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Perera MPN, Gotsis ES, Bailey NW, Fitzgibbon BM, Fitzgerald PB. Exploring functional connectivity in large-scale brain networks in obsessive-compulsive disorder: a systematic review of EEG and fMRI studies. Cereb Cortex 2024; 34:bhae327. [PMID: 39152672 PMCID: PMC11329673 DOI: 10.1093/cercor/bhae327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/16/2024] [Accepted: 07/25/2024] [Indexed: 08/19/2024] Open
Abstract
Obsessive-compulsive disorder (OCD) is a debilitating psychiatric condition that is difficult to treat due to our limited understanding of its pathophysiology. Functional connectivity in brain networks, as evaluated through neuroimaging studies, plays a pivotal role in understanding OCD. While both electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) have been extensively employed in OCD research, few have fully synthesized their findings. To bridge this gap, we reviewed 166 studies (10 EEG, 156 fMRI) published up to December 2023. In EEG studies, OCD exhibited lower connectivity in delta and alpha bands, with inconsistent findings in other frequency bands. Resting-state fMRI studies reported conflicting connectivity patterns within the default mode network (DMN) and sensorimotor cortico-striato-thalamo-cortical (CSTC) circuitry. Many studies observed decreased resting-state connectivity between the DMN and salience network (SN), implicating the 'triple network model' in OCD. Task-related hyperconnectivity within the DMN-SN and hypoconnectivity between the SN and frontoparietal network suggest OCD-related cognitive inflexibility, potentially due to triple network dysfunction. In conclusion, our review highlights diverse connectivity differences in OCD, revealing complex brain network interplay that contributes to symptom manifestation. However, the presence of conflicting findings underscores the necessity for targeted research to achieve a comprehensive understanding of the pathophysiology of OCD.
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Affiliation(s)
- M Prabhavi N Perera
- College of Health and Medicine, Australian National University, Building 4, The Canberra Hospital, Hospital Rd, Garran ACT 2605, Australia
- Monarch Research Institute, Monarch Mental Health Group, Level 4, 131 York Street Sydney NSW 2000, Australia
| | - Efstathia S Gotsis
- College of Health and Medicine, Australian National University, Building 4, The Canberra Hospital, Hospital Rd, Garran ACT 2605, Australia
- Monarch Research Institute, Monarch Mental Health Group, Level 4, 131 York Street Sydney NSW 2000, Australia
| | - Neil W Bailey
- College of Health and Medicine, Australian National University, Building 4, The Canberra Hospital, Hospital Rd, Garran ACT 2605, Australia
- Monarch Research Institute, Monarch Mental Health Group, Level 4, 131 York Street Sydney NSW 2000, Australia
| | - Bernadette M Fitzgibbon
- College of Health and Medicine, Australian National University, Building 4, The Canberra Hospital, Hospital Rd, Garran ACT 2605, Australia
- Monarch Research Institute, Monarch Mental Health Group, Level 4, 131 York Street Sydney NSW 2000, Australia
| | - Paul B Fitzgerald
- College of Health and Medicine, Australian National University, Building 4, The Canberra Hospital, Hospital Rd, Garran ACT 2605, Australia
- Monarch Research Institute, Monarch Mental Health Group, Level 4, 131 York Street Sydney NSW 2000, Australia
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2
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Khayrullina G, Panfilova E, Martynova O. Increased error rate and delayed response to negative emotional stimuli in antisaccade task in obsessive-compulsive disorder. Int J Psychophysiol 2023; 192:62-71. [PMID: 37604280 DOI: 10.1016/j.ijpsycho.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/02/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023]
Abstract
Ample evidence links impaired inhibitory control, attentional distortions, emotional dysregulation, and obsessive-compulsive disorder (OCD). However, it remains unclear what underlies the deficit that triggers the OCD cycle. The present study used an antisaccade paradigm with emotional valences to compare eye movement patterns reflecting inhibitory control and attention switching in OCD and healthy control groups. Thirty-two patients with OCD and thirty healthy controls performed the antisaccade task with neutral, positive, and negative visual images served as fixation stimuli. Presentation of the fixation stimulus overlapped with target stimuli appearance for 200 ms. The OCD group showed more errors to negative stimuli than the control group and they also performed antisaccades more slowly to negative and neutral stimuli than positive ones. Other patterns, including mean gaze velocity of correct antisaccades did not differ between groups. The mean gaze velocity of correct antisaccades was higher for negative and positive stimuli than for neutral stimuli in both groups. The peak velocity parameter did not show any differences either between groups or between valences. The findings support a hypothesis that an attentional bias toward negative stimuli interferes with inhibitory control in OCD.
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Affiliation(s)
- Guzal Khayrullina
- Institute of Higher Nervous Activity and Neurophysiology RAS, Butlerova 5A, Moscow 117484, Russia; Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Myasnitskaya 20, Moscow 101000, Russia.
| | - Elizaveta Panfilova
- Institute of Higher Nervous Activity and Neurophysiology RAS, Butlerova 5A, Moscow 117484, Russia
| | - Olga Martynova
- Institute of Higher Nervous Activity and Neurophysiology RAS, Butlerova 5A, Moscow 117484, Russia; Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Myasnitskaya 20, Moscow 101000, Russia
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3
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Becker H, Liu Y, Hanna GL, Bilek E, Block SR, Hardee JE, Heitzeg MM, Pagliaccio D, Marsh R, Fitzgerald KD. Error-related brain activity associated with obsessive-compulsive symptoms in youth. Brain Behav 2023; 13:e2941. [PMID: 36919195 PMCID: PMC10097091 DOI: 10.1002/brb3.2941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 02/04/2023] [Accepted: 02/14/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Subclinical obsessive-compulsive symptoms (OCS) are common in children, and increase risk for later onset of obsessive-compulsive disorder (OCD). In pediatric patients with OCD, neuroimaging research implicates altered neural mechanisms for error-processing, but whether abnormal brain response occurs with subclinical OCS remains poorly understood. METHODS Using functional magnetic resonance imaging (fMRI), 113 youth (8-18 years; 45 female) from a community sample were scanned during an error-eliciting Go/No-Go task. OCS were assessed dimensionally using the obsessive-compulsive subscale of the Child Behavior Checklist. The association between OCS scores and error-related brain activity was examined at the whole-brain level. RESULTS Lower OCS scores associated with stronger response to errors in dorsal anterior cingulate cortex (dACC), caudate, putamen, thalamus, and occipital cortex. Additionally, lower OCS related to higher capacity for inhibitory control, as indexed by greater accuracy on No-Go trials during fMRI scanning. The relationship between lower OCS and better accuracy on No-Go trials was mediated by greater error-related dACC activity. CONCLUSIONS The inverse relationship between OCS and error-related activity in the dACC and extended cortical-striatal-thalamic circuitry may index an adaptive process by which subclinical OCS are minimized in youth. Further, these results identify an observable pattern of brain activity that tracks with subclinical OCS severity. Understanding the link between neural networks for error processing and the normal to abnormal range of OCS may pave the way for brain-based strategies to identify children who are more likely to develop OCD and enable the targeting of preventive strategies to reduce risk.
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Affiliation(s)
- Hannah Becker
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Yanni Liu
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Gregory L Hanna
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily Bilek
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Jillian E Hardee
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.,Addiction Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Mary M Heitzeg
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.,Addiction Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - David Pagliaccio
- New York State Psychiatric Institute, Columbia University, New York, New York, USA
| | - Rachel Marsh
- New York State Psychiatric Institute, Columbia University, New York, New York, USA
| | - Kate D Fitzgerald
- New York State Psychiatric Institute, Columbia University, New York, New York, USA
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4
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Fang A, Baran B, Beatty CC, Mosley J, Feusner JD, Phan KL, Wilhelm S, Manoach DS. Maladaptive self-focused attention and default mode network connectivity: a transdiagnostic investigation across social anxiety and body dysmorphic disorders. Soc Cogn Affect Neurosci 2022; 17:645-654. [PMID: 34875086 PMCID: PMC9250304 DOI: 10.1093/scan/nsab130] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/12/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
Maladaptive self-focused attention (SFA) is a bias toward internal thoughts, feelings and physical states. Despite its role as a core maintaining factor of symptoms in cognitive theories of social anxiety and body dysmorphic disorders (BDDs), studies have not examined its neural basis. In this study, we hypothesized that maladaptive SFA would be associated with hyperconnectivity in the default mode network (DMN) in self-focused patients with these disorders. Thirty patients with primary social anxiety disorder or primary BDD and 28 healthy individuals were eligible and scanned. Eligibility was determined by scoring greater than 1SD or below 1SD of the Public Self-Consciousness Scale normative mean, respectively, for each group. Seed-to-voxel functional connectivity was computed using a DMN posterior cingulate cortex (PCC) seed. There was no evidence of increased DMN functional connectivity in patients compared to controls. Patients (regardless of diagnosis) showed reduced functional connectivity of the PCC with several brain regions, including the bilateral superior parietal lobule (SPL), compared to controls, which was inversely correlated with maladaptive SFA but not associated with social anxiety, body dysmorphic, depression severity or rumination. Abnormal PCC-SPL connectivity may represent a transdiagnostic neural marker of SFA that reflects difficulty shifting between internal versus external attention.
