OCD.
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Affiliation(s)
- Henry Szechtman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
| | - Brian H Harvey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
| | - Erik Z Woody
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
| | - Kurt Leroy Hoffman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
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10
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Evidence for Distinct Forms of Compulsivity in the SAPAP3 Mutant-Mouse Model for Obsessive-Compulsive Disorder. eNeuro 2020; 7:ENEURO.0245-19.2020. [PMID: 32234806 PMCID: PMC7189488 DOI: 10.1523/eneuro.0245-19.2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 02/06/2020] [Accepted: 02/12/2020] [Indexed: 01/16/2023] Open
Abstract
The specific mechanisms underlying compulsive behavior in obsessive-compulsive disorder (OCD) are unknown. It has been suggested that such compulsivity may have its origin in cognitive dysfunction such as impaired processing of feedback information, received after the completion of goal-directed actions. The signal attenuation (SA) task models such a processing deficit in animals by attenuating the association strength between food reward and audiovisual feedback (signal) presented after performance of an operant response. The compulsive-like responding resulting from SA is well characterized in rats, but was so far not established in mice, a species for which powerful genetic OCD models exist. Thus, first, we demonstrate that the SA task can be implemented in mice and show that attenuation of reward-associated response feedback produces similar behavior in C57BL/6 mice as previously reported in rats. Second, we tested the hypothesis that SAPAP3 knock-out mice (SAPAP3-/-), prone to exhibit several OCD-like abnormalities including excessive grooming, show enhanced compulsive-like behavior in the SA task compared with their wild-type (WT) littermates. However, task-related compulsivity measures in SAPAP3-/- and WT did not yield significant differences, neither following SA nor during “regular” extinction of operant behavior. Thus, compulsive-like instrumental behavior following feedback distortion was not potentiated in compulsively grooming mice, implicating specifically that (1) a general deficit in feedback processing is not related to excessive grooming in SAPAP3-/- and (2) different manifestations of compulsivity may be driven by independent mechanisms.
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11
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Kilicaslan EE, Türe HS, Kasal Mİ, Çavuş NN, Akyüz DA, Akhan G, Besiroglu L. Differences in obsessive-compulsive symptom dimensions between patients with epilepsy with obsessive-compulsive symptoms and patients with OCD. Epilepsy Behav 2020; 102:106640. [PMID: 31805512 DOI: 10.1016/j.yebeh.2019.106640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/28/2019] [Accepted: 09/28/2019] [Indexed: 01/24/2023]
Abstract
Clinical correlates of obsessive-compulsive symptoms (OCS) were evaluated in 100 adult consecutive outpatients with epilepsy, using the Obsessive-Compulsive Inventory (OCI-R), Beck Depression Inventory (BDI), Dissociative Experiences Scale (DES-II), and the Schizotypal Personality Questionnaire (SPQ). Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) was applied to determine the types and severity of OCS to the 45 patients with epilepsy who were over 21 points on the OCI-R scale and 30 patients who were with diagnosed obsessive-compulsive disorder (OCD) among the patients in the psychiatry outpatient clinic, as a control group. As a result, it was found that patients with epilepsy with OCS tend to have more symmetry/exactness obsessions and compulsions, whereas patients with OCD had significantly more contamination/cleaning and aggressiveness obsessions and compulsions. In addition, OCS was found to be significantly higher in temporal lobe epilepsy (TLE) and extratemporal epilepsy than generalized epilepsy. However, OCS were correlated with depression, dissociation, and schizotypy in patients with epilepsy, while only depression was predictive when regression analysis was performed for OCS. This study is the first study to compare patients with OCD with patients with epilepsy in terms of the nature of OCS and first identified the differences in OCS dimensions between patients with epilepsy with OCS and patients with OCD.
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Affiliation(s)
- Esin Evren Kilicaslan
- Izmir Katip Celebi University, Atatürk Education and Training Hospital, Psychiatry Department, Basin Sitesi, 35150 Izmir, Turkey.
| | - H Sabiha Türe
- Izmir Katip Celebi University, Atatürk Education and Training Hospital, Neurology Department, Basin Sitesi, 35150 Izmir, Turkey
| | - Meltem İzci Kasal
- Izmir Katip Celebi University, Atatürk Education and Training Hospital, Psychiatry Department, Basin Sitesi, 35150 Izmir, Turkey
| | - Nebile Nur Çavuş
- Izmir Katip Celebi University, Atatürk Education and Training Hospital, Psychiatry Department, Basin Sitesi, 35150 Izmir, Turkey
| | - Dilek Altın Akyüz
- Izmir Katip Celebi University, Atatürk Education and Training Hospital, Neurology Department, Basin Sitesi, 35150 Izmir, Turkey
| | - Galip Akhan
- Izmir Katip Celebi University, Atatürk Education and Training Hospital, Neurology Department, Basin Sitesi, 35150 Izmir, Turkey
| | - Lutfullah Besiroglu
- Izmir Katip Celebi University, Atatürk Education and Training Hospital, Psychiatry Department, Basin Sitesi, 35150 Izmir, Turkey
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12
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Mitchell E, Tavares TP, Palaniyappan L, Finger EC. Hoarding and obsessive-compulsive behaviours in frontotemporal dementia: Clinical and neuroanatomic associations. Cortex 2019; 121:443-453. [PMID: 31715541 DOI: 10.1016/j.cortex.2019.09.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 04/25/2019] [Accepted: 09/20/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hoarding and obsessive-compulsive behaviours (OCB) are well documented symptoms in frontotemporal dementia (FTD). While contemporary models consider hoarding and obsessive-compulsive disorder distinct, the related behaviours have not been separately examined in patients with FTD, and the neuroanatomical correlates of hoarding in patients with FTD have not been previously examined (American Psychiatric Association, 2013; Grisham and Baldwin, 2015; Mataix-Cols et al., 2010). METHODS Patients with FTD who were evaluated between 2004 and 2018 at our centre were included. Cortical thickness and subcortical volumetric analyses were completed on available T1 high resolution anatomic scans using FreeSurfer. RESULTS Eighty-seven patients met inclusion criteria, and 49 had scans available for quantitative MRI volumetric analysis. New hoarding behaviours were present in 29% of patients and were more common in the semantic variant subtype of FTD, while 49% of individuals had new or increased OCB. Hoarding behaviours were associated with decreased thickness in a factor comprised of left temporal, insular and anterior cingulate cortices. The presence of OCB was predicted by reduced cortical thickness and volumes in a factor comprised of the anterior cingulate and subcortical volumes in the bilateral amygdala and hippocampus. OCB were associated with greater right temporal cortical thickness in comparison to patients with hoarding. DISCUSSION The association of the semantic variant with hoarding, together with the observed associations between left temporal atrophy and hoarding indicate that degeneration of the left temporal lobe has a role in the emergence of hoarding in FTD. As in current models of Hoarding disorder and Obsessive-Compulsive disorder, our results suggest that in patients with FTD, hoarding and OCB are clinically and anatomically partially dissociable phenomenon. The results may also help to further elucidate the cognitive processes and neural networks contributing to Hoarding disorder and Obsessive-Compulsive disorder in persons without dementia.
