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Kwon H, Ha M, Choi S, Park S, Jang M, Kim M, Kwon JS. Resting-state functional connectivity of amygdala subregions across different symptom subtypes of obsessive-compulsive disorder patients. Neuroimage Clin 2024; 43:103644. [PMID: 39042954 PMCID: PMC11325364 DOI: 10.1016/j.nicl.2024.103644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/30/2024] [Accepted: 07/16/2024] [Indexed: 07/25/2024]
Abstract
AIM Obsessive-compulsive disorder (OCD) is a heterogeneous condition characterized by distinct symptom subtypes, each with varying pathophysiologies and treatment responses. Recent research has highlighted the role of the amygdala, a brain region that is central to emotion processing, in these variations. However, the role of amygdala subregions with distinct functions has not yet been fully elucidated. In this study, we aimed to clarify the biological mechanisms underlying OCD subtype heterogeneity by investigating the functional connectivity (FC) of amygdala subregions across distinct OCD symptom subtypes. METHODS Resting-state functional magnetic resonance images were obtained from 107 medication-free OCD patients and 110 healthy controls (HCs). Using centromedial, basolateral, and superficial subregions of the bilateral amygdala as seed regions, whole-brain FC was compared between OCD patients and HCs and among patients with different OCD symptom subtypes, which included contamination fear and washing, obsessive (i.e., harm due to injury, aggression, sexual, and religious), and compulsive (i.e., symmetry, ordering, counting, and checking) subtypes. RESULTS Compared to HCs, compulsive-type OCD patients exhibited hypoconnectivity between the left centromedial amygdala (CMA) and bilateral superior frontal gyri. Compared with patients with contamination fear and washing OCD subtypes, patients with compulsive-type OCD showed hypoconnectivity between the left CMA and left frontal cortex. CONCLUSIONS CMA-frontal cortex hypoconnectivity may contribute to the compulsive presentation of OCD through impaired control of behavioral responses to negative emotions. Our findings underscored the potential significance of the distinct neural underpinnings of different OCD manifestations, which could pave the way for more targeted treatment strategies in the future.
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Affiliation(s)
- Harah Kwon
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Clinical Medical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minji Ha
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Sunah Choi
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Sunghyun Park
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Moonyoung Jang
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Jun Soo Kwon
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
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2
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Picó-Pérez M, Fullana MA, Albajes-Eizagirre A, Vega D, Marco-Pallarés J, Vilar A, Chamorro J, Felmingham KL, Harrison BJ, Radua J, Soriano-Mas C. Neural predictors of cognitive-behavior therapy outcome in anxiety-related disorders: a meta-analysis of task-based fMRI studies. Psychol Med 2023; 53:3387-3395. [PMID: 35916600 DOI: 10.1017/s0033291721005444] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cognitive-behavior therapy (CBT) is a well-established first-line intervention for anxiety-related disorders, including specific phobia, social anxiety disorder, panic disorder/agoraphobia, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. Several neural predictors of CBT outcome for anxiety-related disorders have been proposed, but previous results are inconsistent. METHODS We conducted a systematic review and meta-analysis of task-based functional magnetic resonance imaging (fMRI) studies investigating whole-brain predictors of CBT outcome in anxiety-related disorders (17 studies, n = 442). RESULTS Across different tasks, we observed that brain response in a network of regions involved in salience and interoception processing, encompassing fronto-insular (the right inferior frontal gyrus-anterior insular cortex) and fronto-limbic (the dorsomedial prefrontal cortex-dorsal anterior cingulate cortex) cortices was strongly associated with a positive CBT outcome. CONCLUSIONS Our results suggest that there are robust neural predictors of CBT outcome in anxiety-related disorders that may eventually lead (probably in combination with other data) to develop personalized approaches for the treatment of these mental disorders.
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Affiliation(s)
- Maria Picó-Pérez
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Clinical Academic Center - Braga, Braga, Portugal
| | - Miquel A Fullana
- Adult Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clinic, Barcelona, Spain
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain
| | - Anton Albajes-Eizagirre
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain
- Opticks Security, Barcelona, Spain
| | - Daniel Vega
- Psychiatry and Mental Health Department, Consorci Sanitari de l'Anoia & Fundació Sanitària d'Igualada, Igualada, Barcelona, Spain
- Unitat de Psicologia Mèdica, Departament de Psiquiatria i Medicina Legal & Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Josep Marco-Pallarés
- Department of Cognition, Development and Educational Psychology, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Ana Vilar
- Institut de Neuropsiquiatria i Addiccions, Hospital de Dia Infanto Juvenil Litoral Mar, Parc de Salut Mar, Barcelona, Spain
| | - Jacobo Chamorro
- Anxiety Unit, Institute of Neuropsychiatry and Addictions, Parc de Salut Mar, Barcelona, Spain
| | - Kim L Felmingham
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Ben J Harrison
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Carlton, Victoria, Australia
| | - Joaquim Radua
- 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
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Carles Soriano-Mas
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- CIBERSAM, Barcelona, Spain
- Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain
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3
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Castle D, Feusner J, Laposa JM, Richter PMA, Hossain R, Lusicic A, Drummond LM. Psychotherapies and digital interventions for OCD in adults: What do we know, what do we need still to explore? Compr Psychiatry 2023; 120:152357. [PMID: 36410261 PMCID: PMC10848818 DOI: 10.1016/j.comppsych.2022.152357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/07/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite significant advances in the understanding and treatment of obsessive compulsive disorder (OCD), current treatment options are limited in terms of efficacy for symptom remission. Thus, assessing the potential role of iterative or alternate psychotherapies is important. Also, the potential role of digital technologies to enhance the accessibility of these therapies, should not be underestimated. We also need to embrace the idea of a more personalized treatment choice, being cognisant of clinical, genetic and neuroimaging predictors of treatment response. PROCEDURES Non-systematic review of current literature on emerging psychological and digital therapies for OCD, as well as of potential biomarkers of treatment response. FINDINGS A number of 'third wave' therapies (e.g., Acceptance and Commitment Therapy, Mindfulness-Based Cognitive Therapy) have an emerging and encouraging evidence base in OCD. Other approaches entail employment of elements of other psychotherapies such as Dialectical Behaviour Therapy; or trauma-focussed therapies such as Eye Movement Desensitisation and Reprocessing, and Imagery Rescripting and Narrative Therapy. Further strategies include Danger Ideation Reduction Therapy and Habit Reversal. For these latter approaches, large-scale randomised controlled trials are largely lacking, and the precise role of these therapies in treating people with OCD, remains to be clarified. A concentrated 4-day program (the Bergen program) has shown promising short- and long-term results. Exercise, music, and art therapy have not been adequately tested in people with OCD, but may have an adjunctive role. Digital technologies are being actively investigated for enhancing reach and efficacy of psychological therapies for OCD. Biomarkers, including genetic and neuroimaging, are starting to point to a future with more 'personalised medicine informed' treatment strategizing for OCD. CONCLUSIONS There are a number of potential psychological options for the treatment of people with OCD who do not respond adequately to exposure/response prevention or cognitive behaviour therapy. Adjunctive exercise, music, and art therapy might be useful, albeit the evidence base for these is very small. Consideration should be given to different ways of delivering such interventions, including group-based, concentrated, inpatient, or with outreach, where appropriate. Digital technologies are an emerging field with a number of potential applications for aiding the treatment of OCD. Biomarkers for treatment response determination have much potential capacity and deserve further empirical testing.
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Affiliation(s)
- David Castle
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario M6J 1H4, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
| | - Jamie Feusner
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1RB, Canada
| | - Judith M Laposa
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, 100 Stokes St., Toronto, Ontario M6J 1H4, Canada
| | - Peggy M A Richter
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Frederick W Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, 2075 Bayview, Toronto, Ontario M4N 3M5, Canada
| | - Rahat Hossain
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada
| | - Ana Lusicic
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario M6J 1H4, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada
| | - Lynne M Drummond
- Service for OCD/ BDD, South-West London and St George's NHS Trust, Glenburnie Road, London SW17 7DJ, United Kingdom
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Grützmann R, Klawohn J, Elsner B, Reuter B, Kaufmann C, Riesel A, Bey K, Heinzel S, Kathmann N. Error-related activity of the sensorimotor network contributes to the prediction of response to cognitive-behavioral therapy in obsessive-compulsive disorder. Neuroimage Clin 2022; 36:103216. [PMID: 36208547 PMCID: PMC9668595 DOI: 10.1016/j.nicl.2022.103216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although cognitive behavioral therapy is a highly effective treatment for obsessive-compulsive disorder (OCD), yielding large symptom reductions on the group level, individual treatment response varies considerably. Identification of treatment response predictors may provide important information for maximizing individual treatment response and thus achieving efficient treatment resource allocation. Here, we investigated the predictive value of previously identified biomarkers of OCD, namely the error-related activity of the supplementary motor area (SMA) and the sensorimotor network (SMN, postcentral gyrus/precuneus). METHODS Seventy-two participants with a primary diagnosis of OCD underwent functional magnetic resonance imaging (fMRI) scanning while performing a flanker task prior to receiving routine-care CBT. RESULTS Error-related BOLD response of the SMN significantly contributed to the prediction of treatment response beyond the variance accounted for by clinical and sociodemographic variables. Stronger error-related SMN activity at baseline was associated with a higher likelihood of treatment response. CONCLUSIONS The present results illustrate that the inclusion of error-related SMN activity can significantly increase treatment response prediction quality in OCD. Stronger error-related activity of the SMN may reflect the ability to activate symptom-relevant processing networks and may thus facilitate response to exposure-based CBT interventions.
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Affiliation(s)
- Rosa Grützmann
- Humboldt-Universität zu Berlin, Department of Psychology, Germany; MSB Medical School Berlin, Department of Psychology, Germany.
| | - Julia Klawohn
- Humboldt-Universität zu Berlin, Department of Psychology, Germany; MSB Medical School Berlin, Department of Medicine, Germany
| | - Björn Elsner
- Humboldt-Universität zu Berlin, Department of Psychology, Germany
| | - Benedikt Reuter
- Humboldt-Universität zu Berlin, Department of Psychology, Germany; MSB Medical School Berlin, Department of Medicine, Germany
| | | | - Anja Riesel
- Humboldt-Universität zu Berlin, Department of Psychology, Germany; Universität Hamburg, Department of Psychology, Germany
| | - Katharina Bey
- University Hospital Bonn, Department of Psychiatry and Psychotherapy, Germany
| | - Stephan Heinzel
- Humboldt-Universität zu Berlin, Department of Psychology, Germany; Freie Universität Berlin, Department of Education and Psychology, Germany
| | - Norbert Kathmann
- Humboldt-Universität zu Berlin, Department of Psychology, Germany
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Spontaneous alternation and stereotypical behaviour in deer mice: response to escitalopram and levetiracetam. Behav Pharmacol 2022; 33:282-290. [PMID: 35621170 DOI: 10.1097/fbp.0000000000000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Obsessive-compulsive disorder is varyingly associated with cognitive impairment, that is, deficits in spatial working memory, although it seems unlikely that this is generalised across all domains of functioning. Further, it is unclear whether symptoms will respond to potentially novel, non-serotonergic drugs that have shown promise as so-called cognitive enhancers. Here, we studied low (Norm-N; n = 31) and compulsive-like high (Comp-H; n = 34) stereotypical deer mice (Peromyscus maniculatus bairdii) to establish (1) whether there is a relationship between stereotypical intensity and working memory ability as measured by spontaneous T-maze arm alternation and (2) if and how stereotypy and its association with changes in working memory, would respond to the known anti-compulsive agent, escitalopram, and the proposed cognitive enhancer, levetiracetam. After assessing the stereotypical and alternation behaviour of all animals at baseline, they were divided into three socially housed drug exposure groups, that is, water control (n = 11 per phenotype), escitalopram 50 mg/kg/d (n = 11 per phenotype) and levetiracetam 75 mg/kg/d (Norm-N: n = 9; Comp-H: n = 12). Drugs were administered for 28 days before stereotypy and alternation assessment were repeated. The present data indicate a weak negative relationship between stereotypical intensity and spontaneous alternation. While levetiracetam increased the time spent engaging in normal rodent activity by Comp-H, but not Norm-N animals, neither of the interventions affected the expression of Comp-H behaviour or the alternation behaviour of deer mice. In conclusion, this work points to some degree of cognitive involvement in Comp-H expression, which should be explored to further our understanding of compulsive-like stereotypy.
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Li X, Li H, Cao L, Liu J, Xing H, Huang X, Gong Q. Application of graph theory across multiple frequency bands in drug-naïve obsessive-compulsive disorder with no comorbidity. J Psychiatr Res 2022; 150:272-278. [PMID: 35427825 DOI: 10.1016/j.jpsychires.2022.03.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 03/14/2022] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
Abstract
Recently, graph theoretical analysis based on resting-state functional magnetic resonance imaging has provided a means of investigating the complex brain connectome in obsessive-compulsive disorder (OCD) patients. However, these studies have been restricted to spontaneous blood oxygen level-dependent (BOLD) signals with frequency bands between 0.01 and 0.08 Hz, and the parameters from graph theory across multiple frequency bands have seldom been studied. Here, we calculated global metrics (small-worldness, global efficiency and modularity) and nodal metrics (degree centrality, betweenness centrality, nodal clustering coefficient and shortest path) at four different frequency bands (slow-2 (0.199-0.25 Hz), slow-3 (0.074-0.198 Hz), slow-4 (0.027-0.073 Hz) and slow-5 (0.01-0.027 Hz), from 0.01 to 0.25 Hz) in seventy-three OCD patients and ninety healthy controls. The analyses were also calculated in traditional low-frequency bands (0.01-0.08 Hz) for reference. For the global metrics, the OCD patients showed increased small-worldness and modularity only in the slow-3 band. For the local metrics, we observed a frequency-dependent characteristic, with the main significant differences in regions including the right precentral gyrus, occipital region, right anterior cingulum cortex and fusiform cortex. Our results suggested frequency-specific abnormalities of the brain connectome in OCD and the future studies may need to consider different frequency bands when measuring spontaneous activity in the brain.