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Affiliation(s)
- Angela Fang
- Department of Psychology, University of Washington, Seattle, WA 98195-1525, USA
| | - Bengi Baran
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA 52242-1407, USA
| | - Clare C Beatty
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500, USA
| | - Jennifer Mosley
- Department of Psychology, University of Washington, Seattle, WA 98195-1525, USA
| | - Jamie D Feusner
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA 90095-8346, USA.,Centre for Addiction and Mental Health, Toronto, Ontario M5T 1R8, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada
| | - K Luan Phan
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH 43210-1240, USA
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114-2696, USA
| | - Dara S Manoach
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114-2696, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129-2020, USA
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5
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Rueppel M, Mannella KA, Fitzgerald KD, Schroder HS. Post-error slowing in anxiety and obsessive-compulsive disorders. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2022; 22:610-624. [PMID: 34966981 DOI: 10.3758/s13415-021-00976-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
Altered brain response to errors in anxiety and obsessive-compulsive disorders (OCD) suggests cognitive control abnormalities across both types of illness, but behavioral metrics of cognitive control function have yet to be compared in patients selected from these different diagnostic categories. Thus, we examined post-error slowing (PES), a behavioral adjustment that typically occurs after a mistake, in children and adolescents with and without a primary anxiety disorder (N = 103 anxiety and N = 28 healthy controls) and adolescents and adults with and without OCD (N = 118 OCD and N = 60 healthy controls) using a go/no-go task. Primary analyses tested for differences in PES between diagnostic groups (anxiety, OCD, healthy), controlling for age, overall reaction time, and overall accuracy. Results indicated that patients with anxiety disorders exhibited more post-error slowing than both patients with OCD and healthy volunteers. In contrast, participants with OCD did not differ from healthy volunteers in post-error slowing. In subgroup analyses restricted to adolescent participants (ages 13-17 years), more post-error slowing was observed in the anxiety disorders group compared with either the OCD or healthy groups. These data suggest that excessive post-error slowing, an index of behavioral adjustment following errors, may uniquely characterize patients with anxiety disorders relative to healthy individuals and those with OCD.
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Affiliation(s)
- Meryl Rueppel
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
| | - Kristin A Mannella
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
| | - Kate D Fitzgerald
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
| | - Hans S Schroder
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA.
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6
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Luttenbacher I, Phillips A, Kazemi R, Hadipour AL, Sanghvi I, Martinez J, Adamson MM. Transdiagnostic role of glutamate and white matter damage in neuropsychiatric disorders: A Systematic Review. J Psychiatr Res 2022; 147:324-348. [PMID: 35151030 DOI: 10.1016/j.jpsychires.2021.12.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/08/2021] [Accepted: 12/19/2021] [Indexed: 12/09/2022]
Abstract
Neuropsychiatric disorders including generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia (SZ) have been considered distinct categories of diseases despite their overlapping characteristics and symptomatology. We aimed to provide an in-depth review elucidating the role of glutamate/Glx and white matter (WM) abnormalities in these disorders from a transdiagnostic perspective. The PubMed online database was searched for studies published between 2010 and 2021. After careful screening, 401 studies were included. The findings point to decreased levels of glutamate in the Anterior Cingulate Cortex in both SZ and BD, whereas Glx is elevated in the Hippocampus in SZ and MDD. With regard to WM abnormalities, the Corpus Callosum and superior Longitudinal Fascicle were the most consistently identified brain regions showing decreased fractional anisotropy (FA) across all the reviewed disorders, except GAD. Additionally, the Uncinate Fasciculus displayed decreased FA in all disorders, except OCD. Decreased FA was also found in the inferior Longitudinal Fasciculus, inferior Fronto-Occipital Fasciculus, Thalamic Radiation, and Corona Radiata in SZ, BD, and MDD. Decreased FA in the Fornix and Corticospinal Tract were found in BD and SZ patients. The Cingulum and Anterior Limb of Internal Capsule exhibited decreased FA in MDD and SZ patients. The results suggest a gradual increase in severity from GAD to SZ defined by the number of brain regions with WM abnormality which may be partially caused by abnormal glutamate levels. WM damage could thus be considered a potential marker of some of the main neuropsychiatric disorders.
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Affiliation(s)
- Ines Luttenbacher
- Department of Social & Behavioral Sciences, University of Amsterdam, Amsterdam, Netherlands; Rehabilitation Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Angela Phillips
- Rehabilitation Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Reza Kazemi
- Department of Cognitive Psychology, Institute for Cognitive Science Studies, Tehran, Iran
| | - Abed L Hadipour
- Department of Cognitive Sciences, University of Messina, Messina, Italy
| | - Isha Sanghvi
- Rehabilitation Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA; Department of Neuroscience, University of Southern California, Los Angeles, CA, USA
| | - Julian Martinez
- Rehabilitation Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA; Palo Alto University, Palo Alto, CA, USA
| | - Maheen M Adamson
- Rehabilitation Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA; Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.
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7
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Ahmari SE, Rauch SL. The prefrontal cortex and OCD. Neuropsychopharmacology 2022; 47:211-224. [PMID: 34400778 PMCID: PMC8617188 DOI: 10.1038/s41386-021-01130-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/13/2021] [Accepted: 07/22/2021] [Indexed: 01/03/2023]
Abstract
Obsessive Compulsive Disorder (OCD) is a highly prevalent and severe neuropsychiatric disorder, with an incidence of 1.5-3% worldwide. However, despite the clear public health burden of OCD and relatively well-defined symptom criteria, effective treatments are still limited, spotlighting the need for investigation of the neural substrates of the disorder. Human neuroimaging studies have consistently highlighted abnormal activity patterns in prefrontal cortex (PFC) regions and connected circuits in OCD during both symptom provocation and performance of neurocognitive tasks. Because of recent technical advances, these findings can now be leveraged to develop novel targeted interventions. Here we will highlight current theories regarding the role of the prefrontal cortex in the generation of OCD symptoms, discuss ways in which this knowledge can be used to improve treatments for this often disabling illness, and lay out challenges in the field for future study.
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Affiliation(s)
- Susanne E Ahmari
- Translational Neuroscience Program, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA.
- Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, USA.
| | - Scott L Rauch
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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8
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Bellato A, Norman L, Idrees I, Ogawa CY, Waitt A, Zuccolo PF, Tye C, Radua J, Groom MJ, Shephard E. A systematic review and meta-analysis of altered electrophysiological markers of performance monitoring in Obsessive-Compulsive Disorder (OCD), Gilles de la Tourette Syndrome (GTS), Attention-Deficit/Hyperactivity disorder (ADHD) and Autism. Neurosci Biobehav Rev 2021; 131:964-987. [PMID: 34687698 DOI: 10.1016/j.neubiorev.2021.10.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 12/15/2022]
Abstract
Altered performance monitoring is implicated in obsessive-compulsive disorder (OCD), Gilles de la Tourette syndrome (GTS), attention-deficit/hyperactivity disorder (ADHD) and autism. We conducted a systematic review and meta-analysis of electrophysiological correlates of performance monitoring (error-related negativity, ERN; error positivity, Pe; feedback-related negativity, FRN; feedback-P3) in individuals with OCD, GTS, ADHD or autism compared to control participants, or associations between correlates and symptoms/traits of these conditions. Meta-analyses on 97 studies (5890 participants) showed increased ERN in OCD (Hedge's g = 0.54[CIs:0.44,0.65]) and GTS (g = 0.99[CIs:0.05,1.93]). OCD also showed increased Pe (g = 0.51[CIs:0.21,0.81]) and FRN (g = 0.50[CIs:0.26,0.73]). ADHD and autism showed reduced ERN (ADHD: g=-0.47[CIs:-0.67,-0.26]; autism: g=-0.61[CIs:-1.10,-0.13]). ADHD also showed reduced Pe (g=-0.50[CIs:-0.69,-0.32]). These findings suggest overlap in electrophysiological markers of performance monitoring alterations in four common neurodevelopmental conditions, with increased amplitudes of the markers in OCD and GTS and decreased amplitudes in ADHD and autism. Implications of these findings in terms of shared and distinct performance monitoring alterations across these neurodevelopmental conditions are discussed. PROSPERO pre-registration code: CRD42019134612.
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Affiliation(s)
- Alessio Bellato
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK; Academic Unit of Mental Health & Clinical Neurosciences, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Luke Norman
- Section on Neurobehavioral and Clinical Research, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Iman Idrees
- Academic Unit of Mental Health & Clinical Neurosciences, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Carolina Y Ogawa
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Alice Waitt
- Academic Unit of Mental Health & Clinical Neurosciences, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Pedro F Zuccolo
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Charlotte Tye
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | - Joaquim Radua
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK; Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain; Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Madeleine J Groom
- Academic Unit of Mental Health & Clinical Neurosciences, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Elizabeth Shephard
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK; Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil.