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Affiliation(s)
- Eric Mitchell
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada
| | - Tamara P Tavares
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; Robarts Research Institute, Canada; Lawson Health Research Institute, Canada
| | - Elizabeth C Finger
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; Robarts Research Institute, Canada; Lawson Health Research Institute, Canada; Parkwood Institute, St. Josephs Health Care, Canada.
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13
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Luigjes J, Lorenzetti V, de Haan S, Youssef GJ, Murawski C, Sjoerds Z, van den Brink W, Denys D, Fontenelle LF, Yücel M. Defining Compulsive Behavior. Neuropsychol Rev 2019; 29:4-13. [PMID: 31016439 PMCID: PMC6499743 DOI: 10.1007/s11065-019-09404-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/27/2019] [Indexed: 11/25/2022]
Abstract
Compulsive tendencies are a central feature of problematic human behavior and thereby are of great interest to the scientific and clinical community. However, no consensus exists about the precise meaning of ‘compulsivity,’ creating confusion in the field and hampering comparison across psychiatric disorders. A vague conceptualization makes compulsivity a moving target encompassing a fluctuating variety of behaviors, which is unlikely to improve the new dimension-based psychiatric or psychopathology approach. This article aims to help progress the definition of what constitutes compulsive behavior, cross-diagnostically, by analyzing different definitions in the psychiatric literature. We searched PubMed for articles in human psychiatric research with ‘compulsive behavior’ or ‘compulsivity’ in the title that focused on the broader concept of compulsivity—returning 28 articles with nine original definitions. Within the definitions, we separated three types of descriptive elements: phenomenological, observational and explanatory. The elements most applicable, cross-diagnostically, resulted in this definition: Compulsive behavior consists of repetitive acts that are characterized by the feeling that one ‘has to’ perform them while one is aware that these acts are not in line with one’s overall goal. Having a more unified definition for compulsive behavior will make its meaning precise and explicit, and therefore more transferable and testable across clinical and non-clinical populations.
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Affiliation(s)
- Judy Luigjes
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, PA3.227, PO Box 22660, 1100DD, Amsterdam, The Netherlands. .,Brain Imaging Center, Academic Medical Center, Amsterdam UMC, Amsterdam, The Netherlands.
| | | | - Sanneke de Haan
- Culture Studies, Tilburg University, Tilburg, The Netherlands
| | - George J Youssef
- School of Psychology, Deakin University, Geelong, Australia.,Murdoch Childrens Research Institute, Population Studies of Adolescents, The Royal Children's Hospital Melbourne, Parkville, Australia
| | - Carsten Murawski
- Department of Finance, The University of Melbourne, Parkville, Victoria, Australia
| | - Zsuzsika Sjoerds
- Institute of Psychology, Cognitive Psychology Unit & Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands.,Department of Neurology, Max-Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, PA3.227, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, PA3.227, PO Box 22660, 1100DD, Amsterdam, The Netherlands.,Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Leonardo F Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Murat Yücel
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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14
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Bruin W, Denys D, van Wingen G. Diagnostic neuroimaging markers of obsessive-compulsive disorder: Initial evidence from structural and functional MRI studies. Prog Neuropsychopharmacol Biol Psychiatry 2019; 91:49-59. [PMID: 30107192 DOI: 10.1016/j.pnpbp.2018.08.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/30/2018] [Accepted: 08/09/2018] [Indexed: 01/09/2023]
Abstract
As of yet, no diagnostic biomarkers are available for obsessive-compulsive disorder (OCD), and its diagnosis relies entirely upon the recognition of behavioural features assessed through clinical interview. Neuroimaging studies have shown that various brain structures are abnormal in OCD patients compared to healthy controls. However, the majority of these results are based on average differences between groups, which limits diagnostic usage in clinical practice. In recent years, a growing number of studies have applied multivariate pattern analysis (MVPA) techniques on neuroimaging data to extract patterns of altered brain structure, function and connectivity typical for OCD. MVPA techniques can be used to develop predictive models that extract regularities in data to classify individual subjects based on their diagnosis. In the present paper, we reviewed the literature of MVPA studies using data from different imaging modalities to distinguish OCD patients from controls. A systematic search retrieved twelve articles that fulfilled the inclusion and exclusion criteria. Reviewed studies have been able to classify OCD diagnosis with accuracies ranging from 66% up to 100%. Features important for classification were different across imaging modalities and widespread throughout the brain. Although studies have shown promising results, sample sizes used are typically small which can lead to high variance of the estimated model accuracy, cohort-specific solutions and lack of generalizability of findings. Some of the challenges are discussed that need to be overcome in order to move forward toward clinical applications.
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Affiliation(s)
- Willem Bruin
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands.
