1
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Spiroiu FI, Minuzzi L, Duarte D, McCabe RE, Soreni N. Neurocognitive effects of transcranial direct current stimulation in obsessive-compulsive disorder: a systematic review. Int J Neurosci 2024:1-14. [PMID: 38913323 DOI: 10.1080/00207454.2024.2371303] [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: 11/16/2023] [Accepted: 06/15/2024] [Indexed: 06/25/2024]
Abstract
Transcranial direct current stimulation (tDCS) has been used with increasing frequency as a therapeutic tool to alleviate clinical symptoms of obsessive compulsive-disorder (OCD). However, little is known about the effects of tDCS on neurocognitive functioning among OCD patients. The aim of this review was to provide a comprehensive overview of the literature examining the effects of tDCS on specific neurocognitive functions in OCD. A literature search following PRISMA guidelines was conducted on the following databases: PubMed, PsycINFO, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science. The search yielded 4 results: one randomized, sham-controlled study (20 patients), one randomized, controlled, partial crossover trial (12 patients), one open-label study (5 patients), and one randomized, double-blind, sham-controlled, parallel-group trial (37 patients). A total of 51 patients received active tDCS with some diversity in electrode montages targeting the dorsolateral prefrontal cortex, the pre-supplementary motor area, or the orbitofrontal cortex. tDCS was associated with improved decision-making in study 1, enhanced attentional monitoring and response inhibition in study 2, improved executive and inhibitory control in study 3, and reduced attentional bias and improved response inhibition and working memory in study 4. Limitations of this review include its small sample, the absence of a sham group in half of the studies, and the heterogeneity in tDCS parameters. These preliminary results highlight the need for future testing in randomized, sham-controlled trials to examine whether and how tDCS induces relevant cognitive benefits in OCD.
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Affiliation(s)
- Flavia I Spiroiu
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Luciano Minuzzi
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Dante Duarte
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Randi E McCabe
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Noam Soreni
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Pediatric OCD Consultation Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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2
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Bruin WB, Abe Y, Alonso P, Anticevic A, Backhausen LL, Balachander S, Bargallo N, Batistuzzo MC, Benedetti F, Bertolin Triquell S, Brem S, Calesella F, Couto B, Denys DAJP, Echevarria MAN, Eng GK, Ferreira S, Feusner JD, Grazioplene RG, Gruner P, Guo JY, Hagen K, Hansen B, Hirano Y, Hoexter MQ, Jahanshad N, Jaspers-Fayer F, Kasprzak S, Kim M, Koch K, Bin Kwak Y, Kwon JS, Lazaro L, Li CSR, Lochner C, Marsh R, Martínez-Zalacaín I, Menchon JM, Moreira PS, Morgado P, Nakagawa A, Nakao T, Narayanaswamy JC, Nurmi EL, Zorrilla JCP, Piacentini J, Picó-Pérez M, Piras F, Piras F, Pittenger C, Reddy JYC, Rodriguez-Manrique D, Sakai Y, Shimizu E, Shivakumar V, Simpson BH, Soriano-Mas C, Sousa N, Spalletta G, Stern ER, Evelyn Stewart S, Szeszko PR, Tang J, Thomopoulos SI, Thorsen AL, Yoshida T, Tomiyama H, Vai B, Veer IM, Venkatasubramanian G, Vetter NC, Vriend C, Walitza S, Waller L, Wang Z, Watanabe A, Wolff N, Yun JY, Zhao Q, van Leeuwen WA, van Marle HJF, van de Mortel LA, van der Straten A, van der Werf YD, Thompson PM, Stein DJ, van den Heuvel OA, van Wingen GA. The functional connectome in obsessive-compulsive disorder: resting-state mega-analysis and machine learning classification for the ENIGMA-OCD consortium. Mol Psychiatry 2023; 28:4307-4319. [PMID: 37131072 PMCID: PMC10827654 DOI: 10.1038/s41380-023-02077-0] [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: 08/17/2022] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 05/04/2023]
Abstract
Current knowledge about functional connectivity in obsessive-compulsive disorder (OCD) is based on small-scale studies, limiting the generalizability of results. Moreover, the majority of studies have focused only on predefined regions or functional networks rather than connectivity throughout the entire brain. Here, we investigated differences in resting-state functional connectivity between OCD patients and healthy controls (HC) using mega-analysis of data from 1024 OCD patients and 1028 HC from 28 independent samples of the ENIGMA-OCD consortium. We assessed group differences in whole-brain functional connectivity at both the regional and network level, and investigated whether functional connectivity could serve as biomarker to identify patient status at the individual level using machine learning analysis. The mega-analyses revealed widespread abnormalities in functional connectivity in OCD, with global hypo-connectivity (Cohen's d: -0.27 to -0.13) and few hyper-connections, mainly with the thalamus (Cohen's d: 0.19 to 0.22). Most hypo-connections were located within the sensorimotor network and no fronto-striatal abnormalities were found. Overall, classification performances were poor, with area-under-the-receiver-operating-characteristic curve (AUC) scores ranging between 0.567 and 0.673, with better classification for medicated (AUC = 0.702) than unmedicated (AUC = 0.608) patients versus healthy controls. These findings provide partial support for existing pathophysiological models of OCD and highlight the important role of the sensorimotor network in OCD. However, resting-state connectivity does not so far provide an accurate biomarker for identifying patients at the individual level.
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Grants
- R01 AG058854 NIA NIH HHS
- R01 MH126213 NIMH NIH HHS
- R21 MH101441 NIMH NIH HHS
- R01 MH121520 NIMH NIH HHS
- R21 MH093889 NIMH NIH HHS
- R01 MH116147 NIMH NIH HHS
- R01 MH111794 NIMH NIH HHS
- R01 MH085900 NIMH NIH HHS
- P41 EB015922 NIBIB NIH HHS
- IA/CPHE/18/1/503956 DBT-Wellcome Trust India Alliance
- UL1 TR001863 NCATS NIH HHS
- R01 MH081864 NIMH NIH HHS
- R01 MH104648 NIMH NIH HHS
- U54 EB020403 NIBIB NIH HHS
- R01 MH117601 NIMH NIH HHS
- R01 MH116038 NIMH NIH HHS
- R01 MH126981 NIMH NIH HHS
- R01 NS107513 NINDS NIH HHS
- RF1 MH123163 NIMH NIH HHS
- R33 MH107589 NIMH NIH HHS
- K24 MH121571 NIMH NIH HHS
- R01 MH121246 NIMH NIH HHS
- Wellcome Trust
- K23 MH115206 NIMH NIH HHS
- R01 AG059874 NIA NIH HHS
- Funding from Japan Society for the Promotion of Science (KAKENHI Grant No. 18K15523)
- Carlos III Health Institute PI18/00856
- NIMH: 5R01MH116038
- Sara Bertolin was supported by Instituto de Salud Carlos III through the grant CM21/00278 (Co-funded by European Social Fund. ESF investing in your future).