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9
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Michael JA, Wang M, Kaur M, Fitzgerald PB, Fitzgibbon BM, Hoy KE. EEG correlates of attentional control in anxiety disorders: A systematic review of error-related negativity and correct-response negativity findings. J Affect Disord 2021; 291:140-153. [PMID: 34038831 DOI: 10.1016/j.jad.2021.04.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/08/2021] [Accepted: 04/26/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Anxiety disorders are highly prevalent and cause substantial personal, social and economic burden. Altered attentional control has been shown to be present across anxiety disorders and is associated with specific changes in brain activity which can be recorded by electroencephalogram (EEG). These include changes in the EEG markers of error-related negativity (ERN) and correct-response negativity (CRN), both believed to reflect response monitoring and attentional control pathophysiology in anxiety. The aim of this review was to systematically assess the research on ERN and CRN in attentional control in individuals with clinical anxiety and healthy controls, across emotional and non-emotional attentional control. METHODS A comprehensive literature search was conducted for studies published prior to October 22nd, 2020. Details of the protocol for this systematic review were registered on PROSPERO (CRD42019144885). RESULTS 66 studies had their data extracted. All 66 studies measured ERN, with 85% finding significantly increased ERN amplitudes associated with clinical anxiety. Only 44 of the extracted studies analysed CRN and only ~20% of these found significant changes in CRN amplitude associated with individuals with clinical anxiety. LIMITATIONS There were several anxiety disorders that had either limited literature (i.e. specific phobia, separation anxiety disorder or agoraphobia) or nil literature (i.e. selective mutism) available. No extracted studies included samples of older adults (i.e. aged 60+ years), and only six extracted studies included measures of emotional attentional control. CONCLUSIONS Findings indicate the promising utility of ERN of attentional control as a robust, transdiagnostic trait marker of clinical anxiety.
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Affiliation(s)
- Jessica A Michael
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, 888 Toorak Rd, Camberwell, Victoria, Australia.
| | - Michael Wang
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, 888 Toorak Rd, Camberwell, Victoria, Australia
| | - Manreena Kaur
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, 888 Toorak Rd, Camberwell, Victoria, Australia; Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Paul B Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, 888 Toorak Rd, Camberwell, Victoria, Australia
| | - Bernadette M Fitzgibbon
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, 888 Toorak Rd, Camberwell, Victoria, Australia
| | - Kate E Hoy
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, 888 Toorak Rd, Camberwell, Victoria, Australia
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10
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Abstract
Post-error slowing is one of the most widely employed measures to study cognitive and behavioral consequences of error commission. Several methods have been proposed to quantify the post-error slowing effect, and we discuss two main methods: The traditional method of comparing response times in correct post-error trials to response times of correct trials that follow another correct trial, and a more recent proposal of comparing response times in correct post-error trials to the corresponding correct pre-error trials. Based on thorough re-analyses of two datasets, we argue that the latter method provides an inflated estimate by also capturing the (partially) independent effect of pre-error speeding. We propose two solutions for improving the assessment of human error processing, both of which highlight the importance of distinguishing between initial pre-error speeding and later post-error slowing.
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11
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Abstract
In this chapter, I address the concept of endophenotypes for obsessive-compulsive disorder (OCD). Endophenotypes are objective and heritable quantitative traits hypothesized to be more biologically tractable than distal clinical phenotypes. This approach has been adopted to gain a better understanding of psychiatric conditions in general. It is theorized that endophenotypes will particularly assist in clarifying both the diagnostic status and aetiological origins of complex neuropsychiatric conditions such as OCD. At the cognitive level, separable constructs of relevance for OCD have been identified. The prevailing model for OCD assumes the development of abnormalities within fronto-striatal neural circuits leading to impairment of executive functions and their neuropsychological subcomponents. Here, I address whether this model can guide towards the identification of endophenotypes for this condition and discuss possible implications.
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Affiliation(s)
- Matilde M Vaghi
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, London, UK.
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12
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Silveira VP, Frydman I, Fontenelle LF, Mattos P, de Oliveira-Souza R, Moll J, Hoexter MQ, Miguel EC, McLaughlin NC, Shephard E, Batistuzzo MC. Exploring response inhibition and error monitoring in obsessive-compulsive disorder. J Psychiatr Res 2020; 126:26-33. [PMID: 32413597 PMCID: PMC7313630 DOI: 10.1016/j.jpsychires.2020.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
Behavioral evidence of impaired response inhibition (RI) and hyperactive error monitoring (EM) in obsessive-compulsive disorder (OCD) is inconsistent. Recent neuroimaging work suggests that EM plays a role in RI impairments in OCD, but this has rarely been investigated using behavioral measures. The aims of this study were to (1) compare RI and EM performance between adults with OCD and non-psychiatric controls (NPC) while investigating possible moderators, and (2) assess whether excessive EM influences RI in OCD. We compared RI and EM performance on the Stop-Signal Task (SST) between 92 adults with OCD and 65 NPC from two Brazilian sites. We used linear regression to investigate which variables (group, age, medication use, clinical symptomatology) influenced performance, as well as to examine possible associations between RI and EM. OCD and NPC did not differ in RI and EM. However, age moderated RI performance in OCD with a medium effect size, reflecting differential effects of age on RI between groups: age was positively associated with RI in OCD but not NPC. Further, OCD severity predicted EM with a medium to large effect size, suggesting that more symptomatic patients showed greater monitoring of their mistakes. Finally, group moderated the relationship between RI and EM with a small effect size. Our findings suggest that demographic factors may influence RI, whereas clinical factors may influence EM. Further, we found preliminary behavioral evidence to indicate that impaired RI and excessive EM are related in OCD.
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Affiliation(s)
- Vitor Portella Silveira
- Departmento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR. R. Dr. Ovídio Pires de Campos, 785 - Cerqueira César, São Paulo, SP, 05403-903, Brazil.
| | - Ilana Frydman
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil. Av. Venceslau Brás, 71 - Botafogo, Rio de Janeiro - RJ, 22290-140, Brazil
| | - Leonardo F. Fontenelle
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil. Av. Venceslau Brás, 71 - Botafogo, Rio de Janeiro - RJ, 22290-140, Brazil,Turner Institute for Brain and Mental Health, Monash University, Wellington Rd, Clayton VIC 3800, Australia,D’Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil. Rua Diniz Cordeiro, 30 - Botafogo, Rio de Janeiro - RJ, 22281-100, Brazil
| | - Paulo Mattos
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil. Rua Diniz Cordeiro, 30 - Botafogo, Rio de Janeiro - RJ, 22281-100, Brazil
| | - Ricardo de Oliveira-Souza
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil. Rua Diniz Cordeiro, 30 - Botafogo, Rio de Janeiro - RJ, 22281-100, Brazil
| | - Jorge Moll
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil. Rua Diniz Cordeiro, 30 - Botafogo, Rio de Janeiro - RJ, 22281-100, Brazil
| | - Marcelo Queiroz Hoexter
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo, SP, Brazil. R. Dr. Ovídio Pires de Campos, 785 - Cerqueira César, São Paulo - SP, 05403-903, Brazil
| | - Eurípedes Constantino Miguel
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo, SP, Brazil. R. Dr. Ovídio Pires de Campos, 785 - Cerqueira César, São Paulo - SP, 05403-903, Brazil
| | - Nicole C.R. McLaughlin
- Butler Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA. 345 Blackstone Blvd, Providence, RI 02906, USA
| | - Elizabeth Shephard
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK. 16 De Crespigny Park, Camberwell, London SE5 8AF, UK
| | - Marcelo Camargo Batistuzzo
- Psychology Department, Health Sciences School, Pontifical Catholic University of São Paulo, São Paulo, SP, Brazil. Rua Monte Alegre 984 - Perdizes, São Paulo - SP, 05014-001, Brazil
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13
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Long J, Luo L, Guo Y, You W, Li Q, Li B, Tang W, Yang Y, Kemp GJ, Sweeney JA, Li F, Gong Q. Altered spontaneous activity and effective connectivity of the anterior cingulate cortex in obsessive-compulsive disorder. J Comp Neurol 2020; 529:296-310. [PMID: 32419131 DOI: 10.1002/cne.24948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/25/2020] [Accepted: 05/07/2020] [Indexed: 02/05/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a disabling neuropsychiatric disorder whose neurobiological basis remains unclear. Magnetic resonance imaging (MRI) studies have reported functional and structural alterations of the anterior cingulate cortex (ACC) in OCD. In this study, we explored the functional activity of subregions of the ACC and effective connectivity (EC) between ACC subregions and the whole brain in OCD. We used a Granger causality analysis (GCA) to identify the direction of information flow and whether the impact of that flow was excitatory or inhibitory. We performed resting-state functional MRI in 31 patients with OCD and 36 healthy controls and analyzed the amplitude of low-frequency fluctuation (ALFF) and coefficient-based GCA. The left pregenual ACC (pACC) in patients with OCD showed decreased ALFF relative to controls. There was significantly decreased excitatory output from the left pACC to both right dorsal superior frontal gyrus (dSFG) and left precuneus in patients compared with controls. Patients also had decreased inhibitory input to left pACC from left ventral SFG and left thalamus and caudate relative to controls. Results were similar in drug-naive patients and those with prior but not current psychopharmacological treatment. In patients, path coefficients of GCA from left pACC to right dSFG showed significant negative correlations with obsession and anxiety ratings. Decreased spontaneous neural activity and altered EC of pACC with widely distributed cortical circuitry, and associations with clinical ratings highlight the importance of pACC functional alteration in OCD.