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Affiliation(s)
- Xue Li
- College of Physics, Sichuan University, Chengdu, PR China; Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China
| | - Hailong Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, PR China
| | - Lingxiao Cao
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, PR China
| | - Jing Liu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, PR China
| | - Haoyang Xing
- College of Physics, Sichuan University, Chengdu, PR China; Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, PR China.
| | - Xiaoqi Huang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, PR China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, PR China
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Hong D, Zhu Y, Chen R, Xiao B, Huang Y, Yu M. The bidirectional effects of obsessive-compulsive symptoms and difficulties in emotion regulation in Chinese adults during the COVID-19 pandemic-a dynamic structural equation model. BMC Psychol 2022; 10:129. [PMID: 35597999 PMCID: PMC9123828 DOI: 10.1186/s40359-022-00841-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 05/12/2022] [Indexed: 01/01/2023] Open
Abstract
Background With the accumulation of negative emotions brought by COVID-19-related dysfunctional beliefs, individuals adopted obsessive–compulsive (OC) symptoms (e.g., over-checking the wearing of masks) and formed difficulties in emotion regulation (DER). This study focused on the temporal dynamics of the bidirectional relation between OC symptoms and DER, which had a devastating effect on the individual's mental health. As an extension, we further explored whether OC and DER and their relationship affect sleep problems. Methods In February 2020, a 14-day (twice a day, of 28 measurement intervals) online questionnaire survey was conducted on 122 Chinese adults (aged 18–55 years; 63 females). Subsequently, this research applied a dynamic structural equation model with a cross-lagged relationship and a time series. Health anxiety, anxiety, and depression were controlled as covariates. Results Both OC symptoms and DER had a significant autoregressive and cross-lagged effect. Comparatively speaking, DER was a stronger predictor of OC symptoms than OC’s prediction of DER. Moreover, both higher levels of OC symptoms and DER were related to the severity of sleep problems. Conclusions More guidance on intervening in OC symptoms and identifying emotion regulation should be added to reduce the negative impact of the COVID-19 pandemic on public mental health. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-022-00841-5.
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Affiliation(s)
- Danping Hong
- Guangdong Provincial Key Laboratory of Social Cognitive Neuroscience and Mental Health, Department of Psychology, Sun Yat-Sen University, Guangzhou, 510006, People's Republic of China.,School of Psychology, South China Normal University, Guangzhou, 510631, People's Republic of China
| | - Yawen Zhu
- Key Laboratory of Behavioral and Mental Health of Gansu Province, School of Psychology, Northwest Normal University, Lanzhou, 730070, People's Republic of China
| | - Runting Chen
- Guangdong Provincial Key Laboratory of Social Cognitive Neuroscience and Mental Health, Department of Psychology, Sun Yat-Sen University, Guangzhou, 510006, People's Republic of China
| | - Bihong Xiao
- Guangdong Provincial Key Laboratory of Social Cognitive Neuroscience and Mental Health, Department of Psychology, Sun Yat-Sen University, Guangzhou, 510006, People's Republic of China
| | - Yueyi Huang
- Guangdong Provincial Key Laboratory of Social Cognitive Neuroscience and Mental Health, Department of Psychology, Sun Yat-Sen University, Guangzhou, 510006, People's Republic of China
| | - Meng Yu
- Guangdong Provincial Key Laboratory of Social Cognitive Neuroscience and Mental Health, Department of Psychology, Sun Yat-Sen University, Guangzhou, 510006, People's Republic of China.
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Du H, Xia J, Fan J, Gao F, Wang X, Han Y, Tan C, Zhu X. Spontaneous neural activity in the right fusiform gyrus and putamen is associated with consummatory anhedonia in obsessive compulsive disorder. Brain Imaging Behav 2022; 16:1708-1720. [DOI: 10.1007/s11682-021-00619-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
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van den Heuvel OA, Boedhoe PS, Bertolin S, Bruin WB, Francks C, Ivanov I, Jahanshad N, Kong X, Kwon JS, O'Neill J, Paus T, Patel Y, Piras F, Schmaal L, Soriano‐Mas C, Spalletta G, van Wingen GA, Yun J, Vriend C, Simpson HB, van Rooij D, Hoexter MQ, Hoogman M, Buitelaar JK, Arnold P, Beucke JC, Benedetti F, Bollettini I, Bose A, Brennan BP, De Nadai AS, Fitzgerald K, Gruner P, Grünblatt E, Hirano Y, Huyser C, James A, Koch K, Kvale G, Lazaro L, Lochner C, Marsh R, Mataix‐Cols D, Morgado P, Nakamae T, Nakao T, Narayanaswamy JC, Nurmi E, Pittenger C, Reddy YJ, Sato JR, Soreni N, Stewart SE, Taylor SF, Tolin D, Thomopoulos SI, Veltman DJ, Venkatasubramanian G, Walitza S, Wang Z, Thompson PM, Stein DJ. An overview of the first 5 years of the ENIGMA obsessive-compulsive disorder working group: The power of worldwide collaboration. Hum Brain Mapp 2022; 43:23-36. [PMID: 32154629 PMCID: PMC8675414 DOI: 10.1002/hbm.24972] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/12/2020] [Accepted: 02/16/2020] [Indexed: 01/12/2023] Open
Abstract
Neuroimaging has played an important part in advancing our understanding of the neurobiology of obsessive-compulsive disorder (OCD). At the same time, neuroimaging studies of OCD have had notable limitations, including reliance on relatively small samples. International collaborative efforts to increase statistical power by combining samples from across sites have been bolstered by the ENIGMA consortium; this provides specific technical expertise for conducting multi-site analyses, as well as access to a collaborative community of neuroimaging scientists. In this article, we outline the background to, development of, and initial findings from ENIGMA's OCD working group, which currently consists of 47 samples from 34 institutes in 15 countries on 5 continents, with a total sample of 2,323 OCD patients and 2,325 healthy controls. Initial work has focused on studies of cortical thickness and subcortical volumes, structural connectivity, and brain lateralization in children, adolescents and adults with OCD, also including the study on the commonalities and distinctions across different neurodevelopment disorders. Additional work is ongoing, employing machine learning techniques. Findings to date have contributed to the development of neurobiological models of OCD, have provided an important model of global scientific collaboration, and have had a number of clinical implications. Importantly, our work has shed new light on questions about whether structural and functional alterations found in OCD reflect neurodevelopmental changes, effects of the disease process, or medication impacts. We conclude with a summary of ongoing work by ENIGMA-OCD, and a consideration of future directions for neuroimaging research on OCD within and beyond ENIGMA.
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Affiliation(s)
- Odile A. van den Heuvel
- Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam NeuroscienceAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Bergen Center for Brain PlasticityHaukeland University HospitalBergenNorway
| | - Premika S.W. Boedhoe
- Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam NeuroscienceAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Sara Bertolin
- Department of PsychiatryBellvitge University Hospital, Bellvitge Biomedical Research Institute‐IDIBELLBarcelonaSpain
| | - Willem B. Bruin
- Department of Psychiatry, Amsterdam NeuroscienceAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Clyde Francks
- Department of Language & GeneticsMax Planck Institute for PsycholinguisticsNijmegenThe Netherlands
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenThe Netherlands
| | - Iliyan Ivanov
- Icahn School of Medicine at Mount SinaiNew YorkNew York
| | - Neda Jahanshad
- Keck USC School of MedicineImaging Genetics Center, Mark & Mary Stevens Institute for Neuroimaging & InformaticsMarina del ReyCalifornia
| | - Xiang‐Zhen Kong
- Department of Language & GeneticsMax Planck Institute for PsycholinguisticsNijmegenThe Netherlands
| | - Jun Soo Kwon
- Department of PsychiatrySeoul National University College of MedicineSeoulSouth Korea
- Department of Brain & Cognitive SciencesSeoul National University College of Natural SciencesSeoulSouth Korea
| | - Joseph O'Neill
- Division of Child & Adolescent PsychiatryUCLA Jane & Terry Semel Institute For NeuroscienceLos AngelesCalifornia
| | - Tomas Paus
- Holland Bloorview Kids Rehabilitation HospitalBloorview Research InstituteTorontoOntarioCanada
| | - Yash Patel
- Holland Bloorview Kids Rehabilitation HospitalBloorview Research InstituteTorontoOntarioCanada
| | - Fabrizio Piras
- Laboratory of NeuropsychiatryIRCCS Santa Lucia FoundationRomeItaly
| | - Lianne Schmaal
- Orygen, The National Centre of Excellence in Youth Mental HealthParkvilleAustralia
- Centre for Youth Mental Health, The University of MelbourneMelbourneAustralia
| | - Carles Soriano‐Mas
- Department of PsychiatryBellvitge University Hospital, Bellvitge Biomedical Research Institute‐IDIBELLBarcelonaSpain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)BarcelonaSpain
- Department of Psychobiology and Methodology in Health SciencesUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Gianfranco Spalletta
- Laboratory of NeuropsychiatryIRCCS Santa Lucia FoundationRomeItaly
- Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTexsas
| | - Guido A. van Wingen
- Department of Psychiatry, Amsterdam NeuroscienceAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Je‐Yeon Yun
- Seoul National University HospitalSeoulRepublic of Korea
- Yeongeon Student Support Center, Seoul National University College of MedicineSeoulRepublic of Korea
| | - Chris Vriend
- Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam NeuroscienceAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - H. Blair Simpson
- Center for OC and Related Disorders at the New York State Psychiatric Institute and Columbia University Irving Medical CenterNew YorkNew York
| | - Daan van Rooij
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenThe Netherlands
| | - Marcelo Q. Hoexter
- Departamento e Instituto de Psiquiatria do Hospital das Clinicas, IPQ HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Martine Hoogman
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenThe Netherlands
- Department of Human GeneticsRadboud University Medical CenterNijmegenThe Netherlands
| | - Jan K. Buitelaar
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenThe Netherlands
| | - Paul Arnold
- Mathison Centre for Mental Health Research & Education and Department of PsychiatryCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada
| | - Jan C. Beucke
- Humboldt‐Universität zu BerlinDepartment of PsychologyBerlinGermany
- Karolinska InstitutetDepartment of Clinical NeuroscienceStockholmSweden
| | - Francesco Benedetti
- Department of Psychiatry and Clinical PsychobiologyScientific Institute OspedaleMilanItaly
| | - Irene Bollettini
- Department of Psychiatry and Clinical PsychobiologyScientific Institute OspedaleMilanItaly
| | - Anushree Bose
- Obsessive‐Compulsive Disorder (OCD) Clinic Department of PsychiatryNational Institute of Mental Health and NeurosciencesBangaloreIndia
| | | | | | - Kate Fitzgerald
- Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborMichigan
| | | | - Edna Grünblatt
- Department of Child and Adolescent Psychiatry and PsychotherapyUniversity Hospital of Psychiatry, University of ZurichZurichSwitzerland
- Neuroscience Center ZurichUniversity of Zurich and ETH ZurichZurichSwitzerland
- Zurich Center for Integrative Human PhysiologyUniversity of ZurichZurichSwitzerland
| | - Yoshiyuki Hirano
- Research Center for Child Mental DevelopmentChiba UniversityChibaJapan
| | - Chaim Huyser
- De Bascule, academic center child and adolescent psychiatryAmsterdamThe Netherlands
| | - Anthony James
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - Kathrin Koch
- Department of Neuroradiology, School of MedicineKlinikum Rechts der Isar, Technical University of MunichMunichGermany
| | - Gerd Kvale
- Bergen Center for Brain PlasticityHaukeland University HospitalBergenNorway
| | - Luisa Lazaro
- Department of Child and Adolescent Psychiatry and Psychology, IDIBAPS, CIBERSAM, Department of MedicineFaculty of BarcelonaBarcelonaSpain
| | - Christine Lochner
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of PsychiatryStellenbosch UniversityMatielandSouth Africa
| | - Rachel Marsh
- Center for OC and Related Disorders at the New York State Psychiatric Institute and Columbia University Irving Medical CenterNew YorkNew York
| | - David Mataix‐Cols
- Department of Psychiatry and Clinical PsychobiologyScientific Institute OspedaleMilanItaly
| | - Pedro Morgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of MinhoBragaPortugal
- ICVS/3B's, PT Government Associate LaboratoryBraga/GuimarãesPortugal
- Clinical Academic Center–BragaBragaPortugal
| | - Takashi Nakamae
- Department of PsychiatryGraduate School of Medical Science, Kyoto Prefectural University of MedicineKyotoJapan
| | - Tomohiro Nakao
- Department of Neuropsychiatry, Graduate School of Medical SciencesKyushu UniversityKyushuJapan
| | - Janardhanan C. Narayanaswamy
- Obsessive‐Compulsive Disorder (OCD) Clinic Department of PsychiatryNational Institute of Mental Health and NeurosciencesBangaloreIndia
| | - Erika Nurmi
- Department of Psychiatry and Biobehavioral SciencesUniversity of CaliforniaLos AngelesCalifornia
| | | | | | - João R. Sato
- Center of Mathematics, Computing and CognitionUniversidade Federal do ABCSanto AndréBrazil
| | - Noam Soreni
- Pediatric OCD Consultation Service, Anxiety Treatment and Research CenterMcMaster UniversityHamiltonOntarioCanada
| | - S. Evelyn Stewart
- Department of PsychiatryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- BC Mental Health and Addictions Research InstituteVancouverBritish ColumbiaCanada
- BC Children's HospitalVancouverBritish ColumbiaCanada
| | - Stephan F. Taylor
- Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborMichigan
| | - David Tolin
- Anxiety Disorders Center, The Institute of LivingHartfordConnecticut
| | - Sophia I. Thomopoulos
- Keck USC School of MedicineImaging Genetics Center, Mark & Mary Stevens Institute for Neuroimaging & InformaticsMarina del ReyCalifornia
| | - Dick J. Veltman
- Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam NeuroscienceAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Ganesan Venkatasubramanian
- Obsessive‐Compulsive Disorder (OCD) Clinic Department of PsychiatryNational Institute of Mental Health and NeurosciencesBangaloreIndia
| | - Susanne Walitza
- Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborMichigan
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Institute of Psychological and Behavioral Science, Shanghai Jiao Tong UniversityShanghaiChina
| | - Paul M. Thompson
- Keck USC School of MedicineImaging Genetics Center, Mark & Mary Stevens Institute for Neuroimaging & InformaticsMarina del ReyCalifornia
| | - Dan J. Stein
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
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10
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Shephard E, Stern ER, van den Heuvel OA, Costa DL, Batistuzzo MC, Godoy PB, Lopes AC, Brunoni AR, Hoexter MQ, Shavitt RG, Reddy JY, Lochner C, Stein DJ, Simpson HB, Miguel EC. Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder. Mol Psychiatry 2021; 26:4583-4604. [PMID: 33414496 PMCID: PMC8260628 DOI: 10.1038/s41380-020-01007-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022]
Abstract
An important challenge in mental health research is to translate findings from cognitive neuroscience and neuroimaging research into effective treatments that target the neurobiological alterations involved in psychiatric symptoms. To address this challenge, in this review we propose a heuristic neurocircuit-based taxonomy to guide the treatment of obsessive-compulsive disorder (OCD). We do this by integrating information from several sources. First, we provide case vignettes in which patients with OCD describe their symptoms and discuss different clinical profiles in the phenotypic expression of the condition. Second, we link variations in these clinical profiles to underlying neurocircuit dysfunctions, drawing on findings from neuropsychological and neuroimaging studies in OCD. Third, we consider behavioral, pharmacological, and neuromodulatory treatments that could target those specific neurocircuit dysfunctions. Finally, we suggest methods of testing this neurocircuit-based taxonomy as well as important limitations to this approach that should be considered in future research.