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands
| | - Guido van Wingen
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands
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15
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Burchi E, Makris N, Lee MR, Pallanti S, Hollander E. Compulsivity in Alcohol Use Disorder and Obsessive Compulsive Disorder: Implications for Neuromodulation. Front Behav Neurosci 2019; 13:70. [PMID: 31139059 PMCID: PMC6470293 DOI: 10.3389/fnbeh.2019.00070] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/22/2019] [Indexed: 01/22/2023] Open
Abstract
Alcohol use Disorder (AUD) is one of the leading causes of morbidity and mortality worldwide. The progression of the disorder is associated with the development of compulsive alcohol use, which in turn contributes to the high relapse rate and poor longer term functioning reported in most patients, even with treatment. While the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines AUD by a cluster of symptoms, parsing its heterogeneous phenotype by domains of behavior such as compulsivity may be a critical step to improve outcomes of this condition. Still, neurobiological underpinnings of compulsivity need to be fully elucidated in AUD in order to better design targeted treatment strategies. In this manuscript, we review and discuss findings supporting common mechanisms between AUD and OCD, dissecting the construct of compulsivity and focusing specifically on characteristic disruptions in habit learning and cognitive control in the two disorders. Finally, neuromodulatory interventions are proposed as a probe to test compulsivity as key pathophysiologic feature of AUD, and as a potential therapy for the subgroup of individuals with compulsive alcohol use, i.e., the more resistant stage of the disorder. This transdiagnostic approach may help to destigmatize the disorder, and suggest potential treatment targets across different conditions.
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Affiliation(s)
- Elisabetta Burchi
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States.,Department of Health Sciences, University of Florence, Florence, Italy
| | - Nikolaos Makris
- Center for Morphometric Analysis, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Mary R Lee
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse, Bethesda, MD, United States
| | - Stefano Pallanti
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, United States
| | - Eric Hollander
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
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16
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Hell F, Palleis C, Mehrkens JH, Koeglsperger T, Bötzel K. Deep Brain Stimulation Programming 2.0: Future Perspectives for Target Identification and Adaptive Closed Loop Stimulation. Front Neurol 2019; 10:314. [PMID: 31001196 PMCID: PMC6456744 DOI: 10.3389/fneur.2019.00314] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/12/2019] [Indexed: 12/28/2022] Open
Abstract
Deep brain stimulation has developed into an established treatment for movement disorders and is being actively investigated for numerous other neurological as well as psychiatric disorders. An accurate electrode placement in the target area and the effective programming of DBS devices are considered the most important factors for the individual outcome. Recent research in humans highlights the relevance of widespread networks connected to specific DBS targets. Improving the targeting of anatomical and functional networks involved in the generation of pathological neural activity will improve the clinical DBS effect and limit side-effects. Here, we offer a comprehensive overview over the latest research on target structures and targeting strategies in DBS. In addition, we provide a detailed synopsis of novel technologies that will support DBS programming and parameter selection in the future, with a particular focus on closed-loop stimulation and associated biofeedback signals.
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Affiliation(s)
- Franz Hell
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
- Graduate School of Systemic Neurosciences, Ludwig Maximilians University, Munich, Germany
| | - Carla Palleis
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
- Department of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Jan H. Mehrkens
- Department of Neurosurgery, Ludwig Maximilians University, Munich, Germany
| | - Thomas Koeglsperger
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
- Department of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Kai Bötzel
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
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17
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Atalayer D. Dürtüsellik ve Aşırı Yeme Arasındaki İlişki: Psikolojik ve Nörobiyolojik Yaklaşımlar. PSIKIYATRIDE GUNCEL YAKLASIMLAR 2018. [DOI: 10.18863/pgy.358090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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A critical review of PANDAS research in the context of obsessive compulsive disorder. HEALTH PSYCHOLOGY REPORT 2018. [DOI: 10.5114/hpr.2018.70356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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19
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Wood RL, Worthington A. Neurobehavioral Abnormalities Associated with Executive Dysfunction after Traumatic Brain Injury. Front Behav Neurosci 2017; 11:195. [PMID: 29123473 PMCID: PMC5662637 DOI: 10.3389/fnbeh.2017.00195] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/03/2017] [Indexed: 11/13/2022] Open
Abstract
Objective: This article will address how anomalies of executive function after traumatic brain injury (TBI) can translate into altered social behavior that has an impact on a person’s capacity to live safely and independently in the community. Method: Review of literature on executive and neurobehavioral function linked to cognitive ageing in neurologically healthy populations and late neurocognitive effects of serious TBI. Information was collated from internet searches involving MEDLINE, PubMed, PyscINFO and Google Scholar as well as the authors’ own catalogs. Conclusions: The conventional distinction between cognitive and emotional-behavioral sequelae of TBI is shown to be superficial in the light of increasing evidence that executive skills are critical for integrating and appraising environmental events in terms of cognitive, emotional and social significance. This is undertaken through multiple fronto-subcortical pathways within which it is possible to identify a predominantly dorsolateral network that subserves executive control of attention and cognition (so-called cold executive processes) and orbito-frontal/ventro-medial pathways that underpin the hot executive skills that drive much of behavior in daily life. TBI frequently involves disruption to both sets of executive functions but research is increasingly demonstrating the role of hot executive deficits underpinning a wide range of neurobehavioral disorders that compromise relationships, functional independence and mental capacity in daily life.
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Affiliation(s)
- Rodger Ll Wood
- Clinical Neuropsychology, College of Medicine, Swansea University, Swansea, United Kingdom
| | - Andrew Worthington
- College of Medicine and College of Human and Health Sciences, Swansea University, Swansea, United Kingdom
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20
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Neudorfer C, El Majdoub F, Hunsche S, Richter K, Sturm V, Maarouf M. Deep Brain Stimulation of the H Fields of Forel Alleviates Tics in Tourette Syndrome. Front Hum Neurosci 2017; 11:308. [PMID: 28659777 PMCID: PMC5468420 DOI: 10.3389/fnhum.2017.00308] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/29/2017] [Indexed: 12/29/2022] Open
Abstract
The current rationale for target selection in Tourette syndrome revolves around the notion of cortico-basal ganglia circuit involvement in the pathophysiology of the disease. However, despite extensive research, the ideal target for deep brain stimulation (DBS) is still under debate, with many structures being neglected and underexplored. Based on clinical observations and taking into account the prevailing hypotheses of network processing in Tourette syndrome, we chose the fields of Forel, namely field H1, as a target for DBS. The fields of Forel constitute the main link between the striatopallidal system and the thalamocortical network, relaying pallidothalamic projections from core anatomical structures to the thalamic ventral nuclear group. In a retrospective study we investigated two patients suffering from chronic, medically intractable Tourette syndrome who underwent bilateral lead implantation in field H1 of Forel. Clinical scales revealed significant alleviation of tics and comorbid symptoms, namely depression and anxiety, in the postoperative course in both patients.