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Affiliation(s)
- Jingyi Long
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Lekai Luo
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yi Guo
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wanfang You
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qian Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Bin Li
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wanjie Tang
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yanchun Yang
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - John A Sweeney
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Department of Psychiatry, University of Cincinnati, Cincinnati, Ohio, USA
| | - Fei Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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14
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Riesel A. The erring brain: Error-related negativity as an endophenotype for OCD-A review and meta-analysis. Psychophysiology 2020; 56:e13348. [PMID: 30838682 DOI: 10.1111/psyp.13348] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/12/2018] [Accepted: 01/20/2019] [Indexed: 12/29/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a complex and heterogeneous disorder that is associated with high personal and societal costs. Feelings of doubt, worry, and repetitive behavior, key symptoms of OCD, have been linked to hyperactive error signals in the brain. The error-related negativity (ERN) represents a validated marker of error processing in the ERP. Increased ERN amplitudes in OCD have been reported very robustly over the last 20 years. This article integrates results from 38 studies analyzing the ERN in OCD, using a quantitative meta-analysis. Meta-regressions were used to examine potential moderators such as task type, symptom severity, age, and sample size. The meta-analysis reveals a robust increase of ERN in OCD patients compared to healthy participants in response-conflict tasks (SMD -0.55) that is not modulated by symptom severity and age. No increase in ERN in OCD was observed in tasks that do not induce response conflict (SMD -0.10). In addition to the meta-analysis, the current article reviews evidence supporting that increased ERN amplitudes in OCD fulfill central criteria for an endophenotype. Further, the specificity of increased ERN amplitudes for OCD and its suitability as a potential transdiagnostic endophenotype is discussed. Finally, the clinical utility and clinical applications are examined. Overall, the evidence that increased ERN amplitudes represent a promising endophenotype indicating vulnerability for OCD is compelling. Furthermore, alterations in ERN are not limited to OCD and may constitute a transdiagnostic endophenotype. Altered neural error signals might serve as a diagnostic or predictive marker and represent a promising target for interventions.
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Affiliation(s)
- Anja Riesel
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
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15
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Ruchensky JR, Bauer EA, MacNamara A. Intolerance of uncertainty, depression and the error-related negativity. Int J Psychophysiol 2020; 153:45-52. [PMID: 32330538 DOI: 10.1016/j.ijpsycho.2020.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 03/03/2020] [Accepted: 04/14/2020] [Indexed: 12/28/2022]
Abstract
Prior work has yielded contradictory findings regarding the association between depression and the error-related negativity (ERN), an event-related potential thought to reflect individual variation in sensitivity to internal threat (i.e., errors), and the error positivity (Pe), which is thought to reflect more elaborative, conscious processing of errors. One possibility is that variation in transdiagnostic dimensional constructs related to threat processing might help explain inconsistencies in the relationship between depression and the ERN and Pe. Here, we used a large, unselected sample (N = 100) to determine whether variation in intolerance of uncertainty (IU), a transdiagnostic trait dimension that is implicated in both depression and anxiety, might moderate associations between depressive symptomatology and error processing. Results showed that greater levels of depressive symptomatology were associated with larger ΔERNs (error minus correct trials) when IU was low, but were unrelated to ΔERN when IU was high; main effects of depression and IU on ΔERN were not observed. The Pe was not associated with IU or depression. Additionally, IU, but not depression, was associated with faster response times on error and correct trials. Overall, results suggest that error processing may differ for individuals with elevated depression with versus without elevated IU. Moreover, prior failures to observe associations between depression and the ERN might stem from failure to account for related transdiagnostic constructs.
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Affiliation(s)
- Jared R Ruchensky
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States of America.
| | - Elizabeth A Bauer
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States of America
| | - Annmarie MacNamara
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States of America
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16
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Mandali A, Weidacker K, Kim SG, Voon V. The ease and sureness of a decision: evidence accumulation of conflict and uncertainty. Brain 2020; 142:1471-1482. [PMID: 30726914 DOI: 10.1093/brain/awz013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 11/09/2018] [Accepted: 12/01/2018] [Indexed: 01/29/2023] Open
Abstract
The likelihood of an outcome (uncertainty or sureness) and the similarity between choices (conflict or ease of a decision) are often critical to decision-making. We often ask ourselves: how likely are we to win or lose? And how different is this option's likelihood from the other? Uncertainty is a characteristic of the stimulus and conflict between stimuli, but these dissociable processes are often confounded. Here, applying a novel hierarchical drift diffusion approach, we study their interaction using a sequential learning task in healthy volunteers and pathological groups characterized by compulsive behaviours, by posing it as an evidence accumulation problem. The variables, Conflict (difficult or easy; difference between reward probabilities of the stimuli) and Uncertainty (low, medium or high; inverse U-shaped probability-uncertainty function) were then used to extract threshold ('a', amount of evidence accumulated before making a decision) and drift rate ('v', information processing speed) parameters. Critically, when a decision was both difficult (high conflict) and uncertain, relative to other conditions, healthy volunteers unexpectedly accumulated less evidence with lower decision thresholds and accuracy rates at chance levels. In contrast, patients with obsessive-compulsive disorder had slower processing speeds during these difficult uncertain decisions; yet, despite this more cautious approach, performed suboptimally with poorer accuracy relative to healthy volunteers below that of chance level. Thus, faced with a difficult uncertain decision, healthy controls are capable of rapid possibly random decisions, displaying almost a willingness to 'walk away', whereas those with obsessive compulsive disorder become more deliberative and cautious but despite appearing to learn the differential contingencies, still perform poorly. These observations might underlie disordered behaviours characterized by pathological uncertainty or doubt despite compulsive checking with impaired performance. In contrast, alcohol-dependent subjects show a different pattern relative to healthy controls with difficulties in adjusting their behavioural patterns with slower drift rates or processing speed despite decisions being easy or low conflict. We emphasize the multidimensional nature of compulsive behaviours and the utility of computational models in detecting subtle underlying processes relative to behavioural measures. These observations have implications for targeted behavioural interventions for specific cognitive impairments across psychiatric disorders.
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Affiliation(s)
- Alekhya Mandali
- University of Cambridge, Department of Psychiatry, Addenbrooke's Hospital, Level E4, Cambridge, UK
| | - Kathrin Weidacker
- University of Cambridge, Department of Psychiatry, Addenbrooke's Hospital, Level E4, Cambridge, UK
| | - Seung-Goo Kim
- University of Cambridge, Department of Psychiatry, Addenbrooke's Hospital, Level E4, Cambridge, UK
| | - Valerie Voon
- University of Cambridge, Department of Psychiatry, Addenbrooke's Hospital, Level E4, Cambridge, UK
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17
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Maatoug R, Ekmen A, Valero-Cabre A, Millet B. Stimulation therapeutic approaches to better understand Obsessive Compulsive Disorder: The issue of 'where' to treat. Encephale 2020; 46:399-403. [PMID: 32014241 DOI: 10.1016/j.encep.2019.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/28/2019] [Accepted: 11/15/2019] [Indexed: 01/04/2023]
Abstract
The use of invasive and non-invasive brain stimulation and neuromodulation technologies combined with neuroimaging approaches can help refine with causal evidence our physiopathological understanding of the Obsessive-Compulsive Disorder (OCD). Two key structures, the Orbitofrontal Cortex (OFC) and the Anterior Cingulate Cortex (ACC) have been found dysfunctional in OCD compared to healthy volunteers and on such basis have been tested as therapeutic targets for invasive and non-invasive neuromodulation therapy. Hereinafter, evidence addressing the cognitive processes subtended by to those two brain regions and their role in wider associated cortico-subcortical networks is reviewed. Very specifically, their relevance for OCD clinical features is discussed in extenso and its modulation with invasive and non-invasive focal brain stimulation such as deep brain stimulation (DBS) or transcranial magnetic Stimulation (TMS). Most importantly, this article brings new insights bridging causal evidence on the structural and functional neuroanatomy subtending OCD and novel therapeutic perspectives based on focal brain stimulation.
