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Aarts I, Thorsen AL, Vriend C, Planting C, van den Heuvel OA, Thomaes K. Effects of psychotherapy on brain activation during negative emotional processing in patients with posttraumatic stress disorder: a systematic review and meta-analysis. Brain Imaging Behav 2023:10.1007/s11682-023-00831-0. [PMID: 38049598 DOI: 10.1007/s11682-023-00831-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/06/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a debilitating condition which has been related to problems in emotional regulation, memory and cognitive control. Psychotherapy has a non-response rate of around 50% and understanding the neurobiological working mechanisms might help improve treatment. To integrate findings from multiple smaller studies, we performed the first meta-analysis of changes in brain activation with a specific focus on emotional processing after psychotherapy in PTSD patients. We performed a meta-analysis of brain activation changes after treatment during emotional processing for PTSD with seed-based d mapping using a pre-registered protocol (PROSPERO CRD42020211039). We analyzed twelve studies with 191 PTSD patients after screening 3700 studies. We performed systematic quality assessment both for the therapeutic interventions and neuroimaging methods. Analyses were done in the full sample and in a subset of studies that reported whole-brain results. We found decreased activation after psychotherapy in the left amygdala, (para)hippocampus, medial temporal lobe, inferior frontal gyrus, ventrolateral prefrontal cortex, right pallidum, anterior cingulate cortex, bilateral putamen, and insula. Decreased activation in the left amygdala and left ventrolateral PFC was also found in eight studies that reported whole-brain findings. Results did not survive correction for multiple comparisons. There is tentative support for decreased activation in the fear and cognitive control networks during emotional processing after psychotherapy for PTSD. Future studies would benefit from adopting a larger sample size, using designs that control for confounding variables, and investigating heterogeneity in symptom profiles and treatment response.
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Affiliation(s)
- Inga Aarts
- Sinai Centrum, Arkin, Amstelveen, The Netherlands.
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands.
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands.
| | - A L Thorsen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - C Vriend
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention program, Amsterdam, The Netherlands
| | - C Planting
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- Vrije Universiteit Amsterdam, University Library, Amsterdam, The Netherlands
| | - O A van den Heuvel
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention program, Amsterdam, The Netherlands
| | - K Thomaes
- Sinai Centrum, Arkin, Amstelveen, The Netherlands
- Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
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2
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Hjelle KM, Eide TO, Thorsen AL, Kvale G, Hagen K, Snorrason I, Björgvinsson T, Hansen B. The Bergen 4-day treatment for panic disorder: adapting to COVID-19 restrictions with a hybrid approach of face-to-face and videoconference modalities. BMC Psychiatry 2023; 23:570. [PMID: 37550696 PMCID: PMC10408203 DOI: 10.1186/s12888-023-05062-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/28/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND The Bergen 4-day treatment (B4DT) is a concentrated exposure-based therapy that has been shown to be effective in the treatment of anxiety disorders. The current study sought to examine the effectiveness of B4DT for panic disorder (PD), when delivered with a combination of face-to-face sessions and videoconferencing. METHODS Treatment was delivered to 50 patients from April 2020 to May 2021. Because of regulations during the pandemic, a significant portion of the treatment was conducted via videoconference. The primary outcome measure was the clinician-rated Panic Disorder Severity Scale (PDSS), and secondary measures included patient-rated symptoms of panic disorder, agoraphobia, generalized anxiety, depression, and treatment satisfaction. Changes in symptom levels over time were estimated using multilevel models. RESULTS Patients showed a significant reduction in clinician-rated symptoms of panic disorder (Measured by PDSS) from before treatment to post treatment (d = 2.18) and 3-month follow-up (d = 2.01). At three months follow-up 62% of patients were classified as in remission, while 70% reported a clinically significant response. We also found a reduction in symptoms of depression and generalized anxiety, and the patients reported high satisfaction with the treatment. CONCLUSION The current study suggests that B4DT delivered in a combination of videoconference and face-to-face meetings may be a useful treatment approach. As the study is uncontrolled, future studies should also include more strictly designed investigations.