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Affiliation(s)
- Elizabeth Shephard
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. .,Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.
| | - Emily R. Stern
- Department of Psychiatry, The New York University School of Medicine, New York, USA.,Nathan Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Odile A. van den Heuvel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Daniel L.C. Costa
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo C. Batistuzzo
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Priscilla B.G. Godoy
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Antonio C. Lopes
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Andre R. Brunoni
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo Q. Hoexter
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Roseli G. Shavitt
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Janardhan Y.C Reddy
- Department of Psychiatry OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Christine Lochner
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Dan J. Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - H. Blair Simpson
- Center for OCD and Related Disorders, New York State Psychiatric Institute and the Department of Psychiatry, Columbia University Irving Medical Center, New York New York
| | - Euripedes C. Miguel
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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11
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Cano M, Martínez-Zalacaín I, Giménez M, Torrents-Rodas D, Real E, Alonso P, Segalàs C, Munuera J, Menchón JM, Cardoner N, Soriano-Mas C, Fullana MA. Neural correlates of fear conditioning and fear extinction and its association with cognitive-behavioral therapy outcome in adults with obsessive-compulsive disorder. Behav Res Ther 2021; 144:103927. [PMID: 34237645 DOI: 10.1016/j.brat.2021.103927] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/23/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Abstract
Recent neurobiological models of obsessive-compulsive disorder (OCD) have highlighted the potential role of abnormalities in fear learning processes. We compared brain activation -as assessed with whole-brain functional magnetic resonance imaging- during fear conditioning, fear extinction learning, and fear extinction recall in patients with OCD (n = 18) and healthy controls (n = 18). We also investigated whether brain activation during any of these processes was associated with exposure-based cognitive-behavioral therapy (CBT) outcome in patients. Patients with OCD showed significantly lower brain activation in the right insulo-opercular region and the dorsal anterior cingulate cortex during fear conditioning in comparison to healthy controls. Moreover, brain activation in the right insula predicted CBT outcome, with lower activation predicting a better outcome. Brain activation during extinction learning or recall did not differ between patients and controls or predicted CBT outcome in patients. Our results suggest that neural activations during fear conditioning in patients with OCD are abnormal and predict CBT outcome.
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Affiliation(s)
- Marta Cano
- Mental Health Department, Unitat de Neurociència Traslacional, Parc Tauli University Hospital, Institut d'Investigació i Innovació Sanitària Parc Tauli (I3PT), Universitat Autònoma de Barcelona, CIBERSAM, Carlos III Health Institute, Sabadell, Spain; Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Ignacio Martínez-Zalacaín
- Department of Psychiatry, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, and CIBERSAM, Carlos III Health Institute, L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Mònica Giménez
- Department of Psychiatry, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, and CIBERSAM, Carlos III Health Institute, L'Hospitalet de Llobregat, Spain
| | | | - Eva Real
- Department of Psychiatry, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, and CIBERSAM, Carlos III Health Institute, L'Hospitalet de Llobregat, Spain
| | - Pino Alonso
- Department of Psychiatry, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, and CIBERSAM, Carlos III Health Institute, L'Hospitalet de Llobregat, Spain
| | - Cinto Segalàs
- Department of Psychiatry, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, and CIBERSAM, Carlos III Health Institute, L'Hospitalet de Llobregat, Spain
| | - Josep Munuera
- Diagnostic Imaging Department, Fundació de Recerca Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - José Manuel Menchón
- Department of Psychiatry, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, and CIBERSAM, Carlos III Health Institute, L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Narcís Cardoner
- Mental Health Department, Unitat de Neurociència Traslacional, Parc Tauli University Hospital, Institut d'Investigació i Innovació Sanitària Parc Tauli (I3PT), Universitat Autònoma de Barcelona, CIBERSAM, Carlos III Health Institute, Sabadell, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Carles Soriano-Mas
- Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Bellaterra, Spain; Department of Psychiatry, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, and CIBERSAM, Carlos III Health Institute, L'Hospitalet de Llobregat, Spain.
| | - Miquel A Fullana
- Adult Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clinic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERSAM, Barcelona, Spain.
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12
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Rangaprakash D, Tadayonnejad R, Deshpande G, O'Neill J, Feusner JD. FMRI hemodynamic response function (HRF) as a novel marker of brain function: applications for understanding obsessive-compulsive disorder pathology and treatment response. Brain Imaging Behav 2021; 15:1622-1640. [PMID: 32761566 PMCID: PMC7865013 DOI: 10.1007/s11682-020-00358-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The hemodynamic response function (HRF) represents the transfer function linking neural activity with the functional MRI (fMRI) signal, modeling neurovascular coupling. Since HRF is influenced by non-neural factors, to date it has largely been considered as a confound or has been ignored in many analyses. However, underlying biophysics suggests that the HRF may contain meaningful correlates of neural activity, which might be unavailable through conventional fMRI metrics. Here, we estimated the HRF by performing deconvolution on resting-state fMRI data from a longitudinal sample of 25 healthy controls scanned twice and 44 adults with obsessive-compulsive disorder (OCD) before and after 4-weeks of intensive cognitive-behavioral therapy (CBT). HRF response height, time-to-peak and full-width at half-maximum (FWHM) in OCD were abnormal before treatment and normalized after treatment in regions including the caudate. Pre-treatment HRF predicted treatment outcome (OCD symptom reduction) with 86.4% accuracy, using machine learning. Pre-treatment HRF response height in the caudate head and time-to-peak in the caudate tail were top-predictors of treatment response. Time-to-peak in the caudate tail, a region not typically identified in OCD studies using conventional fMRI activation or connectivity measures, may carry novel importance. Additionally, pre-treatment response height in caudate head predicted post-treatment OCD severity (R = -0.48, P = 0.001), and was associated with treatment-related OCD severity changes (R = -0.44, P = 0.0028), underscoring its relevance. With HRF being a reliable marker sensitive to brain function, OCD pathology, and intervention-related changes, these results could guide future studies towards novel discoveries not possible through conventional fMRI approaches like standard BOLD activation or connectivity.
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Affiliation(s)
- D Rangaprakash
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, 90095, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School and Harvard-MIT Health Sciences and Technology, Cambridge, MA, 02129, USA
| | - Reza Tadayonnejad
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, 90095, USA
- Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, 91125, USA
| | - Gopikrishna Deshpande
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, 36849, USA
- Department of Psychological Sciences, Auburn University, Auburn, AL, 36849, USA
- Alabama Advanced Imaging Consortium, Auburn University and University of Alabama Birmingham, Auburn, AL, USA
- Center for Health Ecology and Equity Research, Auburn University, Auburn, AL, USA
- Center for Neuroscience, Auburn University, Auburn, AL, USA
- School of Psychology, Capital Normal University, Beijing, China
- Key Laboratory for Learning and Cognition, Capital Normal University, Beijing, China
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Joseph O'Neill
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Jamie D Feusner
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, 90095, USA.
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13
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La Buissonniere-Ariza V, Fitzgerald K, Meoded A, Williams LL, Liu G, Goodman WK, Storch EA. Neural correlates of cognitive behavioral therapy response in youth with negative valence disorders: A systematic review of the literature. J Affect Disord 2021; 282:1288-1307. [PMID: 33601708 DOI: 10.1016/j.jad.2020.12.182] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 11/25/2020] [Accepted: 12/24/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cognitive-behavioral therapy (CBT) is the gold-standard psychotherapeutic treatment for pediatric negative valence disorders. However, some youths do not respond optimally to treatment, which may be due to variations in neural functioning. METHODS We systematically reviewed functional magnetic resonance imaging studies in youths with negative valence disorders to identify pre- and post-treatment neural correlates of CBT response. RESULTS A total of 21 studies were identified, of overall weak to moderate quality. The most consistent findings across negative valence disorders consisted of associations of treatment response with pre- and post-treatment task-based activation and/or functional connectivity within and between the prefrontal cortex, the medial temporal lobe, and other limbic regions. Associations of CBT response with baseline and/or post-treatment activity in the striatum, precentral and postcentral gyri, medial and posterior cingulate cortices, and parietal cortex, connectivity within and between the default-mode, cognitive control, salience, and frontoparietal networks, and metrics of large-scale brain network organization, were also reported, although less consistently. LIMITATIONS The poor quality and limited number of studies and the important heterogeneity of study designs and results considerably limit the conclusions that can be drawn from this literature. CONCLUSIONS Despite these limitations, these findings provide preliminary evidence suggesting youths presenting certain patterns of brain function may respond better to CBT, whereas others may benefit from alternative or augmented forms of treatment.
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Affiliation(s)
- Valerie La Buissonniere-Ariza
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA.
| | - Kate Fitzgerald
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Avner Meoded
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Laurel L Williams
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA
| | - Gary Liu
- Department of Neuroscience, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA
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14
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The effects of cognitive behavioral therapy on the whole brain structural connectome in unmedicated patients with obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2021; 104:110037. [PMID: 32682876 DOI: 10.1016/j.pnpbp.2020.110037] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/09/2020] [Accepted: 07/12/2020] [Indexed: 02/06/2023]
Abstract
Cognitive behavioral therapy (CBT) is considered a first-line treatment for patients with obsessive-compulsive disorder (OCD), and it possesses advantages over pharmacological treatments in stronger tolerance to distress, lower rates of drop out and relapse, and no physical "side-effects". Previous studies have reported CBT-related alterations in focal brain regions and connections. However, the effects of CBT on whole-brain structural networks have not yet been elucidated. Here, we collected diffusion MRI data from 34 unmedicated OCD patients before and after 12 weeks of CBT. Fifty healthy controls (HCs) were also scanned twice at matched intervals. We constructed individual brain white matter connectome and performed a graph-theoretical network analysis to investigate the effects of CBT on whole-brain structural topology. We observed significant group-by-time interactions on the global network clustering coefficient and the nodal clustering of the left lingual gyrus, the left middle temporal gyrus, the left precuneus, and the left fusiform gyrus of 26 CBT responders in OCD patients. Further analysis revealed that these CBT responders showed prominently higher global and nodal clustering compared to HCs at baseline and reduced to normal levels after CBT. Such significant changes in the nodal clustering of the left lingual gyrus were also found in 8 CBT non-responders. The pre-to-post decreases in nodal clustering of the left lingual gyrus and the left fusiform gyrus positively correlated with the improvements in obsessive-compulsive symptoms in the CBT-responding patients. These findings indicated that the network segregation of the whole-brain white matter network in OCD patients was abnormally higher and might recover to normal after CBT, which provides mechanistic insights into the CBT response in OCD and potential imaging biomarkers for clinical practice.