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Affiliation(s)
- R Maatoug
- Hôpital La Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - A Ekmen
- Hôpital La Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - A Valero-Cabre
- Hôpital La Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - B Millet
- Hôpital La Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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18
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Schroder HS, Nickels S, Cardenas E, Breiger M, Perlo S, Pizzagalli DA. Optimizing assessments of post-error slowing: A neurobehavioral investigation of a flanker task. Psychophysiology 2019; 57:e13473. [PMID: 31536142 DOI: 10.1111/psyp.13473] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/01/2019] [Accepted: 08/16/2019] [Indexed: 01/05/2023]
Abstract
Appropriately adjusting to errors is essential for adaptive behavior. Post-error slowing (PES) refers to the increased reaction times on trials following incorrect relative to correct responses. PES has been used as a metric of cognitive control in basic cognitive neuroscience research as well as clinical contexts. However, calculation of PES varies widely among studies and has not yet been standardized, despite recent calls to optimize its measurement. Here, using behavioral and electrophysiological data from a modified flanker task, we considered different methods of calculating PES, assessed their internal consistency, examined their convergent correlations with behavioral performance and error-related event-related brain potentials (ERPs), and evaluated their sensitivity to task demands (e.g., presence of trial-to-trial feedback). Results indicated that the so-called robust measure of PES, calculated using only error-surrounding trials, provided an estimate of PES that was three times larger in magnitude than the traditional calculation. This robust PES correlated with the amplitude of the error positivity (Pe), an index of attention allocation to errors, just as well as the traditional method. However, all PES estimates had very weak internal consistency. Implications for measurement are discussed.
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Affiliation(s)
- Hans S Schroder
- McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Stefanie Nickels
- McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Diego A Pizzagalli
- McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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19
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ERN as a transdiagnostic marker of the internalizing-externalizing spectrum: A dissociable meta-analytic effect. Neurosci Biobehav Rev 2019; 103:133-149. [DOI: 10.1016/j.neubiorev.2019.06.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 05/31/2019] [Accepted: 06/09/2019] [Indexed: 12/30/2022]
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20
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Norman LJ, Taylor SF, Liu Y, Radua J, Chye Y, De Wit SJ, Huyser C, Karahanoglu FI, Luks T, Manoach D, Mathews C, Rubia K, Suo C, van den Heuvel OA, Yücel M, Fitzgerald K. Error Processing and Inhibitory Control in Obsessive-Compulsive Disorder: A Meta-analysis Using Statistical Parametric Maps. Biol Psychiatry 2019; 85:713-725. [PMID: 30595231 PMCID: PMC6474799 DOI: 10.1016/j.biopsych.2018.11.010] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/26/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Error processing and inhibitory control enable the adjustment of behaviors to meet task demands. Functional magnetic resonance imaging studies report brain activation abnormalities in patients with obsessive-compulsive disorder (OCD) during both processes. However, conclusions are limited by inconsistencies in the literature and small sample sizes. Therefore, the aim here was to perform a meta-analysis of the existing literature using unthresholded statistical maps from previous studies. METHODS A voxelwise seed-based d mapping meta-analysis was performed using t-maps from studies comparing patients with OCD and healthy control subjects (HCs) during error processing and inhibitory control. For the error processing analysis, 239 patients with OCD (120 male; 79 medicated) and 229 HCs (129 male) were included, while the inhibitory control analysis included 245 patients with OCD (120 male; 91 medicated) and 239 HCs (135 male). RESULTS Patients with OCD, relative to HCs, showed longer inhibitory control reaction time (standardized mean difference = 0.20, p = .03, 95% confidence interval = 0.016, 0.393) and more inhibitory control errors (standardized mean difference = 0.22, p = .02, 95% confidence interval = 0.039, 0.399). In the brain, patients showed hyperactivation in the bilateral dorsal anterior cingulate cortex, supplementary motor area, and pre-supplementary motor area as well as right anterior insula/frontal operculum and anterior lateral prefrontal cortex during error processing but showed hypoactivation during inhibitory control in the rostral and ventral anterior cingulate cortices and bilateral thalamus/caudate, as well as the right anterior insula/frontal operculum, supramarginal gyrus, and medial orbitofrontal cortex (all seed-based d mapping z value >2, p < .001). CONCLUSIONS A hyperactive error processing mechanism in conjunction with impairments in implementing inhibitory control may underlie deficits in stopping unwanted compulsive behaviors in the disorder.
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Affiliation(s)
- Luke J. Norman
- Department of Psychiatry, Medical School, University of Michigan, Ann Arbor, USA,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Stephan F. Taylor
- Department of Psychiatry, Medical School, University of Michigan, Ann Arbor, USA
| | - Yanni Liu
- Department of Psychiatry, Medical School, University of Michigan, Ann Arbor, USA
| | - Joaquim Radua
- Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Mental Health Research Networking Center (CIBERSAM), Barcelona, Spain,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Yann Chye
- Brain and Mental Health Research Hub, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Stella J. De Wit
- Amsterdam University Medical Centers, Vrije Universiteit, Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam, The Netherlands,GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Chaim Huyser
- Bascule, Academic Centre for Children and Adolescent Psychiatry, Amsterdam, Netherlands
| | - F. Isik Karahanoglu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Tracy Luks
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | - Dara Manoach
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, USA
| | - Carol Mathews
- Department of Psychiatry and Center for OCD, Anxiety and Related Disorders, University of Florida, Gainesville, Florida, USA
| | - Katya Rubia
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Chao Suo
- Brain and Mental Health Research Hub, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Odile A. van den Heuvel
- Amsterdam University Medical Centers, Vrije Universiteit, Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam, The Netherlands,OCD-Team, Haukeland University Hospital, Bergen, Norway
| | - Murat Yücel
- Brain and Mental Health Research Hub, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia,Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Kate Fitzgerald
- Department of Psychiatry, Medical School, University of Michigan, Ann Arbor, USA
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21
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Development of Posterior Medial Frontal Cortex Function in Pediatric Obsessive-Compulsive Disorder. J Am Acad Child Adolesc Psychiatry 2018; 57:397-406. [PMID: 29859555 PMCID: PMC5990044 DOI: 10.1016/j.jaac.2018.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 02/18/2018] [Accepted: 04/13/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Abnormal engagement of the posterior medial frontal cortex (pMFC) occurs during performance monitoring in obsessive-compulsive disorder (OCD), including in pediatric patients. Yet, the development of pMFC function in OCD-affected youth remains poorly understood. METHOD A total of 69 patients with pediatric OCD and 72 healthy controls (HC), 8 to 19 years of age, were scanned during the Multisource Interference Task (MSIT). The effects of group, age, performance, and interactions on pMFC response to errors and interference were tested in the region of interest [ROI]) and whole-brain analyses. Secondary analyses considered bilateral anterior insula/frontal operculum (aI/fO), given the contribution of these regions with pMFC to a cingulo-opercular network (CON) for task control (e.g., error and interference processing). RESULTS Error-related pMFC activity was greater for OCD patients than for HC, increased with age in OCD patients, but decreased with age in HC. Greater pMFC activation associated with better performance in HC but not OCD patients. In the patients, greater pMFC activation to errors was associated with lower OCD severity. Altered error-related activation and performance associations were also observed in the right aI/fO in OCD patients, whereas the left aI/fO response to interference was associated with lower OCD severity. CONCLUSION Atypical increase in error-related pMFC activation with age in pediatric OCD suggests altered development of pMFC function during the early course of illness. Greater pMFC activation with better performance in HC, and with age and lower symptom severity in OCD patients, suggests an adaptive function of heightened pMFC response to errors that could be further enhanced (e.g., via cognitive training) to improve outcomes in OCD from the early course of illness.
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22
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Zhou C, Cheng Y, Ping L, Xu J, Shen Z, Jiang L, Shi L, Yang S, Lu Y, Xu X. Support Vector Machine Classification of Obsessive-Compulsive Disorder Based on Whole-Brain Volumetry and Diffusion Tensor Imaging. Front Psychiatry 2018; 9:524. [PMID: 30405461 PMCID: PMC6206075 DOI: 10.3389/fpsyt.2018.00524] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 10/03/2018] [Indexed: 01/17/2023] Open
Abstract
Magnetic resonance imaging (MRI) methods have been used to detect cerebral anatomical distinction between obsessive-compulsive disorder (OCD) patients and healthy controls (HC). Machine learning approach allows for the possibility of discriminating patients on the individual level. However, few studies have used this automatic technique based on multiple modalities to identify potential biomarkers of OCD. High-resolution structural MRI and diffusion tensor imaging (DTI) data were acquired from 48 OCD patients and 45 well-matched HC. Gray matter volume (GMV), white matter volume (WMV), fractional anisotropy (FA), and mean diffusivity (MD) were extracted as four features were examined using support vector machine (SVM). Ten brain regions of each feature contributed most to the classification were also estimated. Using different algorithms, the classifier achieved accuracies of 72.08, 61.29, 80.65, and 77.42% for GMV, WMV, FA, and MD, respectively. The most discriminative gray matter regions that contributed to the classification were mainly distributed in the orbitofronto-striatal "affective" circuit, the dorsolateral, prefronto-striatal "executive" circuit and the cerebellum. For WMV feature and the two feature sets of DTI, the shared regions contributed the most to the discrimination mainly included the uncinate fasciculus, the cingulum in the hippocampus, corticospinal tract, as well as cerebellar peduncle. Based on whole-brain volumetry and DTI images, SVM algorithm revealed high accuracies for distinguishing OCD patients from healthy subjects at the individual level. Computer-aided method is capable of providing accurate diagnostic information and might provide a new perspective for clinical diagnosis of OCD.