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Affiliation(s)
- Kay Morten Hjelle
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway.
| | - Thorstein Olsen Eide
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Møre and Romsdal Hospital Trust, Molde, Norway
| | - Anders Lillevik Thorsen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Gerd Kvale
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Kristen Hagen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Møre and Romsdal Hospital Trust, Molde, Norway
| | - Ivar Snorrason
- Center for OCD and Related Disorders, Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | | | - Bjarne Hansen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
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3
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Bertolín S, Alonso P, Martínez-Zalacaín I, Menchón JM, Jimenez-Murcia S, Baker JT, Bargalló N, Batistuzzo MC, Boedhoe PSW, Brennan BP, Feusner JD, Fitzgerald KD, Fontaine M, Hansen B, Hirano Y, Hoexter MQ, Huyser C, Jahanshad N, Jaspers-Fayer F, Kuno M, Kvale G, Lazaro L, Machado-Sousa M, Marsh R, Morgado P, Nakagawa A, Norman L, Nurmi EL, O'Neill J, Ortiz AE, Perriello C, Piacentini J, Picó-Pérez M, Shavitt RG, Shimizu E, Simpson HB, Stewart SE, Thomopoulos SI, Thorsen AL, Walitza S, Wolters LH, Thompson PM, van den Heuvel OA, Stein DJ, Soriano-Mas C. Right Prefrontal Cortical Thickness Is Associated With Response to Cognitive-Behavioral Therapy in Children With Obsessive-Compulsive Disorder. J Am Acad Child Adolesc Psychiatry 2023; 62:403-414. [PMID: 36526161 PMCID: PMC10065927 DOI: 10.1016/j.jaac.2022.07.865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/26/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Cognitive-behavioral therapy (CBT) is considered a first-line treatment for obsessive-compulsive disorder (OCD) in pediatric and adult populations. Nevertheless, some patients show partial or null response. The identification of predictors of CBT response may improve clinical management of patients with OCD. Here, we aimed to identify structural magnetic resonance imaging (MRI) predictors of CBT response in 2 large series of children and adults with OCD from the worldwide ENIGMA-OCD consortium. METHOD Data from 16 datasets from 13 international sites were included in the study. We assessed which variations in baseline cortical thickness, cortical surface area, and subcortical volume predicted response to CBT (percentage of baseline to post-treatment symptom reduction) in 2 samples totaling 168 children and adolescents (age range 5-17.5 years) and 318 adult patients (age range 18-63 years) with OCD. Mixed linear models with random intercept were used to account for potential cross-site differences in imaging values. RESULTS Significant results were observed exclusively in the pediatric sample. Right prefrontal cortex thickness was positively associated with the percentage of CBT response. In a post hoc analysis, we observed that the specific changes accounting for this relationship were a higher thickness of the frontal pole and the rostral middle frontal gyrus. We observed no significant effects of age, sex, or medication on our findings. CONCLUSION Higher cortical thickness in specific right prefrontal cortex regions may be important for CBT response in children with OCD. Our findings suggest that the right prefrontal cortex plays a relevant role in the mechanisms of action of CBT in children.
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Affiliation(s)
- Sara Bertolín
- Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain; CIBERSAM, Barcelona, Spain
| | - Pino Alonso
- Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain; CIBERSAM, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Ignacio Martínez-Zalacaín
- Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Jose M Menchón
- Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain; CIBERSAM, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Susana Jimenez-Murcia
- Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain; University of Barcelona, Barcelona, Spain; CIBERobn, ISCIII, Spain
| | - Justin T Baker
- McLean Hospital, Belmont, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Nuria Bargalló
- CIBERSAM, Barcelona, Spain; University of Barcelona, Barcelona, Spain; Image Diagnostic Center, Hospital Clinic, Barcelona, Spain; Magnetic Resonance Image Core Facility (IDIBAPS), Barcelona, Spain
| | - Marcelo Camargo Batistuzzo
- Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil; Pontificial Catholic University of Sao Paulo, Brazil
| | | | - Brian P Brennan
- McLean Hospital, Belmont, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jamie D Feusner
- University of California Los Angeles, Los Angeles, California; University of Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada; Karolinksa Institutet, Stockholm, Sweden
| | - Kate D Fitzgerald
- Columbia University, New York; The New York State Psychiatric Institute, New York
| | - Martine Fontaine
- Columbia University Medical College, Columbia University, New York
| | - Bjarne Hansen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Centre for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Yoshiyuki Hirano
- 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, Suita, Japan
| | - Marcelo Q Hoexter
- Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil; LiNC - Laboratory of Integrative Neuroscience of Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Chaim Huyser
- Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands; Amsterdam UMC, Amsterdam, the Netherlands
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, California
| | - Fern Jaspers-Fayer
- University of British Columbia, Vancouver, Canada; British Columbia Children's Hospital Research Institute, Vancouver, Canada
| | - Masaru Kuno
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Gerd Kvale
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; University of Bergen, Bergen, Norway
| | - Luisa Lazaro
- CIBERSAM, Barcelona, Spain; University of Barcelona, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Hospital Clínic, Barcelona, Spain
| | - Mafalda Machado-Sousa
- 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
| | - Rachel Marsh
- The New York State Psychiatric Institute, New York; Columbia University Medical College, Columbia University, New York
| | - Pedro Morgado
- 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
| | - Akiko Nakagawa
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | | | - Erika L Nurmi
- University of California Los Angeles, Los Angeles, California
| | - Joseph O'Neill
- UCLA Division of Child and Adolescent Psychiatry, Los Angeles, California; UCLA Brain Research Institute, Los Angeles, California
| | - Ana E Ortiz
- IDIBAPS, Barcelona, Spain; Hospital Clínic, Barcelona, Spain
| | - Chris Perriello
- University of Illinois at Urbana Champaign, Champaign, Illinois
| | - John Piacentini
- UCLA Division of Child and Adolescent Psychiatry, Los Angeles, California; UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - 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
| | - Roseli G Shavitt
- Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - 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, Suita, Japan
| | - Helen Blair Simpson
- The New York State Psychiatric Institute, New York; Columbia University Medical College, Columbia University, New York
| | - S Evelyn Stewart
- University of British Columbia, Vancouver, Canada; British Columbia Children's Hospital Research Institute, Vancouver, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, Canada
| | - Sophia I Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, California
| | - Anders Lillevik Thorsen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Centre for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Susanne Walitza
- University Hospital of Psychiatry Zurich, University of Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, Switzerland
| | - Lidewij H Wolters
- Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, California
| | - Odile A van den Heuvel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Dan J Stein
- SAMRC Unit on Risk and Resilience in Mental Disorders, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Carles Soriano-Mas
- Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain; CIBERSAM, Barcelona, Spain; University of Barcelona, Barcelona, Spain.
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4
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Jaspers-Fayer F, Lin SY, Best JR, Thorsen AL, Negreiros J, Chan E, Ellwyn R, Lin B, de Wit S, van den Heuvel OA, Stewart SE. An fMRI study of cognitive planning before and after symptom provocation in pediatric obsessive-compulsive disorder. J Psychiatry Neurosci 2022; 47:E409-E420. [PMID: 36414328 PMCID: PMC9710544 DOI: 10.1503/jpn.220064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/29/2022] [Accepted: 08/27/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pediatric obsessive-compulsive disorder (OCD) has been associated with poorer planning in laboratory, school and home settings. It is unclear whether this impairment is a standalone cognitive issue or the result of OCD symptoms. No study has examined the influence of provoked distress on planning performance and neural correlates in pediatric OCD. METHODS Before and after a symptom provocation task, youth with OCD (n = 23; 9 boys; mean age ± standard deviation 15.1 ± 2.6 years) and matched healthy controls (n = 23) completed the Tower of London task during functional MRI scanning. RESULTS During planning, participants with OCD recruited the left superior frontal gyrus to a greater extent than healthy controls after symptom provocation (group × time point interaction; t 44 = 5.22, p < 0.001). In a seeded, region of interest-constrained, functional connectivity analysis, we identified greater connectivity between the left superior frontal gyrus and the right middle frontal gyrus, left precuneus and left inferior parietal lobule in participants with OCD than healthy controls. We also identified greater connectivity between the right amygdala and right medial frontal gyrus in patients with OCD than healthy controls, but only before symptom provocation. LIMITATIONS The fixed-order design of the study and the number of participants taking medication (n = 20) should be noted. CONCLUSION Participants with OCD demonstrated greater amygdalar-cortical connectivity before symptom provocation, while sustaining greater recruitment and connectivity of task-related planning areas throughout the task. These results suggest that brain activity and connectivity is altered after symptom provocation, in the absence of impaired planning performance.