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15
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Abstract
In the last 20 years, functional magnetic resonance imaging (fMRI) has been extensively used to investigate system-level abnormalities in the brain of patients with obsessive-compulsive disorder (OCD). In this chapter, we start by reviewing the studies assessing regional brain differences between patients with OCD and healthy controls in task-based fMRI. Specifically, we review studies on executive functioning and emotional processing, protocols in which these patients have been described to show alterations at the behavioral level, as well as research using symptom provocation protocols. Next, we review studies on brain connectivity alterations, focusing on resting-state studies evaluating disruptions in fronto-subcortical functional connectivity and in cortical networks. Likewise, we also review research on effective connectivity, which, different from functional connectivity, allows for ascertaining the directionality of inter-regional connectivity alterations. We conclude by reviewing the most significant findings on a topic of translational impact, such as the use of different fMRI measurements to predict response across a variety of treatment approaches. Overall, results suggest that there exists a pattern of regions, involving, but not limited to, different nodes of the cortico-striatal-thalamo-cortical circuits, showing robust evidence of functional alteration across studies, although the nature of the alterations critically depends on the specific tasks and their particular demands. Moreover, such findings have been, to date, poorly translated into clinical practice. It is suggested that this may be partially accounted for by the difficulty to integrate into a common framework results obtained under a wide variety of analysis approaches.
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Affiliation(s)
- Carles Soriano-Mas
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain. .,Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain.
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16
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Biria M, Cantonas LM, Banca P. Magnetic Resonance Spectroscopy (MRS) and Positron Emission Tomography (PET) Imaging in Obsessive-Compulsive Disorder. Curr Top Behav Neurosci 2021; 49:231-268. [PMID: 33751502 DOI: 10.1007/7854_2020_201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Obsessive-compulsive disorder (OCD) is characterised by structural and functional deficits in the cortico-striato-thalamic-cortical (CSTC) circuitry and abnormal neurochemical changes are thought to modulate these deficits. The hypothesis that an imbalanced concentration of the brain neurotransmitters, in particular glutamate (Glu) and gamma-amino-butyric acid (GABA), could impair the normal functioning of the CSTC, thus leading to OCD symptoms, has been tested in humans using magnetic resonance spectroscopy (MRS) and positron emission tomography (PET). This chapter summarises these neurochemical findings and represents an attempt to condense such scattered literature. We also discuss potential challenges in the field that may explain the inconsistent findings and suggest ways to overcome them. There is some convergent research from MRS pointing towards abnormalities in the brain concentration of neurometabolite markers of neuronal integrity, such as N-acetylaspartate (NAA) and choline (Cho). Lower NAA levels have been found in dorsal and rostral ACC of OCD patients (as compared to healthy volunteers), which increase after CBT and SSRI treatment, and higher Cho concentration has been reported in the thalamus of the OCD brain. However, findings for other neurometabolites are very inconsistent. Studies have reported abnormalities in the concentrations of creatine (Cr), GABA, glutamate (Glu), glutamine (Gln), Ins (myo-inositol), and serotonin (5-HT), but most of the results were not replicated. The question remains whether the NAA and Cho findings are genuinely the only neurochemical abnormalities in OCD or whether the lack of consistent findings for the other neurometabolites is caused by the lower magnetic field (1-3 Tesla (T)) used by the studies conducted so far, their small sample sizes or a lack of proper control for medication effects. To answer these questions and to further inform the biological underpinning of the symptoms and the cognitive problems at the basis of OCD we need better controlled studies using clear medicated vs unmedicated groups, larger sample sizes, stronger magnetic fields (e.g. at 7 T), and more consistency in the definition of the regions of interest.
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Affiliation(s)
- Marjan Biria
- Department of Psychology, University of Cambridge, Cambridge, UK.
| | | | - Paula Banca
- Department of Psychology, University of Cambridge, Cambridge, UK
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17
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Kodancha PG, Shivakumar V, Jose D, Venkatasubramanian G, Reddy YCJ, Narayanaswamy JC. Gray matter volume abnormalities and clinical correlates in OCD with exclusive washing dimension. Asian J Psychiatr 2020; 54:102343. [PMID: 32795957 DOI: 10.1016/j.ajp.2020.102343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/15/2020] [Accepted: 07/27/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Obsessive compulsive disorder (OCD) is increasingly being recognized as a heterogeneous disorder with various symptom dimensions. In order to understand the neurobiology of obsessive-compulsive disorder (OCD), it is important to understand the brain basis of homogeneous symptom groups. In this study we investigated the gray matter (GM) changes and correlates of an exclusively homogenous sample of OCD patients (washers with no other obsessive compulsive symptoms). METHOD We compared the structural MRI scans (3T) using voxel-based morphometry (VBM) of washers (N = 35) with matched healthy controls (HC) (N = 39). RESULTS We found volume deficits corresponding to right inferior frontal gyrus, parahippocampal gyrus and right anterior lobe of cerebellum among washers compared to HC. Among the washers, GM volume of right inferior frontal gyrus, right uncus of the limbic lobe, left cuneus and left superior temporal lobe had significant negative correlation with the illness severity score. CONCLUSION Examining homogenous sub-groups of OCD patients may help us further our understanding of neurobiology of OCD.
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Affiliation(s)
| | - Venkataram Shivakumar
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, 560029, India
| | - Dania Jose
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, 560029, India
| | - Ganesan Venkatasubramanian
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, 560029, India
| | - Y C Janardhan Reddy
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, 560029, India
| | - Janardhanan C Narayanaswamy
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, 560029, India.
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Viol K, Schiepek G, Kronbichler M, Hartl A, Grafetstätter C, Strasser P, Kastinger A, Schöller H, Reiter EM, Said-Yürekli S, Kronbichler L, Kravanja-Spannberger B, Stöger-Schmidinger B, Hütt MT, Aichhorn W, Aas B. Multi-level assessment of obsessive-compulsive disorder (OCD) reveals relations between neural and neurochemical levels. BMC Psychiatry 2020; 20:559. [PMID: 33238940 PMCID: PMC7687999 DOI: 10.1186/s12888-020-02913-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/11/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND While considerable progress has been made in exploring the psychological, the neural, and the neurochemical dimensions of OCD separately, their interplay is still an open question, especially their changes during psychotherapy. METHODS Seventeen patients were assessed at these three levels by psychological questionnaires, fMRI, and venipuncture before and after inpatient psychotherapy. Seventeen controls were scanned at comparable time intervals. First, pre/post treatment changes were investigated for all three levels separately: symptom severity, whole-brain and regional activity, and the concentrations of cortisol, serotonin, dopamine, brain-derived neurotrophic factor (BDNF), and immunological parameters (IL-6, IL-10, TNFα). Second, stepwise linear modeling was used to find relations between the variables of the levels. RESULTS The obsessive-compulsive, depressive, and overall symptom severity was significantly reduced after psychotherapy. At the neural level, the activity in the anterior cingulate cortex (ACC), in frontal regions, in the precuneus, and in the putamen had significantly decreased. No significant changes were found on the neurochemical level. When connecting the levels, a highly significant model was found that explains the decrease in neural activity of the putamen by increases of the concentrations of cortisol, IL-6, and dopamine. CONCLUSION Multivariate approaches offer insight on the influences that the different levels of the psychiatric disorder OCD have on each other. More research and adapted models are needed.
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Affiliation(s)
- Kathrin Viol
- grid.21604.310000 0004 0523 5263Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Ignaz-Harrer-Strasse 79, 5020 Salzburg, Austria ,grid.21604.310000 0004 0523 5263Department of Psychosomatics and Inpatient Psychotherapy, University Hospital for Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
| | - Günter Schiepek
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Ignaz-Harrer-Strasse 79, 5020, Salzburg, Austria. .,Department of Psychosomatics and Inpatient Psychotherapy, University Hospital for Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria. .,Department of Psychology, Ludwig Maximilians University, Munich, Germany.
| | - Martin Kronbichler
- grid.7039.d0000000110156330Centre for Cognitive Neuroscience and Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria ,grid.21604.310000 0004 0523 5263Neuroscience Institute, Christian-Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Arnulf Hartl
- grid.21604.310000 0004 0523 5263Institute for Ecomedicine, Christian-Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Carina Grafetstätter
- grid.21604.310000 0004 0523 5263Institute for Ecomedicine, Christian-Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Peter Strasser
- grid.21604.310000 0004 0523 5263Institute of Biochemical Diagnostic, Paracelsus Medical University, Salzburg, Austria
| | - Anna Kastinger
- grid.21604.310000 0004 0523 5263Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Ignaz-Harrer-Strasse 79, 5020 Salzburg, Austria ,grid.21604.310000 0004 0523 5263Department of Psychosomatics and Inpatient Psychotherapy, University Hospital for Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
| | - Helmut Schöller
- grid.21604.310000 0004 0523 5263Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Ignaz-Harrer-Strasse 79, 5020 Salzburg, Austria ,grid.21604.310000 0004 0523 5263Department of Psychosomatics and Inpatient Psychotherapy, University Hospital for Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
| | - Eva-Maria Reiter
- grid.21604.310000 0004 0523 5263Department for Radiotherapy and Radio-Oncology, Christian-Doppler University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Sarah Said-Yürekli
- grid.7039.d0000000110156330Centre for Cognitive Neuroscience and Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria ,grid.21604.310000 0004 0523 5263Neuroscience Institute, Christian-Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria ,grid.21604.310000 0004 0523 5263Department for Neurology, Christian-Doppler University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Lisa Kronbichler
- grid.7039.d0000000110156330Centre for Cognitive Neuroscience and Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria ,grid.21604.310000 0004 0523 5263Neuroscience Institute, Christian-Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Brigitte Kravanja-Spannberger
- grid.21604.310000 0004 0523 5263Department of Psychosomatics and Inpatient Psychotherapy, University Hospital for Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
| | - Barbara Stöger-Schmidinger
- grid.21604.310000 0004 0523 5263Department of Psychosomatics and Inpatient Psychotherapy, University Hospital for Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
| | - Marc-Thorsten Hütt
- grid.15078.3b0000 0000 9397 8745Department of Life Sciences and Chemistry, Jacobs University, Bremen, Germany
| | - Wolfgang Aichhorn
- grid.21604.310000 0004 0523 5263Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Ignaz-Harrer-Strasse 79, 5020 Salzburg, Austria ,grid.21604.310000 0004 0523 5263Department of Psychosomatics and Inpatient Psychotherapy, University Hospital for Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
| | - Benjamin Aas
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Ludwig Maximilians University, Munich, Germany ,grid.5252.00000 0004 1936 973XFaculty of Psychology and Educational Sciences, LMU Munich, Munich, Germany
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Kwak S, Kim M, Kim T, Kwak Y, Oh S, Lho SK, Moon SY, Lee TY, Kwon JS. Defining data-driven subgroups of obsessive-compulsive disorder with different treatment responses based on resting-state functional connectivity. Transl Psychiatry 2020; 10:359. [PMID: 33106472 PMCID: PMC7589530 DOI: 10.1038/s41398-020-01045-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 12/18/2022] Open
Abstract
Characterization of obsessive-compulsive disorder (OCD), like other psychiatric disorders, suffers from heterogeneities in its symptoms and therapeutic responses, and identification of more homogeneous subgroups may help to resolve the heterogeneity. We aimed to identify the OCD subgroups based on resting-state functional connectivity (rsFC) and to explore their differences in treatment responses via a multivariate approach. From the resting-state functional MRI data of 107 medication-free OCD patients and 110 healthy controls (HCs), we selected rsFC features, which discriminated OCD patients from HCs via support vector machine (SVM) analyses. With the selected brain features, we subdivided OCD patients into subgroups using hierarchical clustering analyses. We identified 35 rsFC features that achieved a high sensitivity (82.74%) and specificity (76.29%) in SVM analyses. The OCD patients were subdivided into two subgroups, which did not show significant differences in their demographic and clinical backgrounds. However, one of the OCD subgroups demonstrated more impaired rsFC that was involved either within the default mode network (DMN) or between DMN brain regions and other network regions. This subgroup also showed both lower improvements in symptom severity in the 16-week follow-up visit and lower responder percentage than the other subgroup. Our results highlight that not only abnormalities within the DMN but also aberrant rsFC between the DMN and other networks may contribute to the treatment response and support the importance of these neurobiological alterations in OCD patients. We suggest that abnormalities in these connectivity may play predictive biomarkers of treatment response, and aid to build more optimal treatment strategies.
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Affiliation(s)
- Seoyeon Kwak
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Taekwan Kim
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Yoobin Kwak
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Sanghoon Oh
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Silvia Kyungjin Lho
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun-Young Moon
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Young Lee
- Department of Neuropsychiatry, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea.
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea.
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20
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Neural primacy of the dorsolateral prefrontal cortex in patients with obsessive-compulsive disorder. NEUROIMAGE-CLINICAL 2020; 28:102432. [PMID: 32987298 PMCID: PMC7522851 DOI: 10.1016/j.nicl.2020.102432] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 02/08/2023]
Abstract
The dorsolateral prefrontal cortex (DLPFC), a key structure in the executive system, has consistently emerged as a crucial element in the pathophysiology of obsessive-compulsive disorder (OCD). However, the neural primacy of the DLPFC remains elusive in this disorder. We investigated the causal interaction (measured by effective connectivity) between the DLPFC and the remaining brain areas using bivariate Granger causality analysis of resting-state fMRI collected from 88 medication-free OCD patients and 88 matched healthy controls. Additionally, we conducted seed-based functional connectivity (FC) analyses to identify network-level neural functional alterations using the bilateral DLPFC as seeds. OCD patients demonstrated reduced FC between the right DLPFC and right orbitofrontal cortex (OFC), and activity in the right OFC had an inhibitory effect on the right DLPFC. Additionally, we observed alterations in both feedforward and reciprocal influences between the inferior temporal gyrus (ITG) and the DLPFC in patients. Furthermore, activity in the cerebellum had an excitatory influence on the right DLPFC in OCD patients. These findings may help to elucidate the psychopathology of OCD by detailing the directional connectivity between the DLPFC and the rest of the brain, ultimately helping to identify regions that could serve as treatment targets in OCD.