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Affiliation(s)
- Clemens Neudorfer
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center, Witten/Herdecke UniversityCologne, Germany
| | - Faycal El Majdoub
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center, Witten/Herdecke UniversityCologne, Germany
| | - Stefan Hunsche
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center, Witten/Herdecke UniversityCologne, Germany
| | - Klaus Richter
- Department of Psychiatry and Psychotherapy, LVR Clinics CologneCologne, Germany
| | - Volker Sturm
- Department of Neurosurgery, University Hospital of WürzburgWürzburg, Germany
| | - Mohammad Maarouf
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center, Witten/Herdecke UniversityCologne, Germany
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21
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Obsessive-Compulsive Disorder Associated with Posterior Cranial Fossa Meningioma. Case Rep Psychiatry 2017; 2017:8164537. [PMID: 28656117 PMCID: PMC5471570 DOI: 10.1155/2017/8164537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 04/27/2017] [Accepted: 05/16/2017] [Indexed: 11/17/2022] Open
Abstract
We report here a patient in whom the effects of a cerebellum mass may have led to development of obsessive-compulsive disorder (OCD). A 33-year-old woman showed symptoms of OCD, including obsessive worry about infection from tainted blood and repetitive confirmation, which worsened during pregnancy. She had comprehension in regard to her illness and no evidence of cognitive dysfunction and did not meet other DSM-5 criteria such as depression. One month after giving childbirth, the symptoms worsened, while headache and dizziness also developed. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score was 34. The patient was examined for a headache and a posterior cranial fossa meningioma was found. Following resection of the meningioma, the OCD symptoms were remarkably reduced (Y-BOCS score 10). There is only one previous report of pure OCD associated with a cerebellar mass and the present findings should help to elucidate the mechanism.
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22
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Hu X, Du M, Chen L, Li L, Zhou M, Zhang L, Liu Q, Lu L, Mreedha K, Huang X, Gong Q. Meta-analytic investigations of common and distinct grey matter alterations in youths and adults with obsessive-compulsive disorder. Neurosci Biobehav Rev 2017; 78:91-103. [PMID: 28442404 DOI: 10.1016/j.neubiorev.2017.04.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 04/15/2017] [Accepted: 04/15/2017] [Indexed: 02/05/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a disabling illness with onset generally in childhood. OCD-youths differ from OCD-adults with regard to gender distribution, comorbidity patterns and treatment options. However, little is known about the neural correlate differences underpin those two populations. The current meta-analysis summarizes voxel based morphometry findings to elucidate whether differences of neural correlates exist between these two populations. Both OCD-youths and OCD-adults demonstrated greater striatal volume and smaller prefrontal grey matter volume (GMV). However, smaller GMV in left visual cortex was observed in OCD-youths only, while smaller GMV in anterior cingulate gyrus and greater GMV in cerebellum were demonstrated only in OCD-adults. Meta-regression showed greater GMV in left putamen was most prominent in samples with higher percentages of medicated OCD-adults. Our findings confirmed the most consistent GMV alterations in OCD were in prefrontal-striatal circuitry. Besides, other regions may involve at different developmental stages including deficits of visual cortex in OCD-youths and abnormalities of limbic-cerebellar circuit in OCD-adults. Medication effect may be more pronounced in the striatum, especially the putamen.
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Affiliation(s)
- Xinyu Hu
- Huaxi MR Research Centre(HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Mingying Du
- Department of Radiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Lizhou Chen
- Huaxi MR Research Centre(HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Lei Li
- Huaxi MR Research Centre(HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Ming Zhou
- Huaxi MR Research Centre(HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Lianqing Zhang
- Huaxi MR Research Centre(HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Qi Liu
- Huaxi MR Research Centre(HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Lu Lu
- Huaxi MR Research Centre(HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Kunal Mreedha
- Huaxi MR Research Centre(HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaoqi Huang
- Huaxi MR Research Centre(HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.
| | - Qiyong Gong
- Huaxi MR Research Centre(HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.
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Masuda A, Kobayashi Y, Kogo N, Saito T, Saido TC, Itohara S. Cognitive deficits in single App knock-in mouse models. Neurobiol Learn Mem 2016; 135:73-82. [DOI: 10.1016/j.nlm.2016.07.001] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/14/2016] [Accepted: 07/01/2016] [Indexed: 12/19/2022]
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Stuchlik A, Radostová D, Hatalova H, Vales K, Nekovarova T, Koprivova J, Svoboda J, Horacek J. Validity of Quinpirole Sensitization Rat Model of OCD: Linking Evidence from Animal and Clinical Studies. Front Behav Neurosci 2016; 10:209. [PMID: 27833539 PMCID: PMC5080285 DOI: 10.3389/fnbeh.2016.00209] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/17/2016] [Indexed: 11/15/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder with 1–3% prevalence. OCD is characterized by recurrent thoughts (obsessions) and repetitive behaviors (compulsions). The pathophysiology of OCD remains unclear, stressing the importance of pre-clinical studies. The aim of this article is to critically review a proposed animal model of OCD that is characterized by the induction of compulsive checking and behavioral sensitization to the D2/D3 dopamine agonist quinpirole. Changes in this model have been reported at the level of brain structures, neurotransmitter systems and other neurophysiological aspects. In this review, we consider these alterations in relation to the clinical manifestations in OCD, with the aim to discuss and evaluate axes of validity of this model. Our analysis shows that some axes of validity of quinpirole sensitization model (QSM) are strongly supported by clinical findings, such as behavioral phenomenology or roles of brain structures. Evidence on predictive validity is contradictory and ambiguous. It is concluded that this model is useful in the context of searching for the underlying pathophysiological basis of the disorder because of the relatively strong biological similarities with OCD.