- Hartmann Müller Foundation (no. 1460, principal investigator: S.Brem)
- NIHM: R01MH085900, R01MH121520
- NIH: K23 MH115206 & IOCDF Annual Research Award
- AMED Brain/MINDS Beyond program Grant No. JP22dm0307002, JSPS KAKENHI Grants No. 22H01090, 21K03084, 19K03309, 16K04344
- NIH: R01MH117601, R01AG059874, P41EB015922, R01MH126213, R01MH121246
- Michael Smith Health Research BC
- the Deutsche Forschungsgemeinschaf (KO 3744/11-1)
- This work was supported by the Medical Research Council of South Africa (SAMRC), and the National Research Foundation of South Africa (Christine Lochner), and we acknowledge the contribution of our research assistants.
- NIMH: R21MH093889, R21MH101441 and R01MH104648
- IM-Z was supported by a PFIS grant (FI17/00294) from the Carlos III Health Institute
- This work was supported by National funds, through the Foundation for Science and Technology (project UIDB/50026/2020 and UIDP/50026/2020); by the Norte Portugal Regional Operational Programme (NORTE 2020) under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF) (projects NORTE-01-0145-FEDER-000013 and NORTE-01-0145-FEDER-000023), and by the FLAD Science Award Mental Health 2021.
- JSPS KAKENHI (C)21K07547, 22K07598 and 22K15766
- Government of India grants from Department of Science and Technology (DST INSPIRE faculty grant -IFA12-LSBM-26) & Department of Biotechnology (BT/06/IYBA/2012)
- NIMH: R01MH081864
- MPP was supported by the Spanish Ministry of Universities, with funds from the European Union - NextGenerationEU (MAZ/2021/11).
- Italian Ministry of Health, Ricerca Corrente 2022, 2023
- NIMH: K24MH121571
- Government of India grants to: Prof. Reddy [(SR/S0/HS/0016/2011) & (BT/PR13334/Med/30/259/2009)], Dr. Janardhanan Narayanaswamy (DST INSPIRE faculty grant -IFA12-LSBM-26) & (BT/06/IYBA/2012) and the Wellcome-DBT India Alliance grant to Dr. Ganesan Venkatasubramanian (500236/Z/11/Z)
- the Japan Agency for Medical Research and Development: JP22dm0307008
- DBT-Wellcome Trust India Alliance Early Career Fellowship grant (IA/CPHE/18/1/503956)
- NIMH: R21MH093889 and R01MH104648
- Grant #PI19/01171 from the Carlos III Health Institute, and 2017SGR 1247 from AGAUR-Generalitat de Catalunya.
- Italian Ministry of Health grant RC19-20-21-22/A
- Grants R01MH126981, R01MH111794, and R33MH107589 from the National Institute of Mental Health/National Institute of Health awarded to ERS.
- National Natural Science Foundation of China (Nos. 81871057, 82171495), and Key Technologies Research and Development Program of China (Nos.2022YFE0103700)
- Helse Vest Health Authority (Grant ID 911754 and 911880)
- JSPS KAKENHI (C) JP21K07547, 22K07598 and 22K15766.
- Ganesan Venkatasubramanian acknowledges the support of Department of Biotechnology (DBT) - Wellcome Trust India Alliance CRC grant (IA/CRC/19/1/610005) & senior fellowship grant (500236/Z/11/Z)
- Supported by an grant from Amsterdam Neuroscience CIA-2019-03-A
- Swiss National Science Foundation (no. 320030_130237, principal investigator: S.Walitza)
- The National Natural Science Foundation of China (82071518)
- Else Kröner Fresenius Stiftung (2017_A101)
- ENIGMA World Aging Center, NIA Award No. R01AG058854; ENIGMA Parkinson's Initiative: A Global Initiative for Parkinson's Disease, NINDS award RO1NS107513
- the Obsessive-Compulsive Foundation to Dan J. Stein
- Dutch Organization for Scientific Research (NWO/ZonMW) VENI grant (916-86-038) and Brain & Behavior Research Foundation (NARSAD grant), Netherlands Brain Foundation (2010(1)-50)
- Netherlands Organization for Scientific Research (NWO/ZonMW Vidi Grant No. 165.610.002, 016.156.318, and 917.15.318 G.A. van Wingen)
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Affiliation(s)
- Willem B Bruin
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Amsterdam, The Netherlands.
| | - Yoshinari Abe
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Pino Alonso
- Department of Psychiatry, Bellvitge University Hospital, Barcelona, Spain
- Department of Clinical Science, Faculty of Medicine, University of Barcelona, Barcelona, Spain
- IDIBELL, Bellvitge University Hospital, Barcelona, Spain
- CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - Alan Anticevic
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Lea L Backhausen
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Srinivas Balachander
- Department of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore, India
| | - Nuria Bargallo
- CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
- Radiology Service, Diagnosis Image Center, Hospital Clinic de Barcelona, Barcelona, Spain
- Magnetic Resonance Image Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marcelo C Batistuzzo
- Department of Psychiatry, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
- Department of Methods and Techniques in Psychology, Pontifical Catholic University, Sao Paulo, Brazil
| | - Francesco Benedetti
- Vita-Salute San Raffaele University, Milano, Italy
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Sara Bertolin Triquell
- Bellvitge Biomedical Research Insitute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain
| | - Silvia Brem
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Federico Calesella
- Vita-Salute San Raffaele University, Milano, Italy
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Beatriz Couto
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Clinical Academic Center-Braga, Braga, Portugal
| | - Damiaan A J P Denys
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Marco A N Echevarria
- Department of Psychiatry, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Goi Khia Eng
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Sónia Ferreira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Clinical Academic Center-Braga, Braga, Portugal
| | - Jamie D Feusner
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- General Adult Psychiatry & Health Systems, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Patricia Gruner
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Joyce Y Guo
- University of California, San Diego, CA, USA
| | - Kristen Hagen
- Molde Hospital, Møre og Romsdal Hospital Trust, Molde, Norway
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bjarne Hansen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Yoshiyuki Hirano
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Marcelo Q Hoexter
- Department of Psychiatry, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Neda Jahanshad
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Fern Jaspers-Fayer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Selina Kasprzak
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, De Boelelaan 1117, Amsterdam, The Netherlands
| | - 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
| | - Kathrin Koch
- Department of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Yoo Bin Kwak
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Luisa Lazaro
- CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
- Magnetic Resonance Image Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | | | - Christine Lochner
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Rachel Marsh
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Ignacio Martínez-Zalacaín
- Bellvitge Biomedical Research Insitute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - Jose M Menchon
- CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
- Bellvitge Biomedical Research Insitute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - Pedro S Moreira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Psychological Neuroscience Lab, CIPsi, School of Psychology, University of Minho, Braga, Portugal
| | - Pedro Morgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Clinical Academic Center-Braga, Braga, Portugal
| | - Akiko Nakagawa
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Tomohiro Nakao
- Graduate School of Medical Sciences, Kyushu University, Fukuoka-shi, Japan
| | - Janardhanan C Narayanaswamy
- National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore, India
- GVAMHS, Goulburn Valley Health, Shepparton, VIC, Australia
| | - Erika L Nurmi
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA
| | - Jose C Pariente Zorrilla
- Magnetic Resonance Image Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, USA
| | - Maria Picó-Pérez
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Departamento de Psicología Básica, Clínica y Psicobiología, Universitat Jaume I, Castelló de la Plana, Spain
| | - Fabrizio Piras
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Federica Piras
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | - Janardhan Y C Reddy
- Department of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore, India
| | - Daniela Rodriguez-Manrique
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center (TUM-NIC) of Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Graduate School of Systemic Neurosciences (GSN), Ludwig-Maximilians-Universität, Munich, Germany
| | - Yuki Sakai
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- ATR Brain Information Communication Research Laboratory Group, Kyoto, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Fukui, Japan
- Department of Cognitive Behavioral Physiology Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Venkataram Shivakumar
- Department of Integrative Medicine, National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore, India
| | - Blair H Simpson
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Carles Soriano-Mas
- CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
- Bellvitge Biomedical Research Insitute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain
- Department of Social Psychology and Quantitative Psychology, Universitat de Barcelona-UB, Barcelona, Spain
| | - Nuno Sousa
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Clinical Academic Center-Braga, Braga, Portugal
| | - Gianfranco Spalletta
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Emily R Stern
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - S Evelyn Stewart
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Philip R Szeszko
- Department of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, NY, USA
| | - Jinsong Tang
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Sophia I Thomopoulos
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anders L Thorsen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Tokiko Yoshida
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Hirofumi Tomiyama
- Graduate School of Medical Sciences, Kyushu University, Fukuoka-shi, Japan
| | - Benedetta Vai
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Ilya M Veer
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore, India
| | - Nora C Vetter
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Department of Psychology, Faculty of Natural Sciences, MSB Medical School Berlin, Berlin, Germany
| | - Chris Vriend
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention program, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging program, Amsterdam, The Netherlands
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Lea Waller
- Department of Psychiatry and Neurosciences CCM, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao, China
| | - Anri Watanabe
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nicole Wolff
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Je-Yeon Yun
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- Yeongeon Student Support Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Qing Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao, China
| | - Wieke A van Leeuwen
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Hein J F van Marle
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Mood Anxiety Psychosis Stress Sleep, Amsterdam, The Netherlands
| | - Laurens A van de Mortel
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Anouk van der Straten
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Ysbrand D van der Werf
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention program, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging program, Amsterdam, The Netherlands
| | - Paul M Thompson
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Dan J Stein
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Odile A van den Heuvel
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention program, Amsterdam, The Netherlands
| | - Guido A van Wingen
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Amsterdam, The Netherlands.
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Fornaro S, Vallesi A. Functional connectivity abnormalities of brain networks in obsessive–compulsive disorder: a systematic review. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-023-04312-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Abstract
Obsessive-compulsive disorder (OCD) is characterized by cognitive abnormalities encompassing several executive processes. Neuroimaging studies highlight functional abnormalities of executive fronto-parietal network (FPN) and default-mode network (DMN) in OCD patients, as well as of the prefrontal cortex (PFC) more specifically. We aim at assessing the presence of functional connectivity (FC) abnormalities of intrinsic brain networks and PFC in OCD, possibly underlying specific computational impairments and clinical manifestations. A systematic review of resting-state fMRI studies investigating FC was conducted in unmedicated OCD patients by querying three scientific databases (PubMed, Scopus, PsycInfo) up to July 2022 (search terms: “obsessive–compulsive disorder” AND “resting state” AND “fMRI” AND “function* *connect*” AND “task-positive” OR “executive” OR “central executive” OR “executive control” OR “executive-control” OR “cognitive control” OR “attenti*” OR “dorsal attention” OR “ventral attention” OR “frontoparietal” OR “fronto-parietal” OR “default mode” AND “network*” OR “system*”). Collectively, 20 studies were included. A predominantly reduced FC of DMN – often related to increased symptom severity – emerged. Additionally, intra-network FC of FPN was predominantly increased and often positively related to clinical scores. Concerning PFC, a predominant hyper-connectivity of right-sided prefrontal links emerged. Finally, FC of lateral prefrontal areas correlated with specific symptom dimensions. Several sources of heterogeneity in methodology might have affected results in unpredictable ways and were discussed. Such findings might represent endophenotypes of OCD manifestations, possibly reflecting computational impairments and difficulties in engaging in self-referential processes or in disengaging from cognitive control and monitoring processes.
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4
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Kammen A, Cavaleri J, Lam J, Frank AC, Mason X, Choi W, Penn M, Brasfield K, Van Noppen B, Murray SB, Lee DJ. Neuromodulation of OCD: A review of invasive and non-invasive methods. Front Neurol 2022; 13:909264. [PMID: 36016538 PMCID: PMC9397524 DOI: 10.3389/fneur.2022.909264] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/19/2022] [Indexed: 12/27/2022] Open
Abstract
Early research into neural correlates of obsessive compulsive disorder (OCD) has focused on individual components, several network-based models have emerged from more recent data on dysfunction within brain networks, including the the lateral orbitofrontal cortex (lOFC)-ventromedial caudate, limbic, salience, and default mode networks. Moreover, the interplay between multiple brain networks has been increasingly recognized. As the understanding of the neural circuitry underlying the pathophysiology of OCD continues to evolve, so will too our ability to specifically target these networks using invasive and noninvasive methods. This review discusses the rationale for and theory behind neuromodulation in the treatment of OCD.
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Affiliation(s)
- Alexandra Kammen
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jonathon Cavaleri
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jordan Lam
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, United States
| | - Adam C. Frank
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Xenos Mason
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Wooseong Choi
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Marisa Penn
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Kaevon Brasfield
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Barbara Van Noppen
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Stuart B. Murray
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Darrin Jason Lee
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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5
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Lee SW, Song H, Jang TY, Cha H, Kim E, Chang Y, Lee SJ. Aberrant functional connectivity of neural circuits associated with thought-action fusion in patients with obsessive-compulsive disorder. Psychol Med 2022; 52:2106-2115. [PMID: 33138873 DOI: 10.1017/s0033291720003980] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cognitive theories of obsessive-compulsive disorder (OCD) stress the importance of dysfunctional beliefs in the development and maintenance of the disorder. However, a neurobiological understanding of these cognitive models, including thought-action fusion (TAF), is surprisingly lacking. Thus, this functional magnetic resonance imaging study aimed to investigate whether altered functional connectivity (FC) is associated with the TAF paradigm in OCD patients. METHODS Forty-one OCD patients and 47 healthy controls (HCs) participated in a functional magnetic resonance imaging study using a TAF task, in which they were asked to read the name of a close or a neutral person in association with positive and negative statements. RESULTS The conventional TAF condition (negative statements/close person) induced significant FC between the regions of interest (ROIs) identified using multivoxel pattern analysis and the visual association areas, default mode network subregions, affective processing, and several subcortical regions in both groups. Notably, sparser FC was observed in OCD patients. Further analysis confined to the cortico-striato-thalamo-cortical (CSTC) and affective networks demonstrated that OCD patients exhibited reduced ROI FC with affective regions and greater ROI FC with CSTC components in the TAF condition compared to HCs. Within the OCD patients, middle cingulate cortex-insula FC was correlated with TAF and responsibility scores. CONCLUSIONS Our TAF paradigm revealed altered context-dependent engagement of the CSTC and affective networks in OCD patients. These findings suggest that the neurobiology of cognitive models corresponds to current neuroanatomical models of OCD. Further, they elucidate the underlying neurobiological mechanisms of OCD at the circuit-based level.