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21
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Cyr M, Pagliaccio D, Yanes-Lukin P, Fontaine M, Rynn MA, Marsh R. Altered network connectivity predicts response to cognitive-behavioral therapy in pediatric obsessive-compulsive disorder. Neuropsychopharmacology 2020; 45:1232-1240. [PMID: 31952071 PMCID: PMC7235012 DOI: 10.1038/s41386-020-0613-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/21/2019] [Accepted: 01/08/2020] [Indexed: 12/12/2022]
Abstract
Obsessive-compulsive disorder (OCD) is commonly associated with alterations in cortico-striato-thalamo-cortical brain networks. Yet, recent investigations of large-scale brain networks suggest that more diffuse alterations in brain connectivity may underlie its pathophysiology. Few studies have assessed functional connectivity within or between networks across the whole brain in pediatric OCD or how patterns of connectivity associate with treatment response. Resting-state functional magnetic resonance imaging scans were acquired from 25 unmedicated, treatment-naive children and adolescents with OCD (12.8 ± 2.9 years) and 23 matched healthy control (HC) participants (11.0 ± 3.3 years) before participants with OCD completed a course of cognitive-behavioral therapy (CBT). Participants were re-scanned after 12-16 weeks. Whole-brain connectomic analyses were conducted to assess baseline group differences and group-by-time interactions, corrected for multiple comparisons. Relationships between functional connectivity and OCD symptoms pre- and post-CBT were examined using longitudinal cross-lagged panel modeling. Reduced connectivity in OCD relative to HC participants was detected between default mode and task-positive network regions. Greater (less altered) connectivity between left angular gyrus and left frontal pole predicted better response to CBT in the OCD group. Altered connectivity between task-positive and task-negative networks in pediatric OCD may contribute to the impaired control over intrusive thoughts early in the illness. This is the first study to show that altered connectivity between large-scale network regions may predict response to CBT in pediatric OCD, highlighting the clinical relevance of these networks as potential circuit-based targets for the development of novel treatments.
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Affiliation(s)
- Marilyn Cyr
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA. .,Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
| | - David Pagliaccio
- grid.413734.60000 0000 8499 1112Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY USA ,grid.21729.3f0000000419368729Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Paula Yanes-Lukin
- grid.413734.60000 0000 8499 1112Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY USA ,grid.21729.3f0000000419368729Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Martine Fontaine
- grid.413734.60000 0000 8499 1112Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY USA ,grid.21729.3f0000000419368729Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Moira A. Rynn
- grid.26009.3d0000 0004 1936 7961Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC USA
| | - Rachel Marsh
- grid.413734.60000 0000 8499 1112Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY USA ,grid.21729.3f0000000419368729Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY USA
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22
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Tibi L, van Oppen P, van Balkom AJLM, Eikelenboom M, Emmelkamp PMG, Anholt GE. Predictors of treatment outcome in OCD: An interpersonal perspective. J Anxiety Disord 2019; 68:102153. [PMID: 31704634 DOI: 10.1016/j.janxdis.2019.102153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/02/2019] [Accepted: 10/13/2019] [Indexed: 10/25/2022]
Abstract
Although effective treatments for obsessive compulsive disorder (OCD) are increasingly available, a considerable percentage of patients fails to respond or relapses. Predictors associated with improved outcome of OCD were identified. However, information on interpersonal determinants is lacking. This study investigated the contribution of attachment style and expressed emotion to the outcome of exposure and response prevention (ERP), while accounting for previously documented intrapersonal (i.e., symptom severity and personality pathology) predictors. Using logistic regression analyses and multi-level modeling, we examined predictors of treatment completion and outcome among 118 adult OCD patients who entered ERP. We assessed outcome at post treatment, and at four and 13 months from treatment completion. OCD baseline severity and fearful attachment style emerged as the main moderators of treatment outcome. Severe and fearfully attached patients were more likely to dropout prematurely. The improvement of fearful clients was attenuated throughout treatment and follow-up compared to non-fearful clients. However, their symptom worsening at the long-term was also mitigated. Severe OCD patients had a more rapid symptom reduction during treatment and at follow-up, compared to less severe clients. The findings suggest that both baseline OCD severity and fearful attachment style play a role in the long-term outcome of ERP.
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Affiliation(s)
- Lee Tibi
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Patricia van Oppen
- Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center, GGZ InGeest, Amsterdam, the Netherlands
| | - Anton J L M van Balkom
- Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center, GGZ InGeest, Amsterdam, the Netherlands
| | - Merijn Eikelenboom
- Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center, GGZ InGeest, Amsterdam, the Netherlands
| | - Paul M G Emmelkamp
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Gideon E Anholt
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Barbosa MR, Moraes JPA, Ventura PR. Alterações do córtex cingulado anterior como um preditor de resposta à terapia cognitivo-comportamental. JORNAL BRASILEIRO DE PSIQUIATRIA 2019. [DOI: 10.1590/0047-2085000000252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RESUMO Objetivo A terapia cognitivo-comportamental (TCC) tem eficácia bem-documentada na literatura científica para transtornos relacionados aos sintomas da ansiedade. No entanto, há uma parcela de pacientes que não responde ao tratamento psicoterápico. Por isso, os estudos sobre as alterações no córtex cingulado anterior (CCA) como preditoras neurais do tratamento têm contribuído para encontrar respostas sobre as diferenças nas respostas ao tratamento. O objetivo do presente estudo é descrever, por meio de revisão sistemática, os estudos encontrados até o ano de 2018 sobre o papel do CCA na predição de resposta à terapia. Métodos Foram realizadas buscas nas bases PsycInfo, Web of Science e PubMed com termos referentes ao tema “córtex cingulado anterior”, “terapia cognitivo-comportamental” e “predição de respostas”, incluindo estudos com neuroimagem estrutural e funcional. Resultados As buscas apresentaram 14 artigos sobre “transtorno de estresse pós-traumático (TEPT)”, “transtorno obsessivo-compulsivo (TOC)” e “transtorno de ansiedade social (TAS)”. Os estudos com neuroimagem estrutural apresentaram resultados promissores. A maior espessura do CCA foi preditora de melhor resposta ao tratamento para TEPT e TOC. Os resultados de neuroimagem funcional foram promissores para maior ativação como preditora de melhor resposta para TAS. Por outro lado, os resultados para TEPT apontaram que a menor ativação pode ser preditora de melhores respostas. Conclusão As alterações nos estudos de neuroimagem sugerem que o CCA tenha um papel de predição de resposta ao tratamento com TCC. Estudos posteriores com amostras maiores podem contribuir para a ampliação da eficácia nos tratamentos de tais transtornos.
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Task-based fMRI predicts response and remission to exposure therapy in obsessive-compulsive disorder. Proc Natl Acad Sci U S A 2019; 116:20346-20353. [PMID: 31548396 DOI: 10.1073/pnas.1909199116] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Exposure and ritual prevention (EX/RP) is an effective first-line treatment for obsessive-compulsive disorder (OCD), but only some patients achieve minimal symptoms following EX/RP. Herein, we investigate whether task-based neural activity can predict who responds best to EX/RP. Unmedicated adult patients with OCD (n = 36) and healthy participants (n = 33) completed the Simon Spatial Incompatibility Task during high-resolution, multiband functional MRI (fMRI); patients were then offered twice-weekly EX/RP (17 sessions). Linear mixed-effects models were used to identify brain regions where conflict-related activity moderated the slope of change in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores across treatment. Conflict-related activity in the left pallidum and 35 cortical parcels/regions significantly predicted symptom improvement with EX/RP for patients with OCD (false discovery rate-corrected P < 0.05). Significant parcels/regions included cingulo-opercular and default mode network regions, specifically the anterior insula and anterior and posterior cingulate. Summarizing across these parcels/regions, greater conflict-related activity predicted greater EX/RP response and which patients achieved remission (Y-BOCS score ≤ 12; Cohen's d = 1.68) with >80% sensitivity and specificity. The association between brain activity and treatment response was partially mediated by patient EX/RP adherence (b = -2.99; 43.61% of total effect; P = 0.02). Brain activity and adherence together were highly predictive of remission. Together, these findings suggest that cingulo-opercular and default mode regions typically implicated in task control and introspective processes, respectively, may be targets for novel treatments that augment the ability of persons with OCD to resolve cognitive conflict and thereby facilitate adherence to EX/RP, increasing the likelihood of remission.
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Kubota Y, Sato W, Kochiyama T, Uono S, Yoshimura S, Sawada R, Toichi M. Corticostriatal-limbic correlates of sub-clinical obsessive-compulsive traits. Psychiatry Res Neuroimaging 2019; 285:40-46. [PMID: 30731370 DOI: 10.1016/j.pscychresns.2019.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/14/2019] [Accepted: 01/29/2019] [Indexed: 11/18/2022]
Abstract
Obsessive-compulsive (OC) traits such as intrusive worrisome ideas or excessive concerns for threats are frequent in general population (5%-13%). However, the structural neural correlates of the sub-clinical OC traits remain largely unknown. Based on the data of obsessive-compulsive disorder (OCD), we hypothesized that the subcortical and cortical structures, constituting the cortico-striatal-thalamo-cortical circuit (CSTC) and the limbic system, could be associated with OC traits. Here we conducted voxel-based morphometry (VBM) in order to investigate fine grained volume changes of these structures in 49 non-clinical subjects. Analysis of structural covariances of these structures was also conducted. We identified volume changes associated with OC traits in the left putamen and the left amygdala. The results of structural covariance analysis revealed increased covariances in relation to the heightened OC traits between the left putamen to bilateral medial prefrontal cortex and to the left cerebellum, and between the left globus pallidus to the bilateral anterior cingulate cortices. The present finding of volume changes of the corticostriatal-limbic structures may reflect neuroplasticity associated with OC traits. Since the abnormality of these structures were also observed in the clinical OCD, the subclinical subjects with OC traits shared "neuronal obsessive traits" that might precondition OCD at the network level.
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Affiliation(s)
- Yasutaka Kubota
- Health and Medical Services Center, Shiga University, 1-1-1, Baba, Hikone, Shiga 522-8522, Japan.
| | - Wataru Sato
- Department of Neurodevelopmental Psychiatry, Habilitation and Rehabilitation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takanori Kochiyama
- ATR Brain Activity Imaging Center, 2-2-2, Hikaridai, Seika-cho, Souraku-gun, Kyoto 619-0288, Japan
| | - Shota Uono
- Department of Neurodevelopmental Psychiatry, Habilitation and Rehabilitation, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Organization for Promotion of Neurodevelopmental Disorder Research, Kyoto, Japan
| | - Sayaka Yoshimura
- Department of Neurodevelopmental Psychiatry, Habilitation and Rehabilitation, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Organization for Promotion of Neurodevelopmental Disorder Research, Kyoto, Japan
| | - Reiko Sawada
- Department of Neurodevelopmental Psychiatry, Habilitation and Rehabilitation, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Organization for Promotion of Neurodevelopmental Disorder Research, Kyoto, Japan
| | - Motomi Toichi
- Organization for Promotion of Neurodevelopmental Disorder Research, Kyoto, Japan; Faculty of Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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26
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Hao H, Chen C, Mao W, Xia W, Yi Z, Zhao P, Pan P, Dai Z. Alterations in resting-state local functional connectivity in obsessive-compulsive disorder. J Affect Disord 2019; 245:113-119. [PMID: 30368070 DOI: 10.1016/j.jad.2018.10.112] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 10/08/2018] [Accepted: 10/16/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is increasingly conceptualized as a brain connectivity disorder. Recently, abnormalities in remote resting-state functional connectivity (FC) have been well demonstrated in the frontoparietal areas that linked impairments in large-scale intrinsic brain networks with aberrant fronto-striatal interactions. Beyond the remote FC abnormalities in OCD, many studies using regional homogeneity (ReHo) analysis have reported local FC alterations. However, their results were not entirely consistent. METHODS We conducted a voxel-wise meta-analysis of ReHo studies to identify consistent local FC abnormalities in patients with OCD. A seed-based d mapping approach was used. RESULTS Eight studies that compared 200 patients with OCD and 187 healthy controls were included. Increased ReHo in the lateral orbitofrontal cortices and dorsomedial prefrontal cortices bilaterally, and decreased ReHo in the fusiform gyri bilaterally were the most consistent and reliable findings in patients with OCD relative to healthy controls. LIMITATIONS The number of available studies included in the meta-analysis was relatively small. Many potential confounds on changes in ReHo warrant further attention. CONCLUSIONS These regions are critically implicated in the pathophysiology of OCD. Our findings in local FC alterations are complementary to the abnormalities in remote FC in OCD, contributing to the modeling of brain functional connectomes in OCD.
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Affiliation(s)
- HuiHui Hao
- Department of Inspection and Pharmacy, Jiangsu College of Nursing, Huai'an, PR China
| | - Chuang Chen
- Huai'an Hospital Affiliated to Xuzhou Medical University, Second People's Hospital of Huai'an City, Huai'an, PR China
| | - WeiBing Mao
- Department of Psychiatry, WuXi Xishan People's Hospital, Affiliated to ZhongDa Hospital, School of Medicine, Southeast University, Wuxi, PR China
| | - Wei Xia
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China
| | - ZhongQuan Yi
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China
| | - PanWen Zhao
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China
| | - PingLei Pan
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China; Department of Neurology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China.
| | - ZhenYu Dai
- Department of Radiology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China.