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Affiliation(s)
- Ales Stuchlik
- Department of Neurophysiology of Memory, Institute of Physiology, Czech Academy of Sciences Prague, Czech Republic
| | - Dominika Radostová
- Department of Neurophysiology of Memory, Institute of Physiology, Czech Academy of Sciences Prague, Czech Republic
| | - Hana Hatalova
- Department of Neurophysiology of Memory, Institute of Physiology, Czech Academy of Sciences Prague, Czech Republic
| | - Karel Vales
- Department of Neurophysiology of Memory, Institute of Physiology, Czech Academy of SciencesPrague, Czech Republic; National Institute of Mental HealthKlecany, Czech Republic
| | - Tereza Nekovarova
- Department of Neurophysiology of Memory, Institute of Physiology, Czech Academy of SciencesPrague, Czech Republic; National Institute of Mental HealthKlecany, Czech Republic
| | - Jana Koprivova
- National Institute of Mental Health Klecany, Czech Republic
| | - Jan Svoboda
- Department of Neurophysiology of Memory, Institute of Physiology, Czech Academy of Sciences Prague, Czech Republic
| | - Jiri Horacek
- National Institute of Mental Health Klecany, Czech Republic
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25
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Sweet JA, Pace J, Girgis F, Miller JP. Computational Modeling and Neuroimaging Techniques for Targeting during Deep Brain Stimulation. Front Neuroanat 2016; 10:71. [PMID: 27445709 PMCID: PMC4927621 DOI: 10.3389/fnana.2016.00071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 06/09/2016] [Indexed: 12/15/2022] Open
Abstract
Accurate surgical localization of the varied targets for deep brain stimulation (DBS) is a process undergoing constant evolution, with increasingly sophisticated techniques to allow for highly precise targeting. However, despite the fastidious placement of electrodes into specific structures within the brain, there is increasing evidence to suggest that the clinical effects of DBS are likely due to the activation of widespread neuronal networks directly and indirectly influenced by the stimulation of a given target. Selective activation of these complex and inter-connected pathways may further improve the outcomes of currently treated diseases by targeting specific fiber tracts responsible for a particular symptom in a patient-specific manner. Moreover, the delivery of such focused stimulation may aid in the discovery of new targets for electrical stimulation to treat additional neurological, psychiatric, and even cognitive disorders. As such, advancements in surgical targeting, computational modeling, engineering designs, and neuroimaging techniques play a critical role in this process. This article reviews the progress of these applications, discussing the importance of target localization for DBS, and the role of computational modeling and novel neuroimaging in improving our understanding of the pathophysiology of diseases, and thus paving the way for improved selective target localization using DBS.
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Affiliation(s)
- Jennifer A Sweet
- Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve University Cleveland, OH, USA
| | - Jonathan Pace
- Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve University Cleveland, OH, USA
| | - Fady Girgis
- Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve University Cleveland, OH, USA
| | - Jonathan P Miller
- Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve University Cleveland, OH, USA
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Figee M, Pattij T, Willuhn I, Luigjes J, van den Brink W, Goudriaan A, Potenza MN, Robbins TW, Denys D. Compulsivity in obsessive-compulsive disorder and addictions. Eur Neuropsychopharmacol 2016; 26:856-68. [PMID: 26774279 DOI: 10.1016/j.euroneuro.2015.12.003] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 08/17/2015] [Accepted: 12/01/2015] [Indexed: 01/05/2023]
Abstract
Compulsive behaviors are driven by repetitive urges and typically involve the experience of limited voluntary control over these urges, a diminished ability to delay or inhibit these behaviors, and a tendency to perform repetitive acts in a habitual or stereotyped manner. Compulsivity is not only a central characteristic of obsessive-compulsive disorder (OCD) but is also crucial to addiction. Based on this analogy, OCD has been proposed to be part of the concept of behavioral addiction along with other non-drug-related disorders that share compulsivity, such as pathological gambling, skin-picking, trichotillomania and compulsive eating. In this review, we investigate the neurobiological overlap between compulsivity in substance-use disorders, OCD and behavioral addictions as a validation for the construct of compulsivity that could be adopted in the Research Domain Criteria (RDoC). The reviewed data suggest that compulsivity in OCD and addictions is related to impaired reward and punishment processing with attenuated dopamine release in the ventral striatum, negative reinforcement in limbic systems, cognitive and behavioral inflexibility with diminished serotonergic prefrontal control, and habitual responding with imbalances between ventral and dorsal frontostriatal recruitment. Frontostriatal abnormalities of compulsivity are promising targets for neuromodulation and other interventions for OCD and addictions. We conclude that compulsivity encompasses many of the RDoC constructs in a trans-diagnostic fashion with a common brain circuit dysfunction that can help identifying appropriate prevention and treatment targets.
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Affiliation(s)
- Martijn Figee
- Academic Medical Center, Department of Psychiatry, Amsterdam, The Netherlands
| | - Tommy Pattij
- Neuroscience Campus Amsterdam, Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Ingo Willuhn
- Academic Medical Center, Department of Psychiatry, Amsterdam, The Netherlands; The Institute for Neuroscience, Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Judy Luigjes
- Academic Medical Center, Department of Psychiatry, Amsterdam, The Netherlands
| | - Wim van den Brink
- Academic Medical Center, Department of Psychiatry, Amsterdam, The Netherlands; Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Anneke Goudriaan
- Academic Medical Center, Department of Psychiatry, Amsterdam, The Netherlands; Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Department of Neurobiology, Yale University School of Medicine, New Haven, CT, United States; Child Study Center, Yale University School of Medicine, New Haven, CT, United States
| | - Trevor W Robbins
- Department of Psychology and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
| | - Damiaan Denys
- Academic Medical Center, Department of Psychiatry, Amsterdam, The Netherlands; The Institute for Neuroscience, Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.
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27
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Barahona-Corrêa JB, Camacho M, Castro-Rodrigues P, Costa R, Oliveira-Maia AJ. From Thought to Action: How the Interplay Between Neuroscience and Phenomenology Changed Our Understanding of Obsessive-Compulsive Disorder. Front Psychol 2015; 6:1798. [PMID: 26635696 PMCID: PMC4655583 DOI: 10.3389/fpsyg.2015.01798] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/07/2015] [Indexed: 01/25/2023] Open
Abstract
The understanding of obsessive-compulsive disorder (OCD) has evolved with the knowledge of behavior, the brain, and their relationship. Modern views of OCD as a neuropsychiatric disorder originated from early lesion studies, with more recent models incorporating detailed neuropsychological findings, such as perseveration in set-shifting tasks, and findings of altered brain structure and function, namely of orbitofrontal corticostriatal circuits and their limbic connections. Interestingly, as neurobiological models of OCD evolved from cortical and cognitive to sub-cortical and behavioral, the focus of OCD phenomenology also moved from thought control and contents to new concepts rooted in animal models of action control. Most recently, the proposed analogy between habitual action control and compulsive behavior has led to the hypothesis that individuals suffering from OCD may be predisposed to rely excessively on habitual rather than on goal-directed behavioral strategies. Alternatively, compulsions have been proposed to result either from hyper-valuation of certain actions and/or their outcomes, or from excessive uncertainty in the monitoring of action performance, both leading to perseveration in prepotent actions such as washing or checking. In short, the last decades have witnessed a formidable renovation in the pathophysiology, phenomenology, and even semantics, of OCD. Nevertheless, such progress is challenged by several caveats, not least psychopathological oversimplification and overgeneralization of animal to human extrapolations. Here we present an historical overview of the understanding of OCD, highlighting converging studies and trends in neuroscience, psychiatry and neuropsychology, and how they influenced current perspectives on the nosology and phenomenology of this disorder.