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Affiliation(s)
- Fern Jaspers-Fayer
- From the Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, B.C. (Jaspers-Fayer, S. Yao Lin, Best, Negreiros, Chan, Ellwyn, B. Lin, Stewart); the British Columbia Children's Hospital Research Institute, Vancouver, B.C. (Jaspers-Fayer, S. Yao Lin, Best, Negreiros, Chan, Ellwyn, B. Lin, Stewart); the Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway (Thorsen, van den Heuvel); the Centre for Crisis Psychology, University of Bergen, Bergen, Norway (Thorsen); the Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy and Neuroscience, Amsterdam Neuroscience, Amsterdam, Netherlands (de Wit, van den Heuvel); the British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, B.C. (Stewart)
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5
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Weeland CJ, Kasprzak S, de Joode NT, Abe Y, Alonso P, Ameis SH, Anticevic A, Arnold PD, Balachander S, Banaj N, Bargallo N, Batistuzzo MC, Benedetti F, Beucke JC, Bollettini I, Brecke V, Brem S, Cappi C, Cheng Y, Cho KIK, Costa DLC, Dallaspezia S, Denys D, Eng GK, Ferreira S, Feusner JD, Fontaine M, Fouche JP, Grazioplene RG, Gruner P, He M, Hirano Y, Hoexter MQ, Huyser C, Hu H, Jaspers-Fayer F, Kathmann N, Kaufmann C, Kim M, Koch K, Bin Kwak Y, Kwon JS, Lazaro L, Li CSR, Lochner C, Marsh R, Martínez-Zalacaín I, Mataix-Cols D, Menchón JM, Minnuzi L, Moreira PS, Morgado P, Nakagawa A, Nakamae T, Narayanaswamy JC, Nurmi EL, Ortiz AE, Pariente JC, Piacentini J, Picó-Pérez M, Piras F, Piras F, Pittenger C, Reddy YCJ, Rodriguez-Manrique D, Sakai Y, Shimizu E, Shivakumar V, Simpson HB, Soreni N, Soriano-Mas C, Sousa N, Spalletta G, Stern ER, Stevens MC, Stewart SE, Szeszko PR, Takahashi J, Tanamatis T, Tang J, Thorsen AL, Tolin D, van der Werf YD, van Marle H, van Wingen GA, Vecchio D, Venkatasubramanian G, Walitza S, Wang J, Wang Z, Watanabe A, Wolters LH, Xu X, Yun JY, Zhao Q, White T, Thompson PM, Stein DJ, van den Heuvel OA, Vriend C. The thalamus and its subnuclei-a gateway to obsessive-compulsive disorder. Transl Psychiatry 2022; 12:70. [PMID: 35190533 PMCID: PMC8861046 DOI: 10.1038/s41398-022-01823-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/06/2022] [Accepted: 01/20/2022] [Indexed: 01/01/2023] Open
Abstract
Larger thalamic volume has been found in children with obsessive-compulsive disorder (OCD) and children with clinical-level symptoms within the general population. Particular thalamic subregions may drive these differences. The ENIGMA-OCD working group conducted mega- and meta-analyses to study thalamic subregional volume in OCD across the lifespan. Structural T1-weighted brain magnetic resonance imaging (MRI) scans from 2649 OCD patients and 2774 healthy controls across 29 sites (50 datasets) were processed using the FreeSurfer built-in ThalamicNuclei pipeline to extract five thalamic subregions. Volume measures were harmonized for site effects using ComBat before running separate multiple linear regression models for children, adolescents, and adults to estimate volumetric group differences. All analyses were pre-registered ( https://osf.io/73dvy ) and adjusted for age, sex and intracranial volume. Unmedicated pediatric OCD patients (<12 years) had larger lateral (d = 0.46), pulvinar (d = 0.33), ventral (d = 0.35) and whole thalamus (d = 0.40) volumes at unadjusted p-values <0.05. Adolescent patients showed no volumetric differences. Adult OCD patients compared with controls had smaller volumes across all subregions (anterior, lateral, pulvinar, medial, and ventral) and smaller whole thalamic volume (d = -0.15 to -0.07) after multiple comparisons correction, mostly driven by medicated patients and associated with symptom severity. The anterior thalamus was also significantly smaller in patients after adjusting for thalamus size. Our results suggest that OCD-related thalamic volume differences are global and not driven by particular subregions and that the direction of effects are driven by both age and medication status.