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Zhong Z, Yang X, Cao R, Li P, Li Z, Lv L, Zhang D. Abnormalities of white matter microstructure in unmedicated patients with obsessive-compulsive disorder: Changes after cognitive behavioral therapy. Brain Behav 2019; 9:e01201. [PMID: 30623612 PMCID: PMC6379596 DOI: 10.1002/brb3.1201] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/22/2018] [Accepted: 12/03/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) is an effective treatment for Obsessive-compulsive disorder (OCD). Structural and functional white matter defects may suggest a vital neurobiological basis of OCD. However, the effects of CBT on white matter in OCD remain unknown. OBJECTIVE The aim was to investigate white matter changes and the effect of CBT on white matter in OCD patients. METHODS Fractional anisotropy (FA) maps were acquired using DTI. Participants included 85 patients with OCD and 90 healthy controls. VBM was then performed to detect regions with significant group differences. RESULTS Obsessive-compulsive disorder patients exhibited significantly reduced FA values in bilateral OFC, right cerebellum, and left SPG, while higher FA values were observed in right PUT compared with healthy controls. Following CBT, OCD patients showed higher FA values in right MFG, left OFC, right cerebellum, and left MTG, and decreased FA values in right PUT in comparison with pretreatment. Furthermore, FA values in the left OFC of patients were significantly positively correlated with the Y-BOCS and its associated Compulsions subscale, and FA values in the right PUT were positively correlated with Compulsions subscale. In addition, the percentage change in FA values in left MTG was positively correlated with the percentage reduction in Compulsions subscale, while the percentage change in FA values in left OFC and right PUT was negatively correlated with the percentage reductions in Obsessive and Compulsions subscale, respectively. CONCLUSIONS Our findings demonstrate the abnormalities of white matter microstructure in unmedicated patients with OCD. These abnormalities may be partly reversed by CBT.
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Affiliation(s)
- ZhaoXi Zhong
- Psychiatry Institute of Mental Health/Peking University Sixth Hospital, Peking University, Beijing, China.,Henan Key Lab of Biological Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - XiangYun Yang
- The China Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - RuiXiang Cao
- The China Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Ping Li
- Department of Psychiatry, Qiqihar Medical University, Qiqihar, China
| | - ZhanJiang Li
- The China Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - LuXian Lv
- Henan Key Lab of Biological Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Dai Zhang
- Psychiatry Institute of Mental Health/Peking University Sixth Hospital, Peking University, Beijing, China
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Marwood L, Wise T, Perkins AM, Cleare AJ. Meta-analyses of the neural mechanisms and predictors of response to psychotherapy in depression and anxiety. Neurosci Biobehav Rev 2018; 95:61-72. [PMID: 30278195 PMCID: PMC6267850 DOI: 10.1016/j.neubiorev.2018.09.022] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 09/17/2018] [Accepted: 09/25/2018] [Indexed: 12/18/2022]
Abstract
Understanding the neural mechanisms underlying psychological therapy could aid understanding of recovery processes and help target treatments. The dual-process model hypothesises that psychological therapy is associated with increased emotional-regulation in prefrontal brain regions and decreased implicit emotional-reactivity in limbic regions; however, research has yielded inconsistent findings. Meta-analyses of brain activity changes accompanying psychological therapy (22 studies, n = 352) and neural predictors of symptomatic improvement (11 studies, n = 293) in depression and anxiety were conducted using seed-based d mapping. Both resting-state and task-based studies were included, and analysed together and separately. The most robust findings were significant decreases in anterior cingulate/paracingulate gyrus, inferior frontal gyrus and insula activation after therapy. Cuneus activation was predictive of subsequent symptom change. The results are in agreement with neural models of improved emotional-reactivity following therapy as evidenced by decreased activity within the anterior cingulate and insula. We propose compensatory as well as corrective neural mechanisms of action underlie therapeutic efficacy, and suggest the dual-process model may be too simplistic to account fully for treatment mechanisms. More research on predictors of psychotherapeutic response is required to provide reliable predictors of response.
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Affiliation(s)
- Lindsey Marwood
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
| | - Toby Wise
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Max Planck UCL Centre for Computational Psychiatry and Ageing Research, London, UK; Wellcome Trust Centre for Neuroimaging, University College London, London, UK
| | - Adam M Perkins
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anthony J Cleare
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
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Cocchi L, Zalesky A, Nott Z, Whybird G, Fitzgerald PB, Breakspear M. Transcranial magnetic stimulation in obsessive-compulsive disorder: A focus on network mechanisms and state dependence. NEUROIMAGE-CLINICAL 2018; 19:661-674. [PMID: 30023172 PMCID: PMC6047114 DOI: 10.1016/j.nicl.2018.05.029] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 02/07/2023]
Abstract
Background Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation technique that has shown promise as an adjunct treatment for the symptoms of Obsessive-Compulsive Disorder (OCD). Establishing a clear clinical role for TMS in the treatment of OCD is contingent upon evidence of significant efficacy and reliability in reducing symptoms. Objectives We present the basic principles supporting the effects of TMS on brain activity with a focus on network-based theories of brain function. We discuss the promises and pitfalls of this technique as a means of modulating brain activity and reducing OCD symptoms. Methods Synthesis of trends and critical perspective on the potential benefits and limitations of TMS interventions in OCD. Findings Our critical synthesis suggests the need to better quantify the role of TMS in a clinical setting. The context in which the stimulation is performed, the neural principles supporting the effects of local stimulation on brain networks, and the heterogeneity of neuroanatomy are often overlooked in the clinical application of TMS. The lack of consideration of these factors may partly explain the variable efficacy of TMS interventions for OCD symptoms. Conclusions Results from existing clinical studies and emerging knowledge about the effects of TMS on brain networks are encouraging but also highlight the need for further research into the use of TMS as a means of selectively normalising OCD brain network dynamics and reducing related symptoms. The combination of neuroimaging, computational modelling, and behavioural protocols known to engage brain networks affected by OCD has the potential to improve the precision and therapeutic efficacy of TMS interventions. The efficacy of this multimodal approach remains, however, to be established and its effective translation in clinical contexts presents technical and implementation challenges. Addressing these practical, scientific and technical issues is required to assess whether OCD can take its place alongside major depressive disorder as an indication for the use of TMS.
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Affiliation(s)
- Luca Cocchi
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia; Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
| | - Zoie Nott
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Paul B Fitzgerald
- Epworh Clinic Epworth Healthcare, Camberwell, Victoria Australia and the MAPrc, Monash University Central Clinical School and The Alfred, Melbourne, Australia
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Li P, Yang X, Greenshaw AJ, Li S, Luo J, Han H, Liu J, Zhong Z, Guo Z, Xiong H, Yao S, Chen Y, Sun J, Li Z. The effects of cognitive behavioral therapy on resting-state functional brain network in drug-naive patients with obsessive-compulsive disorder. Brain Behav 2018; 8:e00963. [PMID: 29761016 PMCID: PMC5943755 DOI: 10.1002/brb3.963] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/08/2018] [Accepted: 02/25/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Although cognitive behavioral therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD), the treatment mechanisms remain poorly understood. This study aimed to investigate the effects of CBT on changes in the intrinsic whole-brain functional network of OCD patients. MATERIALS AND METHODS Twenty drug-naive and noncomorbid OCD patients were recruited, and resting-state functional magnetic resonance imaging was performed before and after 12 weeks of CBT. Moreover, 20 healthy controls were scanned twice with a 12-week interval. A graph-theory degree centrality (DC) approach and functional connectivity method were used to analyze the whole-brain functional network hub and connectivity changes in OCD patients before and after CBT treatment. RESULTS A significant group × time interaction on DC was found in the left dorsolateral prefrontal cortex (DLPFC); the DC in the left DLPFC was significantly reduced after CBT treatment. Resting-state functional connectivity (RSFC) between the left DLPFC and right orbitofrontal cortex was increased in the OCD patients at baseline, and normalized after CBT treatment. RSFC changes between the left DLPFC and default mode network (DMN) positively correlated with changes in clinical symptoms in OCD patients. CONCLUSIONS These findings suggest that CBT can modulate changes in intrinsic functional network hubs in the cortico-striato-thalamo-cortical circuit in OCD patients. Cognitive control network and DMN connectivity may be a potential imaging biomarker for evaluating CBT treatment for OCD.
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Affiliation(s)
- Ping Li
- Department of Psychiatry Qiqihar Medical University Qiqihar Heilongjiang China
| | - Xiangyun Yang
- The China Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital Capital Medical University Beijing China
| | | | - Sufang Li
- Department of Psychiatry & Behavioral Sciences Johns Hopkins University School of Medicine Baltimore MD USA
| | - Jia Luo
- The China Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital Capital Medical University Beijing China
| | - Haiying Han
- The China Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital Capital Medical University Beijing China
| | - Jing Liu
- The China Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital Capital Medical University Beijing China
| | - Zhaoxi Zhong
- The China Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital Capital Medical University Beijing China
| | - Zhihua Guo
- The China Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital Capital Medical University Beijing China
| | - Hongfang Xiong
- The China Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital Capital Medical University Beijing China
| | - Shumin Yao
- The China Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital Capital Medical University Beijing China
| | - Yunhui Chen
- Department of Psychiatry Qiqihar Medical University Qiqihar Heilongjiang China
| | - Jing Sun
- Menzies Health Institute Queensland and School of Medicine Griffith University Nathan Qld Australia
| | - Zhanjiang Li
- The China Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital Capital Medical University Beijing China
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Fontenelle LF, Frydman I, Hoefle S, Oliveira-Souza R, Vigne P, Bortolini TS, Suo C, Yücel M, Mattos P, Moll J. Decoding moral emotions in obsessive-compulsive disorder. Neuroimage Clin 2018; 19:82-89. [PMID: 30035005 PMCID: PMC6051311 DOI: 10.1016/j.nicl.2018.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/07/2018] [Accepted: 04/01/2018] [Indexed: 11/20/2022]
Abstract
Background Patients with obsessive-compulsive disorder (OCD) exhibit abnormal neural responses when they experience particular emotions or when they evaluate stimuli with emotional value. Whether these brain responses are sufficiently distinctive to discriminate between OCD patients and healthy controls is unknown. The present study is the first to investigate the discriminative power of multivariate pattern analysis of regional fMRI responses to moral and non-moral emotions. Method To accomplish this goal, we performed a searchlight-based multivariate pattern analysis to unveil brain regions that could discriminate 18 OCD patients from 18 matched healthy controls during provoked guilt, disgust, compassion, and anger. We also investigated the existence of distinctive neural patterns while combining those four emotions (herein termed multiemotion analysis). Results We found that different frontostriatal regions discriminated OCD patients from controls based on individual emotional experiences. Most notably, the left nucleus accumbens (NAcc) discriminated OCD patients from controls during both disgust and the multiemotion analysis. Among other regions, the angular gyrus responses to anger and the lingual and the middle temporal gyri in the multi-emotion analysis were highly discriminant between samples. Additional BOLD analyses supported the directionality of these findings. Conclusions In line with previous studies, differential activity in regions beyond the frontostriatal circuitry differentiates OCD from healthy volunteers. The finding that the response of the left NAcc to different basic and moral emotions is highly discriminative for a diagnosis of OCD confirms current pathophysiological models and points to new venues of research.
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Affiliation(s)
- Leonardo F Fontenelle
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil; Brain & Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia; Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil.
| | - Ilana Frydman
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil; Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Sebastian Hoefle
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | | | - Paula Vigne
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil; Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Tiago S Bortolini
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Chao Suo
- Brain & Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia
| | - Murat Yücel
- Brain & Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia
| | - Paulo Mattos
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Jorge Moll
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
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Reggente N, Moody TD, Morfini F, Sheen C, Rissman J, O'Neill J, Feusner JD. Multivariate resting-state functional connectivity predicts response to cognitive behavioral therapy in obsessive-compulsive disorder. Proc Natl Acad Sci U S A 2018; 115:2222-2227. [PMID: 29440404 PMCID: PMC5834692 DOI: 10.1073/pnas.1716686115] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cognitive behavioral therapy (CBT) is an effective treatment for many with obsessive-compulsive disorder (OCD). However, response varies considerably among individuals. Attaining a means to predict an individual's potential response would permit clinicians to more prudently allocate resources for this often stressful and time-consuming treatment. We collected resting-state functional magnetic resonance imaging from adults with OCD before and after 4 weeks of intensive daily CBT. We leveraged machine learning with cross-validation to assess the power of functional connectivity (FC) patterns to predict individual posttreatment OCD symptom severity. Pretreatment FC patterns within the default mode network and visual network significantly predicted posttreatment OCD severity, explaining up to 67% of the variance. These networks were stronger predictors than pretreatment clinical scores. Results have clinical implications for developing personalized medicine approaches to identifying individual OCD patients who will maximally benefit from intensive CBT.
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Affiliation(s)
- Nicco Reggente
- Department of Psychology, University of California, Los Angeles, CA 90095;
| | - Teena D Moody
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Francesca Morfini
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Courtney Sheen
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Jesse Rissman
- Department of Psychology, University of California, Los Angeles, CA 90095
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Joseph O'Neill
- Division of Child and Adolescent Psychiatry, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Jamie D Feusner
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
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Thorsen AL, Kvale G, Hansen B, van den Heuvel OA. Symptom dimensions in obsessive-compulsive disorder as predictors of neurobiology and treatment response. ACTA ACUST UNITED AC 2018; 5:182-194. [PMID: 30237966 DOI: 10.1007/s40501-018-0142-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Purpose of review Specific symptom dimensions of obsessive-compulsive disorder (OCD) have been suggested as an approach to reduce the heterogeneity of obsessive-compulsive disorder, predict treatment outcome, and relate to brain structure and function. Here, we review studies addressing these issues. Recent findings The contamination and symmetry/ordering dimensions have not been reliably associated with treatment outcome. Some studies found that greater severity of sexual/aggressive/religious symptoms predicted a worse outcome after cognitive behavioral therapy (CBT) and a better outcome after serotonin reuptake inhibitors (SRIs). Contamination symptoms have been related to increased amygdala and insula activation in a few studies, while sexual/aggressive/religious symptoms have also been related to more pronounced alterations in the function and structure of the amygdala. Increased pre-treatment limbic responsiveness has been related to better outcomes of CBT, but most imaging studies show important limitations and replication in large-scale studies is needed. We review possible reasons for the strong limbic involvement of the amygdala in patients with more sexual/aggressive/religious symptoms, in relation to their sensitivity to CBT. Summary Symptom dimensions may predict treatment outcome, and patients with sexual/religious/aggressive symptoms are at a greater risk of not starting or delaying treatment. This is likely partly due to more shame and perceived immorality which is also related to stronger amygdala response. Competently delivered CBT is likely to help these patients improve to the same degree as patients with other symptoms.