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Affiliation(s)
- J Bernardo Barahona-Corrêa
- Department of Psychiatry and Mental Health, Faculdade de Ciências Médicas, Nova Medical School , Lisbon, Portugal ; Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental , Lisbon, Portugal ; Champalimaud Clinical Centre, Champalimaud Centre for the Unknown , Lisbon, Portugal ; Centro de Apoio ao Desenvolvimento Infantil , Cascais, Portugal
| | - Marta Camacho
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown , Lisbon, Portugal
| | - Pedro Castro-Rodrigues
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown , Lisbon, Portugal ; Centro Hospitalar Psiquiátrico de Lisboa , Lisbon, Portugal
| | - Rui Costa
- Champalimaud Research, Champalimaud Centre for the Unknown , Lisbon, Portugal
| | - Albino J Oliveira-Maia
- Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental , Lisbon, Portugal ; Champalimaud Clinical Centre, Champalimaud Centre for the Unknown , Lisbon, Portugal ; Champalimaud Research, Champalimaud Centre for the Unknown , Lisbon, Portugal
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28
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Hyper-influence of the orbitofrontal cortex over the ventral striatum in obsessive-compulsive disorder. Eur Neuropsychopharmacol 2015; 25:1898-905. [PMID: 26395293 DOI: 10.1016/j.euroneuro.2015.08.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/30/2015] [Accepted: 08/27/2015] [Indexed: 11/24/2022]
Abstract
Dysfunction of the fronto-striato-thalamic circuit routing through the orbitofrontal cortex (OFC) is thought to play the main role in the pathophysiology of obsessive-compulsive disorder (OCD). Repetitious stimulation of the OFC-ventral striatum (VS) projections in mice has been shown to increase the firing of the postsynaptic VS cells and the frequency of OCD-like symptoms. Moreover, increased functional connectivity (FC) between the OFC and the VS has been reported in patients with OCD. While FC is a synchronous, non-directed correlation, the directed influence between these brain regions remains unclear in patients with OCD. We obtained resting state functional magnetic resonance imaging scans from 37 non-medicated patients with OCD and 38 matched healthy volunteers, and calculated bivariative voxel-wise Granger Causality (GC) to and from three striatal regions of interest (ROI) using a blind deconvolution procedure. Additionally, we conducted multivariative GC analysis to determine if the effect revealed by the bivariative voxel-wise GCA is mediated by another seed ROI. We found a significant hyper-influence of the OFC over the VS of subjects with OCD (p<.05, corrected). Multivariative GC analysis confirmed this effect (p<.05, corrected) and that it was not mediated by another brain area within the striatum. This is the first study investigating the directed influence of the fronto-striato-thalamic loop in non-medicated patients with OCD. We confirmed the hyperactive connection from the OFC to the VS that is consistent with previous animal studies. These findings provide evidence for the more detailed pathophysiology of OCD.
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Piantadosi SC, Ahmari SE. Using Optogenetics to Dissect the Neural Circuits Underlying OCD and Related Disorders. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2015; 2:297-311. [PMID: 31867154 PMCID: PMC6924629 DOI: 10.1007/s40501-015-0056-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Opinion Statement
Clinical and preclinical studies have uncovered substantial evidence that dysfunction in cortico-striatal-thalamo-cortical (CSTC) loops central to the selection of action strategies may underlie obsessive compulsive disorder (OCD) symptoms. In human OCD, data suggest that the balance between selections of habitual versus goal-directed action strategies is disrupted, with concomitant hyperactivation of CSTC regions associated with these strategies. Preclinical lesion and inactivation studies of homologous CSTC regions in rodents have shed light on how sub-regions of the frontal cortex and striatum can have dissociable effects on the exhibition of goal-directed or habitual behavior. However, these traditional methods lack the precision necessary to dissect the exact projections and cell types underlying these behaviors. It is essential to uncover this information to begin to determine how disruption in these circuits may lead to disease pathology. Here, we summarize several recent studies that utilize optogenetics, a technique that allows stimulation or inhibition of specific neural projections and cell types using light, to further understand the contribution of CSTC activity to both action selection and the OCD-relevant behavior of perseverative grooming. Based on these experiments and findings in human OCD patients, we argue that OCD symptoms may not only be associated with an enhancement of habitual behavior, but also with aberrant recruitment of goal-directed neural circuits. We also discuss the current status of translating optogenetic technology to primates, as well as how findings in rodents may help inform treatment of patients suffering from OCD and related disorders.
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Affiliation(s)
- Sean C Piantadosi
- 450 Technology Drive, Room 227, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15219, USA
- Center for Neuroscience, University of Pittsburgh, Pittsburgh PA, USA
| | - Susanne E Ahmari
- 450 Technology Drive, Room 227, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15219, USA
- Center for Neuroscience, University of Pittsburgh, Pittsburgh PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
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30
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Tonna M, Ottoni R, Ossola P, De Panfilis C, Marchesi C. Late-onset obsessive-compulsive disorder associated with left cerebellar lesion. THE CEREBELLUM 2015; 13:531-5. [PMID: 24771488 DOI: 10.1007/s12311-014-0561-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The onset of obsessive-compulsive disorder (OCD) after age 50 is rare and generally related to an organic etiology. An involvement of fronto-striatal circuits has been strongly suggested, whereas cerebellum remains so far scarcely explored. We present here the description of a "pure" late-onset OCD associated with a cerebellar lesion, neither comorbid with other mental disorders nor with neurological syndromes. To our knowledge, this condition was not previously described in literature. The patient is a 62-year-old woman who developed a late-onset OCD associated with a left cerebellar lesion due to an arachnoid cyst in the left posterior fossa. We debate the possible role of the cerebellar lesion in favoring a transition from a predisposing liability (namely an obsessive-compulsive personality disorder and a depressive status) to the onset of OCD in this woman.