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Affiliation(s)
- Sang Won Lee
- Department of Psychiatry, Kyungpook National University Chilgok Hospital, Daegu, Korea
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Huijin Song
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Tae Yang Jang
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, Korea
| | - Hyunsil Cha
- Department of Medical & Biological Engineering, Kyungpook National University, Daegu, Korea
| | - Eunji Kim
- Department of Medical & Biological Engineering, Kyungpook National University, Daegu, Korea
| | - Yongmin Chang
- Department of Molecular Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Radiology, Kyungpook National University Hospital, Daegu, Korea
| | - Seung Jae Lee
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, Korea
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6
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Yu J, Zhou P, Yuan S, Wu Y, Wang C, Zhang N, Li CSR, Liu N. Symptom provocation in obsessive-compulsive disorder: A voxel-based meta-analysis and meta-analytic connectivity modeling. J Psychiatr Res 2022; 146:125-134. [PMID: 34971910 DOI: 10.1016/j.jpsychires.2021.12.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/04/2021] [Accepted: 12/11/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a heterogeneous psychiatric illness with a complex array of symptoms and potentially distinct neural underpinnings. We employed meta-analysis and connectivity modeling of symptom dimensions to delineate the circuit mechanisms of OCD. METHODS With the activation likelihood estimation (ALE) algorithm we performed meta-analysis of whole-brain functional magnetic resonance imaging (fMRI) studies of symptom provocation. We contrasted all OCD patients and controls in a primary analysis and divided the studies according to clinical symptoms in secondary meta-analyses. Finally, we employed meta-analytic connectivity modeling analyses (MACMs) to examine co-activation patterns of the brain regions revealed in the primary meta-analysis. RESULTS A total of 14 experiments from 12 eligible studies with a total of 238 OCD patients (124 men) and 219 healthy controls (120 men) were included in the primary analysis. OCD patients showed higher activation in the right caudate body/putamen/insula and lower activation in the left orbitofrontal cortex (OFC), left inferior frontal gyrus (IFG), left caudate body/middle cingulate cortex (MCC), right middle temporal gyrus (MTG), middle occipital gyrus (MOG) and right lateral occipital gyrus (LOG). MACMs revealed significant co-activation between left IFG and left caudate body/MCC, left MOG and right LOG, right LOG and MTG. In the secondary meta-analyses, the washing subgroup showed higher activation in the right OFC, bilateral ACC, left MOG and right caudate body. CONCLUSION OCD patients showed elevated dorsal striatal activation during symptom provocation. In contrast, the washing subgroup engaged higher activation in frontal, temporal and posterior cortical structures as well as right caudate body. Broadly consistent with the proposition of cortico-striatal-thalamic-cortical circuit dysfunction, these findings highlight potentially distinct neural circuits that may underlie the symptoms and potentially etiological subtypes of OCD.
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Affiliation(s)
- Jianping Yu
- The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, China.
| | - Ping Zhou
- Department of Medical Psychology, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, China.
| | - Shiting Yuan
- The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, China.
| | - Yun Wu
- Functional Brain Imaging Institute of Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, China.
| | - Chun Wang
- The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, China.
| | - Ning Zhang
- The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, China.
| | - Chiang-Shan R Li
- Department of Psychiatry, Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA.
| | - Na Liu
- Department of Medical Psychology, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, China.
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7
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Ahmari SE, Rauch SL. The prefrontal cortex and OCD. Neuropsychopharmacology 2022; 47:211-224. [PMID: 34400778 PMCID: PMC8617188 DOI: 10.1038/s41386-021-01130-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/13/2021] [Accepted: 07/22/2021] [Indexed: 01/03/2023]
Abstract
Obsessive Compulsive Disorder (OCD) is a highly prevalent and severe neuropsychiatric disorder, with an incidence of 1.5-3% worldwide. However, despite the clear public health burden of OCD and relatively well-defined symptom criteria, effective treatments are still limited, spotlighting the need for investigation of the neural substrates of the disorder. Human neuroimaging studies have consistently highlighted abnormal activity patterns in prefrontal cortex (PFC) regions and connected circuits in OCD during both symptom provocation and performance of neurocognitive tasks. Because of recent technical advances, these findings can now be leveraged to develop novel targeted interventions. Here we will highlight current theories regarding the role of the prefrontal cortex in the generation of OCD symptoms, discuss ways in which this knowledge can be used to improve treatments for this often disabling illness, and lay out challenges in the field for future study.
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Affiliation(s)
- Susanne E Ahmari
- Translational Neuroscience Program, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA.
- Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, USA.
| | - Scott L Rauch
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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8
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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 DOI: 10.1007/s11682-020-00358-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [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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9
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Pittenger C, Brennan BP, Koran L, Mathews CA, Nestadt G, Pato M, Phillips KA, Rodriguez CI, Simpson HB, Skapinakis P, Stein DJ, Storch EA. Specialty knowledge and competency standards for pharmacotherapy for adult obsessive-compulsive disorder. Psychiatry Res 2021; 300:113853. [PMID: 33975093 PMCID: PMC8536398 DOI: 10.1016/j.psychres.2021.113853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/01/2021] [Indexed: 12/12/2022]
Abstract
Obsessive-compulsive disorder (OCD) affects approximately one person in 40 and causes substantial suffering. Evidence-based treatments can benefit many; however, optimal treatment can be difficult to access. Diagnosis is frequently delayed, and pharmacological and psychotherapeutic interventions often fail to follow evidence-based guidelines. To ameliorate this distressing situation, the International OCD Accreditation Task Force of the Canadian Institute for Obsessive-Compulsive Disorders has developed knowledge and competency standards for specialized treatments for OCD through the lifespan. These are foundational to evidence-based practice and will form the basis for upcoming ATF development of certification/accreditation programs. Here, we present specialty standards for the pharmacological treatment of adult OCD. We emphasize the importance of integrating pharmacotherapy with clear diagnosis, appreciation of complicating factors, and evidence-based cognitive behavioral therapy. Clear evidence exists to inform first- and second-line pharmacological treatments. In disease refractory to these initial efforts, multiple strategies have been investigated, but the evidence is more equivocal. These standards summarize this limited evidence to give the specialist practitioner a solid basis on which to make difficult decisions in complex cases. It is hoped that further research will lead to development of a clear, multi-step treatment algorithm to support each step in clinical decision-making.