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Affiliation(s)
- Cees J. Weeland
- grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam, The Netherlands
| | - Selina Kasprzak
- grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam, The Netherlands
| | - Niels T. de Joode
- grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam, The Netherlands
| | - Yoshinari Abe
- grid.272458.e0000 0001 0667 4960Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Pino Alonso
- grid.411129.e0000 0000 8836 0780Bellvitge Biomedical Research Insitute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain ,grid.469673.90000 0004 5901 7501CIBERSAM, Barcelona, Spain ,grid.5841.80000 0004 1937 0247Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - Stephanie H. Ameis
- grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, Ontario Canada ,grid.42327.300000 0004 0473 9646Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, ON Canada
| | - Alan Anticevic
- grid.47100.320000000419368710Departments of Psychiatry and Neuroscience, Yale University, New Haven, CT USA
| | - Paul D. Arnold
- grid.22072.350000 0004 1936 7697The Mathison Centre for Mental Health Research & Education, Departments of Psychiatry and Medical Genetics, Calgary, Canada ,grid.22072.350000 0004 1936 7697Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Srinivas Balachander
- grid.416861.c0000 0001 1516 2246OCD clinic, Department of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore, India
| | - Nerisa Banaj
- grid.417778.a0000 0001 0692 3437Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Nuria Bargallo
- grid.10403.360000000091771775Magnetic Resonance Image Core Facility, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain ,grid.410458.c0000 0000 9635 9413Image Diagnostic Center, Hospital Clinic, Barcelona, Spain
| | - Marcelo C. Batistuzzo
- grid.11899.380000 0004 1937 0722Departamento de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP Brazil ,grid.11899.380000 0004 1937 0722Department of Methods and Techniques in Psychology, Pontificial Catholic University of Sao Paulo, Sao Paulo, SP Brazil
| | - Francesco Benedetti
- grid.15496.3f0000 0001 0439 0892Vita-Salute San Raffaele University, Milano, Italy ,grid.18887.3e0000000417581884Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Jan C. Beucke
- grid.7468.d0000 0001 2248 7639Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany ,grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden ,grid.461732.5Department of Medical Psychology, Medical School Hamburg, Hamburg, Germany ,grid.461732.5Institute for Systems Medicine and Faculty of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Irene Bollettini
- grid.18887.3e0000000417581884Psychiatry and Clinical Psychobiology, Division of Neuroscience, Scientific Institute Ospedale San Raffaele, Milano, Italy
| | - Vilde Brecke
- grid.412008.f0000 0000 9753 1393Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
| | - Silvia Brem
- grid.7400.30000 0004 1937 0650Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Carolina Cappi
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai Department of Psychiatry, New York, NY USA
| | - Yuqi Cheng
- grid.414902.a0000 0004 1771 3912Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Kang Ik K. Cho
- grid.38142.3c000000041936754XPsychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA ,grid.31501.360000 0004 0470 5905Department of Brain and Cognitive Sciences, Seoul National University College of Natural Science, Seoul, Republic of Korea
| | - Daniel L. C. Costa
- grid.11899.380000 0004 1937 0722Obsessive-Compulsive Spectrum Disorders Program, Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP Brazil
| | - Sara Dallaspezia
- grid.18887.3e0000000417581884IRCCS Ospedale San Raffaele, Milano Italy Psychiatry, Milano, Italy
| | - Damiaan Denys
- grid.484519.5Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Goi Khia Eng
- grid.137628.90000 0004 1936 8753Department of Psychiatry, New York University School of Medicine, New York, NY USA ,grid.250263.00000 0001 2189 4777Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY USA
| | - Sónia Ferreira
- grid.10328.380000 0001 2159 175XLife and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal ,grid.10328.380000 0001 2159 175XICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal ,grid.512329.eClinical Academic Center - Braga, Braga, Portugal
| | - Jamie D. Feusner
- grid.17063.330000 0001 2157 2938Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Canada ,grid.19006.3e0000 0000 9632 6718Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA USA
| | - Martine Fontaine
- grid.21729.3f0000000419368729Columbia University Medical College, Columbia University, New York, NY USA
| | - Jean-Paul Fouche
- grid.7836.a0000 0004 1937 1151Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Rachael G. Grazioplene
- grid.47100.320000000419368710Department of Psychiatry, Yale University, New Haven, CT USA
| | - Patricia Gruner
- grid.47100.320000000419368710Department of Psychiatry, Yale University, New Haven, CT USA
| | - Mengxin He
- grid.414902.a0000 0004 1771 3912Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yoshiyuki Hirano
- grid.136304.30000 0004 0370 1101Research 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, Suita, Japan
| | - Marcelo Q. Hoexter
- grid.11899.380000 0004 1937 0722Departamento de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP Brazil
| | - Chaim Huyser
- Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands ,grid.509540.d0000 0004 6880 3010Amsterdam UMC, Department of Child and Adolescent Psychiatry, Amsterdam, the Netherlands
| | - Hao Hu
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fern Jaspers-Fayer
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, Canada ,grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, Canada
| | - Norbert Kathmann
- grid.7468.d0000 0001 2248 7639Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christian Kaufmann
- grid.7468.d0000 0001 2248 7639Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Minah Kim
- grid.412484.f0000 0001 0302 820XSeoul National University Hospital, Department of Neuropsychiatry, Seoul, Republic of Korea ,grid.31501.360000 0004 0470 5905Seoul National University College of Medicine, Department of Psychiatry, Seoul, Republic of Korea
| | - Kathrin Koch
- grid.6936.a0000000123222966Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität, München, Germany ,grid.6936.a0000000123222966TUM-Neuroimaging Center (TUM-NIC) of Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Yoo Bin Kwak
- grid.31501.360000 0004 0470 5905Department of Brain and Cognitive Sciences, Seoul National University College of Natural Science, Seoul, Republic of Korea
| | - Jun Soo Kwon
- grid.31501.360000 0004 0470 5905Department of Brain and Cognitive Sciences, Seoul National University College of Natural Science, Seoul, Republic of Korea ,grid.31501.360000 0004 0470 5905Seoul National University College of Medicine, Department of Psychiatry, Seoul, Republic of Korea ,grid.412484.f0000 0001 0302 820XDepartment of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea ,grid.31501.360000 0004 0470 5905Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea
| | - Luisa Lazaro
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic, IDIBAPS, Barcelona, Spain ,grid.5841.80000 0004 1937 0247Department of Medicine, University of Barcelona, Barcelona, Spain
| | | | - Christine Lochner
- grid.11956.3a0000 0001 2214 904XStellenbosch University, SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch, South Africa
| | - Rachel Marsh
- grid.21729.3f0000000419368729Columbia University Medical College, Columbia University, New York, NY USA
| | - Ignacio Martínez-Zalacaín
- grid.411129.e0000 0000 8836 0780Bellvitge Biomedical Research Insitute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain ,grid.5841.80000 0004 1937 0247Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - David Mataix-Cols
- grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden ,grid.467087.a0000 0004 0442 1056Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Jose M. Menchón
- grid.411129.e0000 0000 8836 0780Bellvitge Biomedical Research Insitute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain ,grid.469673.90000 0004 5901 7501CIBERSAM, Barcelona, Spain ,grid.5841.80000 0004 1937 0247Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - Luciano Minnuzi
- grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario Canada ,Offord Centre for Child Studies, Hamilton, Ontario Canada
| | - Pedro Silva Moreira
- grid.10328.380000 0001 2159 175XLife and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal ,grid.10328.380000 0001 2159 175XICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal ,grid.10328.380000 0001 2159 175XPsychological Neuroscience Lab, CIPsi, School of Psychology, University of Minho, Braga, Portugal
| | - Pedro Morgado
- grid.10328.380000 0001 2159 175XLife and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal ,grid.10328.380000 0001 2159 175XICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal ,grid.512329.eClinical Academic Center-Braga (2CA), Braga, Portugal ,grid.436922.80000 0004 4655 1975Hospital de Braga, Braga, Portugal
| | - Akiko Nakagawa
- grid.136304.30000 0004 0370 1101Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Takashi Nakamae
- grid.272458.e0000 0001 0667 4960Graduate School of Medical Science Kyoto Prefectural University of Medicine, Department of Psychiatry, Kyoto, Japan
| | - Janardhanan C. Narayanaswamy
- grid.416861.c0000 0001 1516 2246OCD clinic, Department of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore, India
| | - Erika L. Nurmi
- grid.19006.3e0000 0000 9632 6718Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA USA
| | - Ana E. Ortiz
- grid.410458.c0000 0000 9635 9413Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, Barcelona, Spain ,grid.10403.360000000091771775Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jose C. Pariente
- grid.10403.360000000091771775Magnetic Resonance Image Core Facility, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - John Piacentini
- grid.19006.3e0000 0000 9632 6718UCLA Semel Institute, Division of Child and Adolescent Psychiatry, Los Angeles, CA USA
| | - Maria Picó-Pérez
- grid.10328.380000 0001 2159 175XLife and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal ,grid.10328.380000 0001 2159 175XICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal ,grid.512329.eClinical Academic Center - Braga, Braga, Portugal
| | - Fabrizio Piras
- grid.417778.a0000 0001 0692 3437Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Federica Piras
- grid.417778.a0000 0001 0692 3437Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Christopher Pittenger
- grid.47100.320000000419368710Department of Psychiatry and Yale Child Study Center, Yale University, New Haven, CT USA
| | - Y. C. Janardhan Reddy