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Affiliation(s)
- Matteo Tonna
- Mental Health Department, Local Health Service, Parma, Italy
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31
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Kim P, Rigo P, Leckman JF, Mayes LC, Cole PM, Feldman R, Swain JE. A Prospective Longitudinal Study of Perceived Infant Outcomes at 18-24 Months: Neural and Psychological Correlates of Parental Thoughts and Actions Assessed during the First Month Postpartum. Front Psychol 2015; 6:1772. [PMID: 26635679 PMCID: PMC4654106 DOI: 10.3389/fpsyg.2015.01772] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 11/04/2015] [Indexed: 01/12/2023] Open
Abstract
The first postpartum months constitute a critical period for parents to establish an emotional bond with their infants. Neural responses to infant-related stimuli have been associated with parental sensitivity. However, the associations among these neural responses, parenting, and later infant outcomes for mothers and fathers are unknown. In the current longitudinal study, we investigated the relationships between parental thoughts/actions and neural activation in mothers and fathers in the neonatal period with infant outcomes at the toddler stage. At the first month postpartum, mothers (n = 21) and fathers (n = 19) underwent a neuroimaging session during which they listened to their own and unfamiliar baby's cry. Parenting-related thoughts/behaviors were assessed by interview twice at the first month and 3-4 months postpartum and infants' socioemotional outcomes were reported by mothers and fathers at 18-24 months postpartum. In mothers, higher levels of anxious thoughts/actions about parenting at the first month postpartum, but not at 3-4 months postpartum, were associated with infant's low socioemotional competencies at 18-24 months. Anxious thoughts/actions were also associated with heightened responses in the motor cortex and reduced responses in the substantia nigra to own infant cry sounds. On the other hand, in fathers, higher levels of positive perception of being a parent at the first month postpartum, but not at 3-4 months postpartum, were associated with higher infant socioemotional competencies at 18-24 months. Positive thoughts were associated with heightened responses in the auditory cortex and caudate to own infant cry sounds. The current study provides evidence that parental thoughts are related to concurrent neural responses to their infants at the first month postpartum as well as their infant's future socioemotional outcome at 18-24 months. Parent differences suggest that anxious thoughts in mothers and positive thoughts in fathers may be the targets for parenting-focused interventions very early postpartum.
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Affiliation(s)
- Pilyoung Kim
- Department of Psychology, University of DenverDenver, CO, USA
- *Correspondence: Pilyoung Kim,
| | - Paola Rigo
- Department of Psychology and Cognitive Science, University of TrentoTrento, Italy
| | - James F. Leckman
- Child Study Center, Yale University School of MedicineNew Haven, CT, USA
| | - Linda C. Mayes
- Child Study Center, Yale University School of MedicineNew Haven, CT, USA
| | - Pamela M. Cole
- Department of Psychology, The Pennsylvania State UniversityUniversity Park, PA, USA
| | - Ruth Feldman
- Department of Psychology, Bar-Ilan UniversityRamat Gan, Israel
| | - James E. Swain
- Child Study Center, Yale University School of MedicineNew Haven, CT, USA
- Department of Psychiatry, Psychology, Center for Human Growth and Development, Women and Infants Mental Health Program, University of MichiganAnn Arbor, MI, USA
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32
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Nakao T, Okada K, Kanba S. Neurobiological model of obsessive-compulsive disorder: evidence from recent neuropsychological and neuroimaging findings. Psychiatry Clin Neurosci 2014; 68:587-605. [PMID: 24762196 DOI: 10.1111/pcn.12195] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 12/16/2022]
Abstract
Obsessive-compulsive disorder (OCD) was previously considered refractory to most types of therapeutic intervention. There is now, however, ample evidence that selective serotonin reuptake inhibitors and behavior therapy are highly effective methods for treatment of OCD. Furthermore, recent neurobiological studies of OCD have found a close correlation between clinical symptoms, cognitive function, and brain function. A large number of previous neuroimaging studies using positron emission tomography, single-photon emission computed tomography or functional magnetic resonance imaging (fMRI) have identified abnormally high activities throughout the frontal cortex and subcortical structures in patients with OCD. Most studies reported excessive activation of these areas during symptom provocation. Furthermore, these hyperactivities were decreased after successful treatment using either selective serotonin reuptake inhibitors or behavioral therapy. Based on these findings, an orbitofronto-striatal model has been postulated as an abnormal neural circuit that mediates symptomatic expression of OCD. On the other hand, previous neuropsychological studies of OCD have reported cognitive dysfunction in executive function, attention, nonverbal memory, and visuospatial skills. Moreover, recent fMRI studies have revealed a correlation between neuropsychological dysfunction and clinical symptoms in OCD by using neuropsychological tasks during fMRI. The evidence from fMRI studies suggests that broader regions, including dorsolateral prefrontal and posterior regions, might be involved in the pathophysiology of OCD. Further, we should consider that OCD is heterogeneous and might have several different neural systems related to clinical factors, such as symptom dimensions. This review outlines recent neuropsychological and neuroimaging studies of OCD. We will also describe several neurobiological models that have been developed recently. Advanced findings in these fields will update the conventional biological model of OCD.