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Affiliation(s)
- Christopher Pittenger
- Department of Psychiatry and Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States.
| | - Brian P Brennan
- Biological Psychiatry Laboratory and Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Lorrin Koran
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Carol A Mathews
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Gerald Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michele Pato
- Institute for Genomic Health and Department of Psychiatry, SUNY Downstate College of Medicine, Brooklyn, NY, United States
| | - Katharine A Phillips
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, and Department of Psychiatry, Weill Cornell Medical College, New York, NY, United States
| | - Carolyn I Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - H Blair Simpson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Office of Mental Health, Research Foundation for Mental Hygiene, New York Psychiatric Institute, New York, NY, United States
| | - Petros Skapinakis
- Department of Psychiatry, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Dan J Stein
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
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10
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Abstract
Effective pharmacological and psychotherapeutic treatments are well established for obsessive-compulsive disorder (OCD). Serotonin reuptake inhibitors (SRIs) are first-line treatment and are of benefit to about half of patients. Augmentation of SRI treatment with low-dose neuroleptics is an evidence-based second-line strategy. Specialty psychotherapy is also used as both first-line and second-line treatment and can benefit many. However, a substantial number of patients do not respond to these treatments. New alternatives are urgently needed. This review summarizes evidence for these established pharmacotherapeutic strategies, and for others that have been investigated in refractory disease but are not supported by the same level of evidence. We focus on three neurotransmitter systems in the brain: serotonin, dopamine, and glutamate. We summarize evidence from genetic, neuroimaging, animal model, and other lines of investigation that probe these three systems in patients with OCD. We also review recent work on predictors of response to current treatments. While many studies suggest abnormalities that may provide insight into the pathophysiology of the disorder, most studies have been small, and non-replication of reported findings has been common. Nevertheless, the gradual accrual of evidence for neurotransmitter dysregulation may in time lead the way to new pharmacological strategies.
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11
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Zaboski BA, Stern EF, Skosnik PD, Pittenger C. Electroencephalographic Correlates and Predictors of Treatment Outcome in OCD: A Brief Narrative Review. Front Psychiatry 2021; 12:703398. [PMID: 34408681 PMCID: PMC8365146 DOI: 10.3389/fpsyt.2021.703398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/21/2021] [Indexed: 12/28/2022] Open
Abstract
Electroencephalography (EEG) measures the brain's electrical activity with high temporal resolution. In comparison to neuroimaging modalities such as MRI or PET, EEG is relatively cheap, non-invasive, portable, and simple to administer, making it an attractive tool for clinical deployment. Despite this, studies utilizing EEG to investigate obsessive-compulsive disorder (OCD) are relatively sparse. This contrasts with a robust literature using other brain imaging methodologies. The present review examines studies that have used EEG to examine predictors and correlates of response in OCD and draws tentative conclusions that may guide much needed future work. Key findings include a limited literature base; few studies have attempted to predict clinical change from EEG signals, and they are confounded by the effects of both pharmacotherapy and psychotherapy. The most robust literature, consisting of several studies, has examined event-related potentials, including the P300, which several studies have reported to be abnormal at baseline in OCD and to normalize with treatment; but even here the literature is quite heterogeneous, and more work is needed. With more robust research, we suggest that the relatively low cost and convenience of EEG, especially in comparison to fMRI and PET, make it well-suited to the development of feasible personalized treatment algorithms.
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Affiliation(s)
- Brian A Zaboski
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Elisa F Stern
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Patrick D Skosnik
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Christopher Pittenger
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, United States
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12
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Ota M, Kanie A, Kobayashi Y, Nakajima A, Sato N, Horikoshi M. Pseudo-continuous arterial spin labeling MRI study of patients with obsessive-compulsive disorder. Psychiatry Res Neuroimaging 2020; 303:111124. [PMID: 32563075 DOI: 10.1016/j.pscychresns.2020.111124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/18/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
Arterial spin labeling (ASL) magnetic resonance imaging is a novel technique that can measure regional cerebral blood flow (rCBF). Here we used pseudo-continuous ASL (pCASL) to examine the structural and functional imaging data in patients with obsessive-compulsive disorder (OCD). We estimated the gray matter volume imaging and pCASL imaging data by means of a voxel-by-voxel statistical analysis. We evaluated the differences of rCBF and gray matter volume between the OCD patients and healthy subjects. We detected a significant rCBF reduction in OCD patients in the right posterior cingulate extending to the lingual gyrus, thalamus, and hippocampus, and a significant increase in the left temporal gyrus and left frontal white matter region, compared with healthy subjects. We also observed a significant reduction in gray matter volume of OCD patients in the right hippocampus. We also estimated the correlation between the clinical severity of OCD and the rCBF and gray matter volumes, and found significant negative correlations between the severity of illness and the regional gray matter volume in the bilateral anterior cingulate corti. Our study demonstrated significant changes of rCBF in the cortico-striato-thalamo-cortical pathway around the hippocampus in OCD patients. These findings may help to elucidate the pathogenesis of OCD.
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Affiliation(s)
- Miho Ota
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8502, Japan; Department of Neuropsychiatry, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8576, Japan.
| | - Ayako Kanie
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8502, Japan
| | - Yuki Kobayashi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8502, Japan
| | - Aiichiro Nakajima
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8502, Japan
| | - Noriko Sato
- Department of Radiology, National Center of Neurology and Psychiatry, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8502, Japan
| | - Masaru Horikoshi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8502, Japan
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13
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Fajnerova I, Gregus D, Francova A, Noskova E, Koprivova J, Stopkova P, Hlinka J, Horacek J. Functional Connectivity Changes in Obsessive-Compulsive Disorder Correspond to Interference Control and Obsessions Severity. Front Neurol 2020; 11:568. [PMID: 32973642 PMCID: PMC7468468 DOI: 10.3389/fneur.2020.00568] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 05/19/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction: Deficits in neurocognitive mechanisms such as inhibition control and cognitive flexibility have been suggested to mediate the symptoms in obsessive-compulsive disorder (OCD). These mechanisms are proposedly controlled by the "affective" and "executive" orbitofronto-striato-thalamo-cortical (CSTC) circuits with well-documented morphological and functional alterations in OCD that are associated with OCD symptoms. The precuneus region has been suggested in OCD as another key structure associated with the mechanism of "thought-action fusion." Our study aimed to elucidate the association of the altered functional coupling of the CSTC nodes (and precuneus), the OCD symptoms, and interference control/cognitive flexibility. Methods: In a group of 36 (17 medicated and 19 drug-free) OCD patients and matched healthy volunteers, we tested functional connectivity (FC) within the constituents of the dorsolateral prefrontal cortex "executive" CSTC, the orbitofrontal cortex/anterior cingulate "affective" CSTC, and precuneus. The functional connections showing the strongest effects were subsequently entered as explanatory variables to multiple regression analyses to identify possible associations between observed alterations of functional coupling and cognitive (Stroop test) and clinical measures (obsessions, compulsions, and anxiety level). Results: We observed increased FC (FWE p < 0.05 corr.) between CSTC seeds and regions of the parieto-occipital cortex, and between the precuneus and the angular gyrus and dorsolateral prefrontal cortex. Decreased FC was observed within the CSTC loop (caudate nucleus and thalamus) and between the anterior cingulate cortex and the limbic lobe. Linear regression identified a relationship between the altered functional coupling of thalamus with the right somatomotor parietal cortex and the Stroop color-word score. Similar association of thalamus FC has been identified also for obsessions severity. No association was observed for compulsions and anxiety. Conclusions: Our findings demonstrate altered FC in OCD patients with a prevailing increase in FC originating in CSTC regions toward other cortical areas, and a decrease in FC within the constituents of CSTC loops. Moreover, our results support the role of precuneus in OCD. The association of the cognitive and clinical symptoms with the FC between the thalamus and somatomotor cortex indicates that cognitive flexibility and inhibitory control are strongly linked and both mechanisms might contribute to the symptomatology of OCD.