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Affiliation(s)
- Anders Lillevik Thorsen
- OCD-team, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway.,Department of Anatomy & Neurosciences, VU university medical center (VUmc), Amsterdam, The Netherlands
| | - Gerd Kvale
- OCD-team, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Bjarne Hansen
- OCD-team, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Odile A van den Heuvel
- OCD-team, Haukeland University Hospital, Bergen, Norway.,Department of Anatomy & Neurosciences, VU university medical center (VUmc), Amsterdam, The Netherlands.,Department of Psychiatry, VUmc, Amsterdam, The Netherlands.,Neuroscience Amsterdam, Amsterdam, The Netherlands
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Abstract
BACKGROUND Pharmacotherapy for generalized anxiety disorder (GAD) may be effective in reducing symptoms in the majority of patients. The study of moderators and predictors of treatment response may help clinicians both to select appropriate interventions to maximize the probability of response and to inform the general prognosis. METHODS A systematic literature search of electronic databases, selected authors, and reference lists was used to identify articles that reported trials of drug monotherapy in GAD. Data on predictors and moderators were extracted. Quality of evidence was determined by the presence of a priori hypotheses, number of variables investigated, adequate quality of the measurement, and use of interaction-effects testing. RESULTS From the 98 articles meeting inclusion criteria, 24 reported a total of 22 factors associated with treatment response. The reported results were heterogeneous, ranging over sociodemographic, clinical, comorbidity, genetic, and functional-imaging studies. Major depressive symptoms were found to moderate treatment outcome in favor of antidepressants versus benzodiazepines. Neuroticism, previous treatment, genetic polymorphisms (including serotonin receptor gene 2A), and functional activation of the anterior cingulate cortex and amygdala were identified as potential predictors of treatment response. CONCLUSIONS Correlates of poor emotion regulation predicted poor treatment response, but subclinical depression was the only variable capable of informing treatment selection in this review. Future research should focus on further exploring the value of depression as a moderator and on a narrower list of potential genetic, brain-imaging, and temperament predictors of response to pharmacotherapy in GAD.
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Abstract
INTRODUCTION Predictive neuroimaging markers of treatment response are increasingly sought in order to inform the treatment of major depressive and anxiety disorders. We review the existing literature regarding candidate predictive neuroimaging markers of psychotherapy response and assess their potential clinical utility. METHODS We searched Embase, PsycINFO, and PubMed up to October 2014 for studies correlating pretreatment neuroimaging parameters with psychotherapy response in major depressive and anxiety disorders. Our search yielded 40 eligible studies. RESULTS The anterior cingulate cortex, amygdala, and anterior insula emerged as potential markers in major depressive disorder and some anxiety disorders. Results across studies displayed a large degree of variability, however, and to date the findings have not been systematically validated in independent clinical cohorts and have not been shown capable of distinguishing between medication and psychotherapy responders. Also limited is the examination of how neuroimaging compares or might add to other prognostic clinical variables. CONCLUSION While the extant data suggest avenues of further investigation, we are still far from being able to use these markers clinically. Future studies need to focus on longitudinal testing of potential markers, determining their prescriptive value and examining how they might be integrated with clinical factors.
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Rus OG, Reess TJ, Wagner G, Zaudig M, Zimmer C, Koch K. Structural alterations in patients with obsessive-compulsive disorder: a surface-based analysis of cortical volume, surface area and thickness. J Psychiatry Neurosci 2017; 42:395-403. [PMID: 28832321 PMCID: PMC5662461 DOI: 10.1503/jpn.170030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mounting evidence indicates the presence of structural brain alterations in individuals with obsessive-compulsive disorder (OCD). Findings are, however, rather heterogeneous, which may be partly because of differences in methodological approaches or clinical sample characteristics. The aim of the present study was to analyze the whole brain cortical volume, surface area and thickness in a large sample of patients with OCD compared with age- and sex-matched healthy controls. METHODS We conducted whole brain surface-based analyses of grey matter measures using the automated FreeSurfer software in patients with OCD and matched controls. Group analyses were performed and corrected for multiple testing using Monte Carlo simulations (p < 0.05). Altered brain regions and their average morphological values were associated to symptom severity and type (Yale-Brown Obsessive Compulsive Scale scores). RESULTS We included 75 patients and 75 controls in our analyses. Patients with OCD showed decreases in both volume and surface area compared with healthy controls in inferior-superior parieto-occipital regions. In addition, the precuneus, posterior cingulate areas, middle frontal and orbitofrontal areas, and middle inferior temporal areas extending to the fusiform gyrus were characterized by a reduced surface area only. There were no differences in grey matter thickness between the groups. LIMITATIONS The presence of comorbidities, medication usage and the multisymptomatic feature of OCD could have influenced our results to a certain degree. CONCLUSION Our results suggest decreased grey matter volume and surface area in several key regions in patients with OCD. Parietal regions showed reductions in both volume and surface area, which underlines the potential relevance of these regions for the pathophysiology of the disorder.
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Affiliation(s)
- Oana Georgiana Rus
- Correspondence to: G. Rus, Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675 Munich, Germany;
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Empirically supported psychological treatments and the Research Domain Criteria (RDoC). J Affect Disord 2017; 216:78-88. [PMID: 27836118 DOI: 10.1016/j.jad.2016.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 10/11/2016] [Accepted: 10/18/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND The Research Domain Criteria (RDoC) has been developed as an alternative approach to studying psychiatric disorders. The RDoC constructs and units of analysis, from genes up through paradigms, are intended to describe a hierarchy of priority measurements. Several of these have been investigated in the context of empirically-supported treatments, as either moderators or mediators of outcome. METHOD This review considers the available research on the moderating and mediating role of genes, molecules, circuits and physiology in cognitive-behavior therapy (CBT) outcome studies for negative valence system conditions. FINDINGS Based on the review, research has aspired to identify candidate genes, molecules, circuits and physiological moderators or mediators of treatment, but no definitive tests have been conducted. Instead, several candidate variables have been found that deserve further investigation. LIMITATIONS The available research is based on diagnoses from the DSM, whereas the RDoC initiative endeavors to determine empirically valid taxonomic signs. CONCLUSIONS The results of this review are discussed in the joint context of developments in empirically-supported psychological therapy and the specific aims of the RDoC initiative, and conclude with recommendations for future research.
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Tolin DF, Billingsley AL, Hallion LS, Diefenbach GJ. Low pre-treatment end-tidal CO 2 predicts dropout from cognitive-behavioral therapy for anxiety and related disorders. Behav Res Ther 2016; 90:32-40. [PMID: 27960095 DOI: 10.1016/j.brat.2016.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/05/2016] [Accepted: 12/06/2016] [Indexed: 11/26/2022]
Abstract
Recent clinical trial research suggests that baseline low end-tidal CO2 (ETCO2, the biological marker of hyperventilation) may predict poorer response to cognitive-behavioral therapy (CBT) for anxiety-related disorders. The present study examined the predictive value of baseline ETCO2 among patients treated for such disorders in a naturalistic clinical setting. Sixty-nine adults with a primary diagnosis of a DSM-5 anxiety disorder, obsessive-compulsive disorder, or posttraumatic stress disorder completed a 4-min assessment of resting ETCO2, and respiration rate (the first minute was analyzed). Lower ETCO2 was not associated with a diagnosis of panic disorder, and was associated with lower subjective distress ratings on certain measures. Baseline ETCO2 significantly predicted treatment dropout: those meeting cutoff criteria for hypocapnia were more than twice as likely to drop out of treatment, and ETCO2 significantly predicted dropout beyond other pre-treatment variables. Weekly measurement suggested that the lower-ETCO2 patients who dropped out were not responding well to treatment prior to dropout. The present results, along with previous clinical trial data, suggest that lower pre-treatment ETCO2 is a negative prognostic indicator for CBT for anxiety-related disorders. It is suggested that patients with lower ETCO2 might benefit from additional intervention that targets respiratory abnormality.
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Affiliation(s)
- David F Tolin
- The Institute of Living, United States; Yale University School of Medicine, United States.
| | | | | | - Gretchen J Diefenbach
- The Institute of Living, United States; Yale University School of Medicine, United States
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Functional and structural connectivity of the amygdala in obsessive-compulsive disorder. NEUROIMAGE-CLINICAL 2016; 13:246-255. [PMID: 28018851 PMCID: PMC5167243 DOI: 10.1016/j.nicl.2016.12.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 12/04/2016] [Accepted: 12/08/2016] [Indexed: 11/20/2022]
Abstract
Background The amygdala is known to be involved in anxiety processing, but its role in the psychopathology of obsessive-compulsive disorder (OCD) is still unclear. Aims In this MRI study we investigated potential alterations in structural and functional connectivity of the amygdala in 42 adult patients with OCD and 37 healthy subjects. Method Psychophysiological interaction analysis was used to explore amygdala functional connectivity during a negative affective task. Probabilistic tractography was then employed to study structural connectivity and integrity of underlying white matter fiber tracts. Results Compared to controls, OCD patients showed a significantly increased functional connectivity of the left amygdala with mostly parieto-occipital regions during task. No structural connectivity differences could be found between the groups. In addition, only patients showed a significant association between functional and structural connectivity of these regions. Moreover, symptom severity was negatively associated with structural integrity of the underlying white matter tracts. Conclusions Present results emphasize the relevance of the amygdala for OCD and may reflect that neuronal alterations in structural connectivity could be associated with functional connectivity alterations in broader networks.
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Frydman I, de Salles Andrade JB, Vigne P, Fontenelle LF. Can Neuroimaging Provide Reliable Biomarkers for Obsessive-Compulsive Disorder? A Narrative Review. Curr Psychiatry Rep 2016; 18:90. [PMID: 27549605 DOI: 10.1007/s11920-016-0729-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In this integrative review, we discuss findings supporting the use neuroimaging biomarkers in the diagnosis and treatment of obsessive-compulsive disorder (OCD). To do so, we have selected the most recent studies that attempted to identify the underlying pathogenic process associated with OCD and whether they provide useful information to predict clinical features, natural history or treatment responses. Studies using functional magnetic resonance (fMRI), voxel-based morphometry (VBM), diffusion tensor imaging (DTI) and proton magnetic resonance spectroscopy (1H MRS) in OCD patients are generally supportive of an expanded version of the earlier cortico-striatal-thalamus-cortical (CSTC) model of OCD. Although it is still unclear whether this information will be incorporated into the daily clinical practice (due to current conceptual approaches to mental illness), statistical techniques, such as pattern recognition methods, appear promising in identifying OCD patients and predicting their outcomes.
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Affiliation(s)
- Ilana Frydman
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Juliana B de Salles Andrade
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paula Vigne
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo F Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
- Brain and Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria, Australia.
- , Rua Visconde de Pirajá, 547, 617, Ipanema, Rio de Janeiro, RJ, 22410-003, Brazil.
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Connectomics-based structural network alterations in obsessive-compulsive disorder. Transl Psychiatry 2016; 6:e882. [PMID: 27598966 PMCID: PMC5048203 DOI: 10.1038/tp.2016.163] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 07/11/2016] [Accepted: 07/18/2016] [Indexed: 01/12/2023] Open
Abstract
Given the strong involvement of affect in obsessive-compulsive disorder (OCD) and recent findings, the current cortico-striato-thalamo-cortical (CSTC) model of pathophysiology has repeatedly been questioned regarding the specific role of regions involved in emotion processing such as limbic areas. Employing a connectomics approach enables us to characterize structural connectivity on a whole-brain level, extending beyond the CSTC circuitry. Whole-brain structural networks of 41 patients and 42 matched healthy controls were analyzed based on 83 × 83 connectivity matrices derived from cortical and subcortical parcellation of structural T1-weighted magnetic resonance scans and deterministic fiber tracking based on diffusion tensor imaging data. To assess group differences in structural connectivity, the framework of network-based statistic (NBS) was applied. Graph theoretical measures were calculated to further assess local and global network characteristics. The NBS analysis revealed a single network consistently displaying decreased structural connectivity in patients comprising orbitofrontal, striatal, insula and temporo-limbic areas. In addition, graph theoretical measures indicated local alterations for amygdala and temporal pole while the overall topology of the network was preserved. To the best of our knowledge, this is the first study combining the NBS with graph theoretical measures in OCD. Along with regions commonly described in the CSTC model of pathophysiology, our results indicate an involvement of mainly temporo-limbic regions typically associated with emotion processing supporting their importance for neurobiological alterations in OCD.