- grid.416861.c0000 0001 1516 2246OCD clinic, Department of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore, India
| | - Daniela Rodriguez-Manrique
- grid.6936.a0000000123222966TUM-Neuroimaging Center (TUM-NIC) of Klinikum rechts der Isar, Technische Universität München, München, Germany ,grid.6936.a0000000123222966Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany ,grid.5252.00000 0004 1936 973XGraduate School of Systemic Neurosciences (GSN), Ludwig-Maximilians-Universität, Munich, Germany
| | - Yuki Sakai
- grid.272458.e0000 0001 0667 4960Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan ,grid.418163.90000 0001 2291 1583Department of Neural Computation for Decision-Making, Advanced Telecommunications Research Institute International Brain Information Communication Research Laboratory Group, Kyoto, Japan
| | - Eiji Shimizu
- grid.136304.30000 0004 0370 1101Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Venkataram Shivakumar
- grid.416861.c0000 0001 1516 2246Department of Integrative Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Helen Blair Simpson
- grid.21729.3f0000000419368729Columbia University Irving Medical College, Columbia University, New York, NY USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York, NY USA
| | - Noam Soreni
- grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario Canada ,Pediatric OCD Consultation Team, Anxiety Treatment and Research Center, Hamilton, Ontario Canada
| | - Carles Soriano-Mas
- grid.411129.e0000 0000 8836 0780Bellvitge Biomedical Research Insitute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain ,grid.469673.90000 0004 5901 7501CIBERSAM, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuno Sousa
- grid.10328.380000 0001 2159 175XLife and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal ,grid.10328.380000 0001 2159 175XICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal ,grid.512329.eClinical Academic Center - Braga, Braga, Portugal
| | - Gianfranco Spalletta
- grid.417778.a0000 0001 0692 3437IRCCS Santa Lucia Foundation, Laboratory of Neuropsychiatry, Rome, Italy ,grid.39382.330000 0001 2160 926XBaylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, TX USA
| | - Emily R. Stern
- grid.137628.90000 0004 1936 8753Department of Psychiatry, New York University School of Medicine, New York, NY USA ,grid.250263.00000 0001 2189 4777Clinical Research, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY USA
| | - Michael C. Stevens
- grid.277313.30000 0001 0626 2712Institute of Living, Hartford, CT USA ,grid.47100.320000000419368710Yale University School of Medicine, New Haven, CT USA
| | - S. Evelyn Stewart
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, Canada ,grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, Canada ,grid.498716.50000 0000 8794 2105BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada
| | - Philip R. Szeszko
- grid.59734.3c0000 0001 0670 2351Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA ,grid.274295.f0000 0004 0420 1184James J. Peters VA Medical Center, Mental Illness Research, Education and Clinical Center, Bronx, NY USA
| | - Jumpei Takahashi
- grid.411321.40000 0004 0632 2959Department of Child Psychiatry, Chiba University Hospital, Chiba, Japan
| | - Tais Tanamatis
- grid.11899.380000 0004 1937 0722Departamento de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP Brazil
| | - Jinsong Tang
- grid.13402.340000 0004 1759 700XDepartment of Psychiatry, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China ,grid.13402.340000 0004 1759 700XLiangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
| | - Anders Lillevik Thorsen
- grid.412008.f0000 0000 9753 1393Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Centre for Crisis Psychology, University of Bergen, Bergen, Norway
| | - David Tolin
- grid.47100.320000000419368710Yale University School of Medicine, New Haven, CT USA ,grid.277313.30000 0001 0626 2712Institute of Living/Hartford Hospital, Hartford, CT USA
| | - Ysbrand D. van der Werf
- grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam, The Netherlands
| | - Hein van Marle
- grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam, The Netherlands
| | - Guido A. van Wingen
- grid.484519.5Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Daniela Vecchio
- grid.417778.a0000 0001 0692 3437Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - G. Venkatasubramanian
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health And Neurosciences, Department of Psychiatry, Bengaluru, India
| | - Susanne Walitza
- grid.7400.30000 0004 1937 0650Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Jicai Wang
- grid.414902.a0000 0004 1771 3912Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhen Wang
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Anri Watanabe
- grid.272458.e0000 0001 0667 4960Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Lidewij H. Wolters
- grid.509540.d0000 0004 6880 3010Amsterdam UMC, Department of Child and Adolescent Psychiatry, Amsterdam, the Netherlands ,Levvel, Academic Center for Child and Adolescent Psychiatry, Post Box 303, 1115 ZG Duivendrecht, the Netherlands
| | - Xiufeng Xu
- grid.414902.a0000 0004 1771 3912Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Je-Yeon Yun
- grid.412484.f0000 0001 0302 820XSeoul National University Hospital, Seoul, Republic of Korea ,grid.31501.360000 0004 0470 5905Yeongeon Student Support Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Qing Zhao
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Tonya White