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Affiliation(s)
- Iveta Fajnerova
- National Institute of Mental Health (NIMH), Klecany, Czechia
| | - David Gregus
- National Institute of Mental Health (NIMH), Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Anna Francova
- National Institute of Mental Health (NIMH), Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Eliska Noskova
- National Institute of Mental Health (NIMH), Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Jana Koprivova
- National Institute of Mental Health (NIMH), Klecany, Czechia
| | - Pavla Stopkova
- National Institute of Mental Health (NIMH), Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Jaroslav Hlinka
- National Institute of Mental Health (NIMH), Klecany, Czechia.,Institute of Computer Science, Czech Academy of Sciences, Prague, Czechia
| | - Jiri Horacek
- National Institute of Mental Health (NIMH), Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
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14
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Drăgoi AM, Pecie LG, Patrichi BE, Ladea M. Morphopathological changes in obsessive-compulsive disorder. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2020; 61:51-60. [PMID: 32747895 PMCID: PMC7728136 DOI: 10.47162/rjme.61.1.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The pathophysiology of the obsessive-compulsive disorder (OCD) has been studied for many years using several structural magnetic resonance imaging, discovering that the anomalies of function and structure of the brain are widespread, they involve different areas, structures and circuits with a complex interconnectivity. More than that, these anomalies cover all the life of a patient, from early childhood, due to variations of developmental stages until adult life. The research is highly important also because OCD has a major hereditary factor, with the phenotype variance between 27–47% due to hereditary factors. Under this paper, that follows last 10 years studies in this area, we will find some relevant findings consisting on neuroanatomic changes, the morphology findings of striatum, globus pallidus and thalamus, the blood flow circuit changes in various regions of the brain, brain connectivity and various correlations of them. Not to forget that OCD must be understand as an emotional disorder but in the same time as a cognitive disorder too. This approach highlights the abnormalities that have been found in brain regions involved in the cognitive and emotional behavior, as for example: extended temporal, parietal, and occipital regions, anterior cingulate, frontal gyrus, amygdala.
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Affiliation(s)
- Ana Miruna Drăgoi
- Department of Psychiatry, Prof. Dr. Alexandru Obregia Clinical Hospital for Psychiatry, Bucharest, Romania;
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15
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Jacobs E. A potential role for psilocybin in the treatment of obsessive-compulsive disorder. JOURNAL OF PSYCHEDELIC STUDIES 2020. [DOI: 10.1556/2054.2020.00128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AbstractThe recent revivification of interest in the therapeutic use of psychedelics has had a particular focus on mood disorders and addiction, although there is reason to think these drugs may be effective more widely. After outlining pertinent aspects of psilocybin and obsessive-compulsive disorder (OCD), the current review summarizes the evidence indicating that there may be a role for psilocybin in the treatment of OCD, as well as highlighting a range of potential therapeutic mechanisms that reflect the action of psilocybin on brain function. Although the current evidence is limited, that multiple signals point in directions consistent with treatment potential, alongside the psychological and physiological safety of clinically administered psilocybin, support the expansion of research, both in animal models and in further randomized controlled trials, to properly investigate this potential.
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Affiliation(s)
- Edward Jacobs
- 1Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- 2Department of Psychiatry, University of Oxford, Oxford, UK
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16
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Abstract
PURPOSE OF REVIEW To give an update on recent imaging studies probing positron emission tomography (PET) as a tool for improving biomarker-guided diagnosis of neuropsychiatric disorders. RECENT FINDINGS Several studies confirmed the value of imaging of regional neuronal activity and imaging of dopaminergic, serotonergic, and other neuroreceptor function in the diagnostic process of neuropsychiatric disorders, particularly schizophrenia, depression/bipolar disorder, substance use disorders, obsessive compulsive disorders (OCD), and attention-deficit/hyperactivity disorder. Additionally, imaging brain microglial activation using translocator protein 18 kDa (TSPO) radiotracer allows for unique in-vivo insights into pathophysiological neuroinflammatory changes underlying schizophrenia, affective disorders, and OCD. SUMMARY The role of PET imaging in the biomarker-guided diagnostic process of neuropsychiatric disorders has been increasingly acknowledged in recent years. Future prospective studies are needed to define the value of PET imaging for diagnosis, treatment decisions, and prognosis in neuropsychiatric disorders.
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17
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Transcranial direct current stimulation in patients with obsessive
compulsive disorder: A randomized controlled trial. Eur Psychiatry 2020; 62:38-44. [DOI: 10.1016/j.eurpsy.2019.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/13/2019] [Accepted: 08/26/2019] [Indexed: 01/27/2023] Open
Abstract
Abstract
Background:
Obsessive-compulsive disorder (OCD) is a severe mental disorder with
poor response to the available treatments. Neuroimaging studies have
identified dysfunctions within the
orbito-fronto-striato-pallido-thalamic network in patients with OCD.
Here, we assessed the efficacy and safety of transcranial direct current
stimulation (tDCS) applied with the cathode over the orbitofrontal
cortex (OFC) and the anode over the right cerebellum to decrease OCD
symptoms in patients with treatment-resistant OCD.
Methods:
In a randomized sham-controlled double-blind study, 21 patients with
OCD were assigned to receive ten 20-min sessions (two sessions per day)
of either active (2 mA) or sham tDCS. The clinical symptoms were
measured using the Yale-Brown Obsessive and Compulsive Scale (YBOCS).
Acute effects on the symptoms were measured from baseline to immediately
after the 10 tDCS sessions. Long-lasting effects were measured 1 and 3
months after the 10th tDCS session.