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Brooks SJ, Stein DJ. A systematic review of the neural bases of psychotherapy for anxiety and related disorders. DIALOGUES IN CLINICAL NEUROSCIENCE 2016. [PMID: 26487807 PMCID: PMC4610611 DOI: 10.31887/dcns.2015.17.3/sbrooks] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Brain imaging studies over two decades have delineated the neural circuitry of anxiety and related disorders, particularly regions involved in fear processing and in obsessive-compulsive symptoms. The neural circuitry of fear processing involves the amygdala, anterior cingulate, and insular cortex, while cortico-striatal-thalamic circuitry plays a key role in obsessive-compulsive disorder. More recently, neuroimaging studies have examined how psychotherapy for anxiety and related disorders impacts on these neural circuits. Here we conduct a systematic review of the findings of such work, which yielded 19 functional magnetic resonance imaging studies examining the neural bases of cognitive-behavioral therapy (CBT) in 509 patients with anxiety and related disorders. We conclude that, although each of these related disorders is mediated by somewhat different neural circuitry, CBT may act in a similar way to increase prefrontal control of subcortical structures. These findings are consistent with an emphasis in cognitive-affective neuroscience on the potential therapeutic value of enhancing emotional regulation in various psychiatric conditions.
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Affiliation(s)
- Samantha J Brooks
- UCT Department of Psychiatry and Mental Health, Grotte Schuur Hospital, Observatory, Cape Town, South Africa
| | - Dan J Stein
- UCT Department of Psychiatry and Mental Health, Grotte Schuur Hospital, Observatory, Cape Town, South Africa; MRC Unit on Anxiety & Stress Disorders, Cape Town, South Africa
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43
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van den Heuvel OA, van Wingen G, Soriano-Mas C, Alonso P, Chamberlain SR, Nakamae T, Denys D, Goudriaan AE, Veltman DJ. Brain circuitry of compulsivity. Eur Neuropsychopharmacol 2016; 26:810-27. [PMID: 26711687 DOI: 10.1016/j.euroneuro.2015.12.005] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 08/28/2015] [Accepted: 12/01/2015] [Indexed: 01/27/2023]
Abstract
Compulsivity is associated with alterations in the structure and the function of parallel and interacting brain circuits involved in emotional processing (involving both the reward and the fear circuits), cognitive control, and motor functioning. These brain circuits develop during the pre-natal period and early childhood under strong genetic and environmental influences. In this review we bring together literature on cognitive, emotional, and behavioral processes in compulsivity, based mainly on studies in patients with obsessive-compulsive disorder and addiction. Disease symptoms normally change over time. Goal-directed behaviors, in response to reward or anxiety, often become more habitual over time. During the course of compulsive disorders the mental processes and repetitive behaviors themselves contribute to the neuroplastic changes in the involved circuits, mainly in case of chronicity. On the other hand, successful treatment is able to normalize altered circuit functioning or to induce compensatory mechanisms. We conclude that insight in the neurobiological characteristics of the individual symptom profile and disease course, including the potential targets for neuroplasticity is an unmet need to advance the field.
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Affiliation(s)
- Odile A van den Heuvel
- Department of Psychiatry, VU University Medical Center (VUmc), Amsterdam, The Netherlands; Department of Anatomy & Neurosciences, VUmc, Amsterdam, The Netherlands; The Obsessive-Compulsive Disorder Team, Haukeland University Hospital, Bergen, Norway.
| | - Guido van Wingen
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Carles Soriano-Mas
- OCD Clinical and Research Unit, Department of Psychiatry, Bellvitge University Hospital; Bellvitge Biomedical Research Institute (IDIBELL), and CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Barcelona, Spain; Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Spain
| | - Pino Alonso
- OCD Clinical and Research Unit, Department of Psychiatry, Bellvitge University Hospital; Bellvitge Biomedical Research Institute (IDIBELL), and CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Barcelona, Spain; Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain
| | - Samuel R Chamberlain
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Cambridge and Peterborough NHS Foundation Trust (CPFT), Cambridge, United Kingdom
| | - Takashi Nakamae
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anna E Goudriaan
- Academic Medical Center, Department of Psychiatry, Amsterdam Institute for Addiction Research, University of Amsterdam, Amsterdam, The Netherlands; Arkin Mental Health and Jellinek Addiction Treatment, Amsterdam, The Netherlands
| | - Dick J Veltman
- Department of Psychiatry, VU University Medical Center (VUmc), Amsterdam, The Netherlands
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Howells FM, Baldwin DS, Kingdon DG. Can cognitive behaviour therapy beneficially influence arousal mechanisms in psychosis? Hum Psychopharmacol 2016; 31:64-9. [PMID: 26270489 DOI: 10.1002/hup.2499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 07/02/2015] [Accepted: 07/04/2015] [Indexed: 11/07/2022]
Abstract
Cognitive behavioural therapy for psychosis (CBTp) is an approved adjunct therapy for patients with psychotic disorders; however, we do not fully understand the neurobiological effects that this therapy may exert. Arousal, as measured by electroencephalography (EEG), provides a useful electrophysiological marker for assessing psychotic disorders. EEG studies may therefore serve as a useful measure for assessing the underlying effects of CBTp in psychotic disorders.
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Affiliation(s)
- Fleur M Howells
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - David S Baldwin
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry, University of Southampton, Southampton, UK
| | - David G Kingdon
- Department of Psychiatry, University of Southampton, Southampton, UK
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Göttlich M, Krämer UM, Kordon A, Hohagen F, Zurowski B. Resting-state connectivity of the amygdala predicts response to cognitive behavioral therapy in obsessive compulsive disorder. Biol Psychol 2015; 111:100-9. [PMID: 26388257 DOI: 10.1016/j.biopsycho.2015.09.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 08/31/2015] [Accepted: 09/14/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a psychiatric disorder which is characterized by recurrent intrusive thoughts (obsessions) and ritualized, repetitive behaviors or mental acts (compulsions). The gold standard for the treatment of OCD is cognitive behavioral therapy (CBT) with exposure and response prevention. This is the first study exploring the predictive value of resting-state functional connectivity for the outcome of CBT. METHODS We assessed whole-brain resting-state functional connectivity in a group of 17 un-medicated OCD inpatients prior to CBT compared to 19 healthy controls using functional magnetic resonance imaging. The graph theoretical metric degree centrality served as indicator for altered voxel-wise whole-brain functional connectivity. The relative change in the Yale-Brown Obsessive Compulsive Scale (YBOCS) score was used to evaluate treatment outcome. RESULTS The degree centrality of the right basolateral nuclei group of the amygdala was positively correlated with the response to subsequent CBT. OCD patients showed a lower degree centrality of the superficial amygdala (bilateral). CONCLUSIONS Our results suggest that two different sub-regions of the amygdala and their respective neural networks are affected in OCD: the superficial amygdala and networks related to evaluation of reinforcers and risk anticipation and the basolateral amygdala which is implicated in fear processing. The diminished CBT response in patients showing a lower degree centrality of the basolateral amygdala reflects a deficient fear circuit in these patients which may impact fear extinction as a core mechanism of exposure-based CBT.
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Affiliation(s)
- Martin Göttlich
- Department of Neurology, University of Lübeck, Lübeck, Germany.
| | - Ulrike M Krämer
- Department of Neurology, University of Lübeck, Lübeck, Germany; Institute for Psychology II, University of Lübeck, Lübeck, Germany
| | - Andreas Kordon
- Department of Psychiatry, University of Lübeck, Lübeck, Germany
| | - Fritz Hohagen
- Department of Psychiatry, University of Lübeck, Lübeck, Germany
| | - Bartosz Zurowski
- Department of Psychiatry, University of Lübeck, Lübeck, Germany; University of Hamburg, Institute for Systems Neuroscience, Germany
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Sutoh C, Matsuzawa D, Hirano Y, Yamada M, Nagaoka S, Chakraborty S, Ishii D, Matsuda S, Tomizawa H, Ito H, Tsuji H, Obata T, Shimizu E. Transient contribution of left posterior parietal cortex to cognitive restructuring. Sci Rep 2015; 5:9199. [PMID: 25775998 PMCID: PMC4361861 DOI: 10.1038/srep09199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 02/20/2015] [Indexed: 11/09/2022] Open
Abstract
Cognitive restructuring is a fundamental method within cognitive behavioural therapy of changing dysfunctional beliefs into flexible beliefs and learning to react appropriately to the reality of an anxiety-causing situation. To clarify the neural mechanisms of cognitive restructuring, we designed a unique task that replicated psychotherapy during a brain scan. The brain activities of healthy male participants were analysed using functional magnetic resonance imaging. During the brain scan, participants underwent Socratic questioning aimed at cognitive restructuring regarding the necessity of handwashing after using the restroom. The behavioural result indicated that the Socratic questioning effectively decreased the participants' degree of belief (DOB) that they must wash their hands. Alterations in the DOB showed a positive correlation with activity in the left posterior parietal cortex (PPC) while the subject thought about and rated own belief. The involvement of the left PPC not only in planning and decision-making but also in conceptualization may play a pivotal role in cognitive restructuring.
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Affiliation(s)
- Chihiro Sutoh
- 1] Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo, Chiba 260-8670, Japan [2] Research Center for Child Mental Development, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo, Chiba 260-8670, Japan [3] Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage, Chiba 263-8555, Japan
| | - Daisuke Matsuzawa
- 1] Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo, Chiba 260-8670, Japan [2] Research Center for Child Mental Development, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo, Chiba 260-8670, Japan [3] Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage, Chiba 263-8555, Japan
| | - Yoshiyuki Hirano
- 1] Research Center for Child Mental Development, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo, Chiba 260-8670, Japan [2] Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage, Chiba 263-8555, Japan
| | - Makiko Yamada
- Molecular Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage, Chiba 263-8555, Japan
| | - Sawako Nagaoka
- 1] Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo, Chiba 260-8670, Japan [2] Research Center for Child Mental Development, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo, Chiba 260-8670, Japan
| | - Sudesna Chakraborty
- Research Center for Child Mental Development, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo, Chiba 260-8670, Japan
| | - Daisuke Ishii
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo, Chiba 260-8670, Japan
| | - Shingo Matsuda
- National Center for Neurology and Psychiatry, 4-1-1 Ogawa Higashi, Kodaira 187-8551, Japan
| | - Haruna Tomizawa
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo, Chiba 260-8670, Japan
| | - Hiroshi Ito
- Molecular Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage, Chiba 263-8555, Japan
| | - Hiroshi Tsuji
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage, Chiba 263-8555, Japan
| | - Takayuki Obata
- 1] Research Center for Child Mental Development, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo, Chiba 260-8670, Japan [2] Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage, Chiba 263-8555, Japan
| | - Eiji Shimizu
- 1] Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo, Chiba 260-8670, Japan [2] Research Center for Child Mental Development, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo, Chiba 260-8670, Japan [3] Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage, Chiba 263-8555, Japan
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Ball TM, Stein MB, Paulus MP. Toward the application of functional neuroimaging to individualized treatment for anxiety and depression. Depress Anxiety 2014; 31:920-33. [PMID: 25407582 DOI: 10.1002/da.22299] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 07/29/2014] [Accepted: 08/03/2014] [Indexed: 12/11/2022] Open
Abstract
Functional neuroimaging has led to significant gains in understanding the biological bases of anxiety and depressive disorders. However, the ability of functional neuroimaging to directly impact clinical practice is unclear. One important method by which neuroimaging could impact clinical care is to generate single patient level predictions that can guide clinical decision-making. The present review summarizes published functional neuroimaging studies of predictors of medication or psychotherapy outcome in major depressive disorder, obsessive-compulsive disorder (OCD), posttraumatic stress disorder, generalized anxiety disorder, panic disorder, and social anxiety disorder. In major depressive disorder and OCD, there is converging evidence of specific brain circuitry that has both been implicated in the disordered state itself, and where pretreatment activation levels have been predictive of treatment response. Specifically, in major depressive disorder, greater pretreatment ventral and pregenual anterior cingulate cortex (ACC) activation may predict better antidepressant medication outcome but poorer psychotherapy outcome. In OCD, activation in the ACC and orbitofrontal cortex has been inversely associated with pharmacological treatment response. In other anxiety disorders, research in this area is just beginning, with the ACC potentially implicated. However, the question of whether these results can directly translate to clinical practice remains open. In order to achieve the goal of single patient level prediction and individualized treatment, future research should strive to establish replicable models with good predictive performance and clear incremental validity.
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Affiliation(s)
- Tali M Ball
- Department of Psychiatry, University of California, San Diego, California; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
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Fournier JC, Price RB. Psychotherapy and Neuroimaging. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2014; 12:290-298. [PMID: 25346646 PMCID: PMC4207360 DOI: 10.1176/appi.focus.12.3.290] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Technological advances in neuroimaging have enabled researchers to examine, in vivo, the relationship between psychotherapeutic interventions and markers of brain activity. This review focuses on two kinds of neuroimaging studies in psychotherapy: those that examine the patterns of brain activity associated with response to treatments and those that examine the changes that occur in brain activity during treatment. A general, hypothetical neural model of psychotherapy is presented, and support for the model is evaluated across anxiety disorders and major depression. Neuroimaging studies are broadly consistent in observing associations between response to psychotherapy and baseline activity in several key regions within the prefrontal cortex, basal ganglia, and limbic areas. These regions are involved in the generation and regulation of emotion, fear responding, and response to reward. Pre-post examinations of change following psychotherapy also typically observe that psychological treatments for anxiety and depression can affect neural activity in these regions. Despite general consensus that activity in these regions is associated with psychotherapy, substantial discrepancy persists regarding the precise direction of the observed relationships. Methodological challenges of the existing literature are considered, and future directions are discussed.
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Affiliation(s)
- Jay C Fournier
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Rebecca B Price
- Department of Psychiatry, University of Pittsburgh School of Medicine
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