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Affiliation(s)
- Cong Zhou
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China.,Postgraduate College, Kunming Medical University, Kunming, China
| | - Yuqi Cheng
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Liangliang Ping
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China.,Postgraduate College, Kunming Medical University, Kunming, China
| | - Jian Xu
- Department of Internal Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zonglin Shen
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Linling Jiang
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Li Shi
- Department of Internal Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shuran Yang
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yi Lu
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiufeng Xu
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
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23
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Bey K, Lennertz L, Grützmann R, Heinzel S, Kaufmann C, Klawohn J, Riesel A, Meyhöfer I, Ettinger U, Kathmann N, Wagner M. Impaired Antisaccades in Obsessive-Compulsive Disorder: Evidence From Meta-Analysis and a Large Empirical Study. Front Psychiatry 2018; 9:284. [PMID: 30008679 PMCID: PMC6033994 DOI: 10.3389/fpsyt.2018.00284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/11/2018] [Indexed: 01/23/2023] Open
Abstract
Increasing evidence indicates that patients with obsessive-compulsive disorder (OCD) exhibit alterations in fronto-striatal circuitry. Performance deficits in the antisaccade task would support this model, but results from previous small-scale studies have been inconclusive as either increased error rates, prolonged antisaccade latencies, both or neither have been reported in OCD patients. In order to address this issue, we investigated antisaccade performance in a large sample of OCD patients (n = 169) and matched control subjects (n = 183). As impaired antisaccade performance constitutes a potential endophenotype of OCD, unaffected first-degree relatives of OCD patients (n = 100) were assessed, as well. Furthermore, we conducted a quantitative meta-analysis to integrate our data with previous findings. In the empirical study, OCD patients exhibited significantly increased antisaccade latencies, intra-subject variability (ISV) of antisaccade latencies, and antisaccade error rates. The latter effect was driven by errors with express latency (80-130 ms), as patients did not differ significantly from controls with regards to regular errors (>130 ms). Notably, unaffected relatives of OCD patients showed elevated antisaccade express error rates and increased ISV of antisaccade latencies, as well. Antisaccade performance was not associated with state anxiety within groups. Among relatives, however, we observed a significant correlation between antisaccade error rate and harm avoidance. Medication status of OCD patients, symptom severity, depressive comorbidity, comorbid anxiety disorders and OCD symptom dimensions did not significantly affect antisaccade performance. Meta-analysis of 10 previous and the present empirical study yielded a medium-sized effect (SMD = 0.48, p < 0.001) for higher error rates in OCD patients, while the effect for latencies did not reach significance owing to strong heterogeneity (SMD = 0.51, p = 0.069). Our results support the assumption of impaired antisaccade performance in OCD, although effects sizes were only moderately large. Furthermore, we provide the first evidence that increased antisaccade express error rates and ISV of antisaccade latencies may constitute endophenotypes of OCD. Findings regarding these more detailed antisaccade parameters point to potentially underlying mechanisms, such as early pre-stimulus inhibition of the superior colliculus.
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Affiliation(s)
- Katharina Bey
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Leonhard Lennertz
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Rosa Grützmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stephan Heinzel
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.,Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Christian Kaufmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Julia Klawohn
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.,Biomedical Sciences and Psychology, Florida State University, Tallahassee, FL, United States
| | - Anja Riesel
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Inga Meyhöfer
- Department of Psychology, University of Bonn, Bonn, Germany
| | | | - Norbert Kathmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases, Bonn, Germany.,Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
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24
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Schwalm M, Schmid F, Wachsmuth L, Backhaus H, Kronfeld A, Aedo Jury F, Prouvot PH, Fois C, Albers F, van Alst T, Faber C, Stroh A. Cortex-wide BOLD fMRI activity reflects locally-recorded slow oscillation-associated calcium waves. eLife 2017; 6:27602. [PMID: 28914607 PMCID: PMC5658067 DOI: 10.7554/elife.27602] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 09/14/2017] [Indexed: 01/08/2023] Open
Abstract
Spontaneous slow oscillation-associated slow wave activity represents an internally generated state which is characterized by alternations of network quiescence and stereotypical episodes of neuronal activity - slow wave events. However, it remains unclear which macroscopic signal is related to these active periods of the slow wave rhythm. We used optic fiber-based calcium recordings of local neural populations in cortex and thalamus to detect neurophysiologically defined slow calcium waves in isoflurane anesthetized rats. The individual slow wave events were used for an event-related analysis of simultaneously acquired whole-brain BOLD fMRI. We identified BOLD responses directly related to onsets of slow calcium waves, revealing a cortex-wide BOLD correlate: the entire cortex was engaged in this specific type of slow wave activity. These findings demonstrate a direct relation of defined neurophysiological events to a specific BOLD activity pattern and were confirmed for ongoing slow wave activity by independent component and seed-based analyses. When a person is in a deep non-dreaming sleep, neurons in their brain alternate slowly between periods of silence and periods of activity. This gives rise to low-frequency brain rhythms called slow waves, which are thought to help stabilize memories. Slow wave activity can be detected on multiple scales, from the pattern of electrical impulses sent by an individual neuron to the collective activity of the brain’s entire outer layer, the cortex. But does slow wave activity in an individual group of neurons in the cortex affect the activity of the rest of the brain? To find out, Schwalm, Schmid, Wachsmuth et al. took advantage of the fact that slow waves also occur under general anesthesia, and placed anesthetized rats inside miniature whole-brain scanners. A small region of cortex in each rat had been injected with a dye that fluoresces whenever the neurons in that region are active. An optical fiber was lowered into the rat’s brain to transmit the fluorescence signals to a computer. Monitoring these signals while the animals lay inside the scanner revealed that slow-wave activity in any one group of cortical neurons was accompanied by slow-wave activity across the cortex as a whole. This relationship was seen only for slow waves, and not for other brain rhythms. Slow waves seem to occur in all species of animal with a backbone, and in both healthy and diseased brains. While it is not possible to inject fluorescent dyes into the human brain, it is possible to monitor neuronal activity using electrodes. Comparing local electrode recordings with measures of whole-brain activity from scanners could thus allow similar experiments to be performed in people. There is growing evidence – from animal models and from studies of patients – that slow waves may be altered in Alzheimer’s disease. Further work is required to determine whether detecting these changes could help diagnose disease at earlier stages, and whether reversing them may have therapeutic potential.
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Affiliation(s)
- Miriam Schwalm
- Focus Program Translational Neurosciences, Institute for Microscopic Anatomy and Neurobiology, Johannes Gutenberg-University Mainz, Mainz, Germany.,GRADE Brain, Goethe Graduate Academy, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Florian Schmid
- Department of Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Lydia Wachsmuth
- Department of Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Hendrik Backhaus
- Focus Program Translational Neurosciences, Institute for Microscopic Anatomy and Neurobiology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Andrea Kronfeld
- Focus Program Translational Neurosciences, Institute for Microscopic Anatomy and Neurobiology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Felipe Aedo Jury
- Focus Program Translational Neurosciences, Institute for Microscopic Anatomy and Neurobiology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Pierre-Hugues Prouvot
- Focus Program Translational Neurosciences, Institute for Microscopic Anatomy and Neurobiology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Consuelo Fois
- Focus Program Translational Neurosciences, Institute for Microscopic Anatomy and Neurobiology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Franziska Albers
- Department of Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Timo van Alst
- Department of Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Cornelius Faber
- Department of Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Albrecht Stroh
- Focus Program Translational Neurosciences, Institute for Microscopic Anatomy and Neurobiology, Johannes Gutenberg-University Mainz, Mainz, Germany
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25
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Gillan CM, Fineberg NA, Robbins TW. A trans-diagnostic perspective on obsessive-compulsive disorder. Psychol Med 2017; 47:1528-1548. [PMID: 28343453 PMCID: PMC5964477 DOI: 10.1017/s0033291716002786] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 10/04/2016] [Accepted: 10/04/2016] [Indexed: 12/01/2022]
Abstract
Progress in understanding the underlying neurobiology of obsessive-compulsive disorder (OCD) has stalled in part because of the considerable problem of heterogeneity within this diagnostic category, and homogeneity across other putatively discrete, diagnostic categories. As psychiatry begins to recognize the shortcomings of a purely symptom-based psychiatric nosology, new data-driven approaches have begun to be utilized with the goal of solving these problems: specifically, identifying trans-diagnostic aspects of clinical phenomenology based on their association with neurobiological processes. In this review, we describe key methodological approaches to understanding OCD from this perspective and highlight the candidate traits that have already been identified as a result of these early endeavours. We discuss how important inferences can be made from pre-existing case-control studies as well as showcasing newer methods that rely on large general population datasets to refine and validate psychiatric phenotypes. As exemplars, we take 'compulsivity' and 'anxiety', putatively trans-diagnostic symptom dimensions that are linked to well-defined neurobiological mechanisms, goal-directed learning and error-related negativity, respectively. We argue that the identification of biologically valid, more homogeneous, dimensions such as these provides renewed optimism for identifying reliable genetic contributions to OCD and other disorders, improving animal models and critically, provides a path towards a future of more targeted psychiatric treatments.