Results:
Compared with the sham tDCS, active tDCS significantly decreased OCD
symptoms immediately after the 10th tDCS session
(F(1,19) = 5.26, p = 0.03). However, no
significant differences were observed between the active and sham groups
in terms of changes in YBOCS score or the number of responders one and 3
months after tDCS.
Conclusion:
Despite significant acute effects, tDCS with the cathode placed over
the left OFC and the anode placed over the right cerebellum was not
significantly effective in inducing a long-lasting reduction of symptoms
in patients with treatment-resistant OCD.
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18
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Kim M, Kwak S, Yoon YB, Kwak YB, Kim T, Cho KIK, Lee TY, Kwon JS. Functional connectivity of the raphe nucleus as a predictor of the response to selective serotonin reuptake inhibitors in obsessive-compulsive disorder. Neuropsychopharmacology 2019; 44:2073-2081. [PMID: 31189178 PMCID: PMC6898154 DOI: 10.1038/s41386-019-0436-2] [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: 03/19/2019] [Revised: 05/06/2019] [Accepted: 06/03/2019] [Indexed: 11/10/2022]
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are first-line pharmacological agents for treating obsessive-compulsive disorder (OCD). However, because nearly half of patients show insufficient SSRI responses, serotonergic dysfunction in heterogeneous OCD patients should be investigated for precision medicine. We aimed to determine whether functional connectivity (FC) of the raphe nucleus (RN), the major source of most serotonergic neurons, was altered in OCD patients and could predict the SSRI response. A total of 102 medication-free OCD patients and 101 matched healthy control (HC) subjects participated in resting-state functional magnetic resonance imaging. Among them, 54 OCD patients were treated with SSRIs for 16 weeks, resulting in 26 responders and 28 nonresponders. Seed-based whole brain FC with the RN as a seed region was compared between the OCD and HC groups, as well as between SSRI responders and nonresponders. FC cluster values showing significant group differences were used to investigate factors correlated with symptomatic severity before treatment and predictive of SSRI response. Compared to HCs, OCD patients exhibited significantly larger FC between the RN and temporal cortices including the middle temporal gyrus (MTG), paracingulate gyrus, amygdala, hippocampus, putamen, thalamus, and brain stem. Greater RN-left MTG FC was positively correlated with OC symptom severity at baseline. In addition, larger FC of the RN-left MTG was also found in SSRI nonresponders compared to responders, which was a significant predictor of SSRI response after 16 weeks. The FC of RN may reflect the neurobiological underpinning of OCD and could aid future precision medicine as a differential brain-based biomarker.
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Affiliation(s)
- Minah Kim
- 0000 0001 0302 820Xgrid.412484.fDepartment of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea ,0000 0004 0470 5905grid.31501.36Department of Psychiatry, Seoul National University College of Medicine, 101 Daehak-no, Chongno-gu, Seoul, 03080 Republic of Korea
| | - Seoyeon Kwak
- 0000 0004 0470 5905grid.31501.36Department of Brain and Cognitive Sciences, Seoul National University College of Natural Science, Seoul, Republic of Korea
| | - Youngwoo Bryan Yoon
- 0000 0001 2355 7002grid.4367.6Department of Psychiatry, Washington University in St. Louis, St. Louis, MO USA
| | - Yoo Bin Kwak
- 0000 0004 0470 5905grid.31501.36Department of Brain and Cognitive Sciences, Seoul National University College of Natural Science, Seoul, Republic of Korea
| | - Taekwan Kim
- 0000 0004 0470 5905grid.31501.36Department of Brain and Cognitive Sciences, Seoul National University College of Natural Science, Seoul, Republic of Korea
| | - Kang Ik K. Cho
- 0000 0004 0470 5905grid.31501.36Department of Brain and Cognitive Sciences, Seoul National University College of Natural Science, Seoul, Republic of Korea
| | - Tae Young Lee
- 0000 0001 0302 820Xgrid.412484.fDepartment of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea. .,Department of Psychiatry, Seoul National University College of Medicine, 101 Daehak-no, Chongno-gu, Seoul, 03080, Republic of Korea. .,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Science, Seoul, Republic of Korea. .,Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea.
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19
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Manning EE, Dombrovski AY, Torregrossa MM, Ahmari SE. Impaired instrumental reversal learning is associated with increased medial prefrontal cortex activity in Sapap3 knockout mouse model of compulsive behavior. Neuropsychopharmacology 2019; 44:1494-1504. [PMID: 30587851 PMCID: PMC6785097 DOI: 10.1038/s41386-018-0307-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/12/2018] [Accepted: 12/04/2018] [Indexed: 01/29/2023]
Abstract
Convergent functional neuroimaging findings implicate hyperactivity across the prefrontal cortex (PFC) and striatum in the neuropathology of obsessive compulsive disorder (OCD). The impact of cortico-striatal circuit hyperactivity on executive functions subserved by these circuits is unclear, because impaired recruitment of PFC has also been observed in OCD patients during paradigms assessing cognitive flexibility. To investigate the relationship between cortico-striatal circuit disturbances and cognitive functioning relevant to OCD, Sapap3 knockout mice (KOs) and littermate controls were tested in an instrumental reversal-learning paradigm to assess cognitive flexibility. Cortical and striatal activation associated with reversal learning was assessed via quantitative analysis of expression of the immediate early gene cFos and generalized linear mixed-effects models. Sapap3-KOs displayed heterogeneous reversal-learning performance, with almost half (n = 13/28) failing to acquire the reversed contingency, while the other 15/28 had similar acquisition as controls. Notably, reversal impairments were not correlated with compulsive grooming severity. cFos analysis revealed that reversal performance declined as medial PFC (mPFC) activity increased in Sapap3-KOs. No such relationship was observed in controls. Our studies are among the first to describe cognitive impairments in a transgenic OCD-relevant model, and demonstrate pronounced heterogeneity among Sapap3-KOs. These findings suggest that increased neural activity in mPFC is associated with impaired reversal learning in Sapap3-KOs, providing a likely neural basis for this observed heterogeneity. The Sapap3-KO model is thus a useful tool for future mechanistic studies to determine how mPFC hyperactivity contributes to OCD-relevant cognitive dysfunction.
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Affiliation(s)
- Elizabeth E Manning
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15219, USA
- Translational Neuroscience Program, University of Pittsburgh, Pittsburgh, PA, 15219, USA
- Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, 15219, USA
| | - Alexandre Y Dombrovski
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15219, USA
- Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, 15219, USA
| | - Mary M Torregrossa
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15219, USA
- Translational Neuroscience Program, University of Pittsburgh, Pittsburgh, PA, 15219, USA
| | - Susanne E Ahmari
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15219, USA.
- Translational Neuroscience Program, University of Pittsburgh, Pittsburgh, PA, 15219, USA.
- Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, 15219, USA.