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Affiliation(s)
- Tomohiro Nakao
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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33
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Park RJ, Godier LR, Cowdrey FA. Hungry for reward: How can neuroscience inform the development of treatment for Anorexia Nervosa? Behav Res Ther 2014; 62:47-59. [PMID: 25151600 DOI: 10.1016/j.brat.2014.07.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 07/04/2014] [Accepted: 07/16/2014] [Indexed: 12/29/2022]
Abstract
Dysfunctional reward from the pursuit of thinness presents a major challenge to recovery from Anorexia Nervosa (AN). We explore the neuroscientific basis of aberrant reward in AN, with the aim of generating novel hypotheses for translational investigation, and elucidate disease mechanisms to inform the development of targeted interventions. Relevant neuroimaging and behavioural studies are reviewed. These suggest that altered eating in AN may be a consequence of aberrant reward processing combined with exaggerated cognitive control. We consider evidence that such aberrant reward processing is reflected in the compulsive behaviours characterising AN, with substantial overlap in the neural circuits implicated in reward processing and compulsivity. Drawing on contemporary neuroscientific theories of substance dependence, processes underpinning the shift from the initially rewarding pursuit of thinness to extreme and compulsive weight control behaviours are discussed. It is suggested that in AN, weight loss behaviour begins as overtly rewarding, goal-directed and positively reinforced, but over time becomes habitual and increasingly negatively reinforced. Excessive habit formation is suggested as one underlying mechanism perpetuating compulsive behaviour. Ongoing research into the behavioural and neural basis of aberrant reward in AN is required to further elucidate mechanisms. We discuss clinical and transdiagnostic implications, and propose that future treatment innovation may benefit from the development of novel interventions targeting aberrant reward processing in AN.
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Affiliation(s)
- Rebecca J Park
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, United Kingdom.
| | - Lauren R Godier
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, United Kingdom
| | - Felicity A Cowdrey
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, United Kingdom
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34
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Liu J, Zhang X, Liu J. Obsessions appear after the removal a brain tumor in the right frontal lobe. Gen Hosp Psychiatry 2014; 36:450.e3-4. [PMID: 24731833 DOI: 10.1016/j.genhosppsych.2014.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/13/2014] [Accepted: 02/18/2014] [Indexed: 11/29/2022]
Abstract
A series of case reports and neuroimaging research points to the underlying neuropathological substrate for obsessive-compulsive disorder (OCD) and the underlying associations between OCD and areas of the frontal lobe. We report a patient wherein the onset of OCD occurred after resection of meningioma of the right frontal lobe and who was treated successfully with paroxetine hydrochloride. We suggest that the onset of secondary (organic) OCD is associated with the frontal lobe, and we propose that the origin of obsessions is located in the right frontal lobe.
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Affiliation(s)
- Jie Liu
- Department of Psychology and Psychiatry, Medical College, Qingdao University, Qingdao, China
| | - Xinhua Zhang
- Department of Psychology and Psychiatry, Medical College, Qingdao University, Qingdao, China; Psychological Clinic, The Affiliated Hospital of Medical College, Qingdao University, Qingdao, China.
| | - Jihua Liu
- Radiology department, The Affiliated Hospital of Medical College, Qingdao University, Qingdao, China
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35
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Fineberg NA, Chamberlain SR, Goudriaan AE, Stein DJ, Vanderschuren LJ, Gillan CM, Shekar S, Gorwood PA, Voon V, Morein-Zamir S, Denys D, Sahakian BJ, Moeller FG, Robbins TW, Potenza MN. New developments in human neurocognition: clinical, genetic, and brain imaging correlates of impulsivity and compulsivity. CNS Spectr 2014; 19:69-89. [PMID: 24512640 PMCID: PMC4113335 DOI: 10.1017/s1092852913000801] [Citation(s) in RCA: 285] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Impulsivity and compulsivity represent useful conceptualizations that involve dissociable cognitive functions, which are mediated by neuroanatomically and neurochemically distinct components of cortico-subcortical circuitry. The constructs were historically viewed as diametrically opposed, with impulsivity being associated with risk-seeking and compulsivity with harm-avoidance. However, they are increasingly recognized to be linked by shared neuropsychological mechanisms involving dysfunctional inhibition of thoughts and behaviors. In this article, we selectively review new developments in the investigation of the neurocognition of impulsivity and compulsivity in humans, in order to advance our understanding of the pathophysiology of impulsive, compulsive, and addictive disorders and indicate new directions for research.
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Affiliation(s)
- Naomi A. Fineberg
- Hertfordshire Partnership NHS University Foundation Trust, Queen Elizabeth II Hospital, Howlands, Welwyn Garden City, Hertfordshire, UK
- University of Hertfordshire, School of Postgraduate Medicine, College Lane, Hatfield, Hertfordshire, UK
- Cambridge University, School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge, UK
| | - Samuel R. Chamberlain
- Cambridge University, School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge, UK
- Cambridge and Peterborough NHS Foundation Trust (CPFT), Cambridge, UK
| | - Anna E. Goudriaan
- Department of Psychiatry, Amsterdam Institute for Addiction Research, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Arkin Mental Health, Amsterdam, The Netherlands
| | - Dan J. Stein
- Department of Psychiatry, University of Cape Town, S. Africa
| | - Louk J.M.J. Vanderschuren
- Dept. of Animals in Science and Society, Division of Behavioural Neuroscience, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
- Rudolf Magnus Institute of Neuroscience, Dept. of Neuroscience and Pharmacology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Claire M. Gillan
- Behavioural and Clinical Neuroscience Institute (BCNI), University of Cambridge, Cambridge, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Sameer Shekar
- Hertfordshire Partnership NHS University Foundation Trust, Queen Elizabeth II Hospital, Howlands, Welwyn Garden City, Hertfordshire, UK
| | - Philip A.P.M. Gorwood
- INSERM UMR894 (Centre of Psychiatry and Neuroscience), 2ter rue d’Alesia, Paris, FRANCE
- Sainte-Anne hospital, CMME (University Paris Descartes), 100 rue de la Santé, Paris, FRANCE
| | - Valerie Voon
- Behavioural and Clinical Neuroscience Institute (BCNI), University of Cambridge, Cambridge, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Sharon Morein-Zamir
- Behavioural and Clinical Neuroscience Institute (BCNI), University of Cambridge, Cambridge, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- The Netherlands Institute for Neuroscience, an institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Barbara J. Sahakian
- Cambridge University, School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge, UK
- Behavioural and Clinical Neuroscience Institute (BCNI), University of Cambridge, Cambridge, UK
| | - F. Gerard Moeller
- Departments of Psychiatry and Pharmacology and Toxicology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Trevor W. Robbins
- Behavioural and Clinical Neuroscience Institute (BCNI), University of Cambridge, Cambridge, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Marc N. Potenza
- Departments of Psychiatry, Child Study and Neurobiology, Yale School of Medicine, New Haven, Connecticut, USA
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