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Affiliation(s)
- C. M. Gillan
- Department of Psychology,
New York University, New York, NY,
USA
- Department of Psychology,
University of Cambridge, Cambridge,
UK
- Behavioural and Clinical Neuroscience Institute,
University of Cambridge, Cambridge,
UK
| | - N. A. Fineberg
- National Obsessive Compulsive Disorders Specialist
Service, Hertfordshire Partnership NHS University Foundation
Trust, UK
- Department of Postgraduate Medicine,
University of Hertfordshire, Hatfield,
UK
| | - T. W. Robbins
- Department of Psychology,
University of Cambridge, Cambridge,
UK
- Behavioural and Clinical Neuroscience Institute,
University of Cambridge, Cambridge,
UK
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26
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Bey K, Kloft L, Lennertz L, Grützmann R, Heinzel S, Kaufmann C, Klawohn J, Riesel A, Meyhöfer I, Kathmann N, Wagner M. Volitional saccade performance in a large sample of patients with obsessive-compulsive disorder and unaffected first-degree relatives. Psychophysiology 2017; 54:1284-1294. [PMID: 28481032 DOI: 10.1111/psyp.12884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 01/16/2023]
Abstract
Recent evidence indicates that patients with obsessive-compulsive disorder (OCD) as well as their unaffected first-degree relatives show deficits in the volitional control of saccades, suggesting that volitional saccade performance may constitute an endophenotype of OCD. Here, we aimed to replicate and extend these findings in a large, independent sample. One hundred and fifteen patients with OCD, 103 healthy comparison subjects without a family history of OCD, and 31 unaffected first-degree relatives of OCD patients were examined using structured clinical interviews and performed a volitional saccade task as well as a prosaccade task. In contrast to previous reports, neither patients nor relatives showed impairments in the performance of volitional saccades compared to healthy controls. Notably, medicated patients did not differ from nonmedicated patients, and there was no effect of depressive comorbidity. Additional analyses investigating correlations between saccade performance and OCD symptom dimensions yielded no significant associations. In conclusion, the present results do not support the notion that volitional saccade execution constitutes an endophenotype of OCD. Possible explanations for inconsistencies with previous studies are discussed.
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Affiliation(s)
- Katharina Bey
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Lisa Kloft
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - Leonhard Lennertz
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Rosa Grützmann
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - Stephan Heinzel
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany.,Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Christian Kaufmann
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - Julia Klawohn
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - Anja Riesel
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - Inga Meyhöfer
- Department of Psychology, University of Bonn, Bonn, Germany
| | - Norbert Kathmann
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
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27
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Norman LJ, Carlisi CO, Christakou A, Cubillo A, Murphy CM, Chantiluke K, Simmons A, Giampietro V, Brammer M, Mataix-Cols D, Rubia K. Shared and disorder-specific task-positive and default mode network dysfunctions during sustained attention in paediatric Attention-Deficit/Hyperactivity Disorder and obsessive/compulsive disorder. Neuroimage Clin 2017; 15:181-193. [PMID: 28529874 PMCID: PMC5429245 DOI: 10.1016/j.nicl.2017.04.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/29/2017] [Accepted: 04/15/2017] [Indexed: 12/24/2022]
Abstract
Patients with Attention-Deficit/Hyperactivity Disorder (ADHD) and obsessive/compulsive disorder (OCD) share problems with sustained attention, and are proposed to share deficits in switching between default mode and task positive networks. The aim of this study was to investigate shared and disorder-specific brain activation abnormalities during sustained attention in the two disorders. Twenty boys with ADHD, 20 boys with OCD and 20 age-matched healthy controls aged between 12 and 18 years completed a functional magnetic resonance imaging (fMRI) version of a parametrically modulated sustained attention task with a progressively increasing sustained attention load. Performance and brain activation were compared between groups. Only ADHD patients were impaired in performance. Group by sustained attention load interaction effects showed that OCD patients had disorder-specific middle anterior cingulate underactivation relative to controls and ADHD patients, while ADHD patients showed disorder-specific underactivation in left dorsolateral prefrontal cortex/dorsal inferior frontal gyrus (IFG). ADHD and OCD patients shared left insula/ventral IFG underactivation and increased activation in posterior default mode network relative to controls, but had disorder-specific overactivation in anterior default mode regions, in dorsal anterior cingulate for ADHD and in anterior ventromedial prefrontal cortex for OCD. In sum, ADHD and OCD patients showed mostly disorder-specific patterns of brain abnormalities in both task positive salience/ventral attention networks with lateral frontal deficits in ADHD and middle ACC deficits in OCD, as well as in their deactivation patterns in medial frontal DMN regions. The findings suggest that attention performance in the two disorders is underpinned by disorder-specific activation patterns.
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Affiliation(s)
- Luke J Norman
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Christina O Carlisi
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Anastasia Christakou
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, UK
| | - Ana Cubillo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Clodagh M Murphy
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Kaylita Chantiluke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Andrew Simmons
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) for Mental Health at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Vincent Giampietro
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Michael Brammer
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Katya Rubia
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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28
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Bandelow B, Baldwin D, Abelli M, Bolea-Alamanac B, Bourin M, Chamberlain SR, Cinosi E, Davies S, Domschke K, Fineberg N, Grünblatt E, Jarema M, Kim YK, Maron E, Masdrakis V, Mikova O, Nutt D, Pallanti S, Pini S, Ströhle A, Thibaut F, Vaghix MM, Won E, Wedekind D, Wichniak A, Woolley J, Zwanzger P, Riederer P. Biological markers for anxiety disorders, OCD and PTSD: A consensus statement. Part II: Neurochemistry, neurophysiology and neurocognition. World J Biol Psychiatry 2017; 18:162-214. [PMID: 27419272 PMCID: PMC5341771 DOI: 10.1080/15622975.2016.1190867] [Citation(s) in RCA: 173] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Biomarkers are defined as anatomical, biochemical or physiological traits that are specific to certain disorders or syndromes. The objective of this paper is to summarise the current knowledge of biomarkers for anxiety disorders, obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD). METHODS Findings in biomarker research were reviewed by a task force of international experts in the field, consisting of members of the World Federation of Societies for Biological Psychiatry Task Force on Biological Markers and of the European College of Neuropsychopharmacology Anxiety Disorders Research Network. RESULTS The present article (Part II) summarises findings on potential biomarkers in neurochemistry (neurotransmitters such as serotonin, norepinephrine, dopamine or GABA, neuropeptides such as cholecystokinin, neurokinins, atrial natriuretic peptide, or oxytocin, the HPA axis, neurotrophic factors such as NGF and BDNF, immunology and CO2 hypersensitivity), neurophysiology (EEG, heart rate variability) and neurocognition. The accompanying paper (Part I) focuses on neuroimaging and genetics. CONCLUSIONS Although at present, none of the putative biomarkers is sufficient and specific as a diagnostic tool, an abundance of high quality research has accumulated that should improve our understanding of the neurobiological causes of anxiety disorders, OCD and PTSD.