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20
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Pujol J, Blanco-Hinojo L, Maciá D, Alonso P, Harrison BJ, Martínez-Vilavella G, Deus J, Menchón JM, Cardoner N, Soriano-Mas C. Mapping Alterations of the Functional Structure of the Cerebral Cortex in Obsessive–Compulsive Disorder. Cereb Cortex 2019; 29:4753-4762. [DOI: 10.1093/cercor/bhz008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 12/18/2022] Open
Abstract
AbstractWe mapped alterations of the functional structure of the cerebral cortex using a novel imaging approach in a sample of 160 obsessive–compulsive disorder (OCD) patients. Whole-brain functional connectivity maps were generated using multidistance measures of intracortical neural activity coupling defined within isodistant local areas. OCD patients demonstrated neural activity desynchronization within the orbitofrontal cortex and in primary somatosensory, auditory, visual, gustatory, and olfactory areas. Symptom severity was significantly associated with the degree of functional structure alteration in OCD-relevant brain regions. By means of a novel imaging perspective, we once again identified brain alterations in the orbitofrontal cortex, involving areas purportedly implicated in the pathophysiology of OCD. However, our results also indicated that weaker intracortical activity coupling is also present in each primary sensory area. On the basis of previous neurophysiological studies, such cortical activity desynchronization may best be interpreted as reflecting deficient inhibitory neuron activity and altered sensory filtering.
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Affiliation(s)
- Jesus Pujol
- MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain
| | - Laura Blanco-Hinojo
- MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain
| | - Dídac Maciá
- MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain
| | - Pino Alonso
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, Spain
| | - Ben J Harrison
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | | | - Joan Deus
- MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain
- Department of Clinical and Health Psychology, Autonomous University of Barcelona, Spain
| | - José M Menchón
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, Spain
| | - Narcís Cardoner
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain
- Mental Health Department, Parc Taulí Sabadell University Hospital, Institut d’Investigació i Innovació Sanitària Parc Taulí (I3PT), Barelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Spain
| | - Carles Soriano-Mas
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Spain
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21
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Hazari N, Narayanaswamy JC, Venkatasubramanian G. Neuroimaging findings in obsessive-compulsive disorder: A narrative review to elucidate neurobiological underpinnings. Indian J Psychiatry 2019; 61:S9-S29. [PMID: 30745673 PMCID: PMC6343409 DOI: 10.4103/psychiatry.indianjpsychiatry_525_18] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Obsessive compulsive disorder (OCD) is a common psychiatric illness and significant research has been ongoing to understand its neurobiological basis. Neuroimaging studies right from the 1980s have revealed significant differences between OCD patients and healthy controls. Initial imaging findings showing hyperactivity in the prefrontal cortex (mainly orbitofrontal cortex), anterior cingulate cortex and caudate nucleus led to the postulation of the cortico-striato-thalamo-cortical (CSTC) model for the neurobiology of OCD. However, in the last two decades emerging evidence suggests the involvement of widespread associative networks, including regions of the parietal cortex, limbic areas (including amygdala) and cerebellum. This narrative review discusses findings from structural [Magnetic Resonance Imaging (MRI), Diffusion Tensor Imaging(DTI)], functional [(functional MRI (fMRI), Single photon emission computed tomography (SPECT), Positron emission tomography (PET), functional near-infrared spectroscopy (fNIRS)], combined structural and functional imaging studies and meta-analyses. Subsequently, we collate these findings to describe the neurobiology of OCD including CSTC circuit, limbic system, parietal cortex, cerebellum, default mode network and salience network. In future, neuroimaging may emerge as a valuable tool for personalised medicine in OCD treatment.
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Affiliation(s)
- Nandita Hazari
- Department of Psychiatry, Vidyasagar Institute of Mental Health and Neurosciences, Delhi, India
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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22
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Transcranial Direct Current Stimulation for Obsessive-Compulsive Disorder: A Systematic Review. Brain Sci 2018; 8:brainsci8020037. [PMID: 29495298 PMCID: PMC5836056 DOI: 10.3390/brainsci8020037] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/19/2018] [Accepted: 02/23/2018] [Indexed: 11/26/2022] Open
Abstract
Despite the advances in psychopharmacology and established psychotherapeutic interventions, more than 40% of patients with obsessive-compulsive disorder (OCD) do not respond to conventional treatment approaches. Transcranial direct current stimulation (tDCS) has been recently proposed as a therapeutic tool to alleviate treatment-resistant symptoms in patients with OCD. The aim of this review was to provide a comprehensive overview of the current state of the art and future clinical applications of tDCS in patients with OCD. A literature search conducted on the PubMed database following PRISMA guidelines and completed by a manual search yielded 12 results: eight case reports, three open-label studies (with 5, 8, and 42 participants), and one randomized trial with two active conditions (12 patients). There was no sham-controlled study. A total of 77 patients received active tDCS with a large diversity of electrode montages mainly targeting the dorsolateral prefrontal cortex, the orbitofrontal cortex or the (pre-) supplementary motor area. Despite methodological limitations and the heterogeneity of stimulation parameters, tDCS appears to be a promising tool to decrease obsessive-compulsive symptoms as well as comorbid depression and anxiety in patients with treatment-resistant OCD. Further sham-controlled studies are needed to confirm these preliminary results.
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23
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Manning EE, Ahmari SE. How can preclinical mouse models be used to gain insight into prefrontal cortex dysfunction in obsessive-compulsive disorder? Brain Neurosci Adv 2018; 2:2398212818783896. [PMID: 32166143 PMCID: PMC7058260 DOI: 10.1177/2398212818783896] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/18/2018] [Indexed: 01/09/2023] Open
Abstract
Obsessive-compulsive disorder is a debilitating psychiatric disorder that is characterised by perseverative thoughts and behaviours. Cognitive and affective disturbances play a central role in this illness, and it is therefore not surprising that clinical neuroimaging studies have demonstrated widespread alterations in prefrontal cortex functioning in patients. Preclinical mouse experimental systems provide the opportunity to gain mechanistic insight into the neurobiological changes underlying prefrontal cortex dysfunction through new technologies that allow measurement and manipulation of activity in discrete neural populations in awake, behaving mice. However, recent preclinical research has focused on striatal dysfunction, and has therefore provided relatively little insight regarding the role of the prefrontal cortex in obsessive-compulsive disorder-relevant behaviours. Here, we will discuss a number of translational prefrontal cortex-dependent paradigms, including obsessive-compulsive disorder-relevant tasks that produce compulsive responding, and how they can be leveraged in this context. Drawing on recent examples that have led to mechanistic insight about specific genes, cell types and circuits that mediate prefrontal cortex contributions to distinct aspects of cognition, we will provide a framework for applying similar strategies to identify neural mechanisms underlying obsessive-compulsive disorder-relevant behavioural domains. We propose that research using clinically relevant paradigms will accelerate translation of findings from preclinical mouse models, thus supporting the development of novel therapeutics targeted to specific pathophysiological mechanisms.
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Affiliation(s)
| | - Susanne E. Ahmari
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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