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Affiliation(s)
- Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University of Göttingen, Germany
| | - David Baldwin
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Marianna Abelli
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Blanca Bolea-Alamanac
- School of Social and Community Medicine, Academic Unit of Psychiatry, University of Bristol, Bristol, UK
| | - Michel Bourin
- Neurobiology of Anxiety and Mood Disorders, University of Nantes, Nantes, France
| | - Samuel R. Chamberlain
- Hertfordshire Partnership University NHS Foundation Trust and University of Hertfordshire, Parkway, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Eduardo Cinosi
- Department of Neuroscience Imaging and Clinical Sciences, Gabriele D’Annunzio University, Chieti, Italy
| | - Simon Davies
- Centre for Addiction and Mental Health, Geriatric Psychiatry Division, University of Toronto, Toronto, Canada
- School of Social and Community Medicine, Academic Unit of Psychiatry, University of Bristol, Bristol, UK
| | - Katharina Domschke
- Department of Psychiatry Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - Naomi Fineberg
- Hertfordshire Partnership University NHS Foundation Trust and University of Hertfordshire, Parkway, UK
| | - Edna Grünblatt
- Department of Psychiatry Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and the ETH Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Marek Jarema
- Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warszawa, Poland
| | - Yong-Ku Kim
- Department of Psychiatry College of Medicine, Korea University, Seoul, Republic of Korea
| | - Eduard Maron
- Department of Psychiatry, North Estonia Medical Centre, Tallinn, Estonia
- Department of Psychiatry, University of Tartu, Estonia
- Faculty of Medicine Department of Medicine, Centre for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London, UK
| | - Vasileios Masdrakis
- Athens University Medical School, First Department of Psychiatry, Eginition Hospital, Athens, Greece
| | - Olya Mikova
- Foundation Biological Psychiatry, Sofia, Bulgaria
| | - David Nutt
- Faculty of Medicine Department of Medicine, Centre for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London, UK
| | - Stefano Pallanti
- UC Davis Department of Psychiatry and Behavioural Sciences, Sacramento, CA, USA
| | - Stefano Pini
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité – University Medica Center Berlin, Berlin, Germany
| | - Florence Thibaut
- Faculty of Medicine Paris Descartes, University Hospital Cochin, Paris, France
| | - Matilde M. Vaghix
- Department of Psychology and Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK
| | - Eunsoo Won
- Department of Psychiatry College of Medicine, Korea University, Seoul, Republic of Korea
| | - Dirk Wedekind
- Department of Psychiatry and Psychotherapy, University of Göttingen, Germany
| | - Adam Wichniak
- Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warszawa, Poland
| | - Jade Woolley
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Peter Zwanzger
- kbo-Inn-Salzach-Klinikum Wasserburg am Inn, Germany
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Peter Riederer
- Department of Psychiatry Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany
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29
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Grützmann R, Endrass T, Kaufmann C, Allen E, Eichele T, Kathmann N. Presupplementary Motor Area Contributes to Altered Error Monitoring in Obsessive-Compulsive Disorder. Biol Psychiatry 2016; 80:562-71. [PMID: 25659234 DOI: 10.1016/j.biopsych.2014.12.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 11/05/2014] [Accepted: 12/09/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hyperactive performance monitoring, as measured by the error-related negativity (ERN) in the event-related potential, is a reliable finding in obsessive-compulsive disorder (OCD) research and may be an endophenotype of the disorder. Imaging studies revealed inconsistent results as to which brain regions are involved in altered performance monitoring in OCD. We investigated performance monitoring in OCD with simultaneous recording of electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) signals to determine the neural source of the enhanced ERN. METHODS Concurrent EEG and fMRI data were collected from 20 patients with OCD and 22 healthy control subjects during a flanker task. Independent component analysis was used separately on EEG and fMRI to segment the data functionally and focus on processes of interest. The ERN, hemodynamic responses following errors, and intraindividual correlation of the ERN and blood oxygen level-dependent activity were compared between groups. RESULTS Patients with OCD showed significantly increased ERN amplitudes. Blood oxygen level-dependent activity in midcingulate cortex was not significantly different between groups. Increased activation of the right amygdala and the subgenual anterior cingulate cortex following errors was observed in patients with OCD. Increased intraindividual correlation of the ERN and activity of the presupplementary motor area was found in patients with OCD compared with healthy controls. CONCLUSIONS Higher error-related activity was found in the amygdala and subgenual anterior cingulate cortex, suggesting a stronger affective response toward errors in patients with OCD. Additionally, increased correlation of the ERN and presupplementary motor area may indicate stronger recruitment of proactive control in OCD.
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Affiliation(s)
- Rosa Grützmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin.
| | - Tanja Endrass
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin; Department of Psychology, Otto-von-Guericke Universität Magdeburg, Magdeburg, Germany
| | | | - Elena Allen
- K.G. Jebsen Center for Research on Neuropsychiatric Disorders, University of Bergen; The Mind Research Network, Albuquerque, New Mexico
| | - Tom Eichele
- K.G. Jebsen Center for Research on Neuropsychiatric Disorders, University of Bergen; Section for Clinical Neurophysiology, Department of Neurology, Haukeland University Hospital, Bergen, Norway; The Mind Research Network, Albuquerque, New Mexico
| | - Norbert Kathmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin
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Ribas VR, Ribas RDMG, Martins HADL. The Learning Curve in neurofeedback of Peter Van Deusen: A review article. Dement Neuropsychol 2016; 10:98-103. [PMID: 29213440 PMCID: PMC5642400 DOI: 10.1590/s1980-5764-2016dn1002005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Learning Curve (TLC) in neurofeedback concept emerged after Peter Van Deusen compiled the results of articles on the expected electrical activity of the brain. This concept was subsequently tested on patients at four clinics in Atlanta between 1994 and 2001. The aim of this paper was to report the historical aspects of TLC. Articles published on the electronic databases MEDLINE/PubMed and Web of Science were reviewed. During patient evaluation, TLC investigates categories called disconnected, hot temporal lobes, reversal of alpha and beta waves, blocking, locking, and filtering or processing. This enables neuroscientists to use their training designs and, by means of behavioral psychology, to work on neuroregulation, as self-regulation for patients. TLC shows the relationships between electrical, mental and behavioral activity in patients. It also identifies details of patterns that can assist physicians in their choice of treatment.
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Affiliation(s)
| | | | - Hugo André de Lima Martins
- Graduated in Medicine, Expert in Neurology and Psychiatry, Masters and Doctorate in Neuropsychiatry, UFPE
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McGovern RA, Sheth SA. Role of the dorsal anterior cingulate cortex in obsessive-compulsive disorder: converging evidence from cognitive neuroscience and psychiatric neurosurgery. J Neurosurg 2016; 126:132-147. [PMID: 27035167 DOI: 10.3171/2016.1.jns15601] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Advances in understanding the neurobiological basis of psychiatric disorders will improve the ability to refine neuromodulatory procedures for treatment-refractory patients. One of the core dysfunctions in obsessive-compulsive disorder (OCD) is a deficit in cognitive control, especially involving the dorsal anterior cingulate cortex (dACC). The authors' aim was to derive a neurobiological understanding of the successful treatment of refractory OCD with psychiatric neurosurgical procedures targeting the dACC. METHODS First, the authors systematically conducted a review of the literature on the role of the dACC in OCD by using the search terms "obsessive compulsive disorder" and "anterior cingulate." The neuroscience literature on cognitive control mechanisms in the dACC was then combined with the literature on psychiatric neurosurgical procedures targeting the dACC for the treatment of refractory OCD. RESULTS The authors reviewed 89 studies covering topics that included structural and functional neuroimaging and electrophysiology. The majority of resting-state functional neuroimaging studies demonstrated dACC hyperactivity in patients with OCD relative to that in controls, while task-based studies were more variable. Electrophysiological studies showed altered dACC-related biomarkers of cognitive control, such as error-related negativity in OCD patients. These studies were combined with the cognitive control neurophysiology literature, including the recently elaborated expected value of control theory of dACC function. The authors suggest that a central feature of OCD pathophysiology involves the generation of mis-specified cognitive control signals by the dACC, and they elaborate on this theory and provide suggestions for further study. CONCLUSIONS Although abnormalities in brain structure and function in OCD are distributed across a wide network, the dACC plays a central role. The authors propose a theory of cognitive control dysfunction in OCD that attempts to explain the therapeutic efficacy of dACC neuromodulation. This theoretical framework should help to guide further research into targeted treatments of OCD and other disorders of cognitive control.
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Affiliation(s)
- Robert A McGovern
- Department of Neurological Surgery, The Neurological Institute, Columbia University Medical Center, New York, New York
| | - Sameer A Sheth
- Department of Neurological Surgery, The Neurological Institute, Columbia University Medical Center, New York, New York
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Liu S, Cai W, Liu S, Zhang F, Fulham M, Feng D, Pujol S, Kikinis R. Multimodal neuroimaging computing: a review of the applications in neuropsychiatric disorders. Brain Inform 2015; 2:167-180. [PMID: 27747507 PMCID: PMC4737664 DOI: 10.1007/s40708-015-0019-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 08/08/2015] [Indexed: 12/20/2022] Open
Abstract
Multimodal neuroimaging is increasingly used in neuroscience research, as it overcomes the limitations of individual modalities. One of the most important applications of multimodal neuroimaging is the provision of vital diagnostic data for neuropsychiatric disorders. Multimodal neuroimaging computing enables the visualization and quantitative analysis of the alterations in brain structure and function, and has reshaped how neuroscience research is carried out. Research in this area is growing exponentially, and so it is an appropriate time to review the current and future development of this emerging area. Hence, in this paper, we review the recent advances in multimodal neuroimaging (MRI, PET) and electrophysiological (EEG, MEG) technologies, and their applications to the neuropsychiatric disorders. We also outline some future directions for multimodal neuroimaging where researchers will design more advanced methods and models for neuropsychiatric research.
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Affiliation(s)
- Sidong Liu
- School of IT, The University of Sydney, Sydney, Australia.
| | - Weidong Cai
- School of IT, The University of Sydney, Sydney, Australia
| | - Siqi Liu
- School of IT, The University of Sydney, Sydney, Australia
| | - Fan Zhang
- Surgical Planning Laboratory, Harvard Medical School, Boston, USA
| | - Michael Fulham
- Department of PET and Nuclear Medicine, Royal Prince Alfred Hospital, and the Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Dagan Feng
- School of IT, The University of Sydney, Sydney, Australia
- Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Sonia Pujol
- Surgical Planning Laboratory, Harvard Medical School, Boston, USA
| | - Ron Kikinis
- Surgical Planning Laboratory, Harvard Medical School, Boston, USA
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