- grid.5645.2000000040459992XErasmus Medical Center, Department of Child and Adolescent Psychiatry/Psychology, Wytemaweg 8, 3015 GD Rotterdam, the Netherlands ,grid.42505.360000 0001 2156 6853Department of Radiology and Nuclear Medicine, University of Southern California, Los Angeles, CA USA
| | - Paul M. Thompson
- grid.42505.360000 0001 2156 6853Imaging Genetics Center, Stevens Institute for Neuroimaging & Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Dan J. Stein
- grid.7836.a0000 0004 1937 1151SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Odile A. van den Heuvel
- grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam, The Netherlands
| | - Chris Vriend
- grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam, The Netherlands
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6
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Hagland P, Thorsen AL, Ousdal OT, Gjestad R, de Wit SJ, Hansen B, Hagen K, Kvale G, van den Heuvel OA. Disentangling Within- and Between-Person Effects During Response Inhibition in Obsessive-Compulsive Disorder. Front Psychiatry 2021; 12:519727. [PMID: 33841194 PMCID: PMC8026876 DOI: 10.3389/fpsyt.2021.519727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Obsessive-compulsive disorder (OCD) has been related to worse performance, abnormal brain activity, and functional connectivity during response inhibition. Whether these findings are indications of stable traits that contribute to the development of the disorder, or whether they are a result of the state severity of obsessions and anxiety, remains unclear since previous research mainly has employed cross-sectional designs. The present study aimed to assess longitudinal between- and within-person relationships between symptoms, task performance, right inferior frontal gyrus brain activation, and connectivity between the right amygdala and the right pre-supplementary motor area in 29 OCD patients before and after concentrated exposure and response prevention treatment. Method: Patients received exposure and response prevention delivered during 4 consecutive days, following the Bergen 4-day Treatment format. Patients performed a Stop Signal Task during 3T functional Magnetic Resonance Imaging the day before treatment, as well as 1 week and 3 months after treatment completion. Multilevel models were used to analyze disaggregated within- and between-person effects over time. Independent variables were scores on the symptom severity scales for OCD, anxiety, depression, and state distress during scanning. Dependent variables were reaction time for go trials, stop signal response time, task-related brain activation and connectivity. Results: A positive between-person effect was found for obsessive-compulsive, anxiety, and depressive symptom severity on go trial reaction time, indicating that patients with higher symptom scores on average respond slower during accurate go trials. We also found no significant between- or within-person relations between symptom severity and task-related activation or fronto-limbic connectivity. Conclusions: The between-person findings may point toward a general association between slower processing speed and symptom severity in OCD. Longitudinal studies should disaggregate between- and within-person effects to better understand variation over time.
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Affiliation(s)
- Pernille Hagland
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Anders Lillevik Thorsen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Olga Therese Ousdal
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Department of Radiology, Haukeland University Hospital, Bergen, Norway.,Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Rolf Gjestad
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Stella J de Wit
- Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Bjarne Hansen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Kristen Hagen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Psychiatric Department, Hospital of Molde, Molde, Norway
| | - Gerd Kvale
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Odile A van den Heuvel
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, Netherlands
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7
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Brecke V, Thorsen AL, Ousdal OT, Vriend C, Alnæs D, Hagen K, Hansen B, Kvale G, van den Heuvel OA. Diffusion Tensor Imaging Before and 3 Months After Concentrated Exposure Response Prevention in Obsessive-Compulsive Disorder. Front Psychiatry 2021; 12:674020. [PMID: 34122191 PMCID: PMC8187597 DOI: 10.3389/fpsyt.2021.674020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/28/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Subtle differences in white matter microstructure have been found in obsessive-compulsive disorder (OCD) compared to controls using diffusion tensor imaging (DTI), but it is unclear if and how this change after treatment. The primary aim of this pre-registered study was to investigate white matter integrity between OCD patients and controls and changes after concentrated exposure and response prevention (ERP). Methods: Fractional anisotropy (FA), radial diffusivity (RD), axial diffusivity (AD) and mean diffusivity (MD) were estimated using FMRIB Software Library (FSL). The images were registered to a study-specific template using a longitudinal pipeline based on full tensor information in DTI-TK. Voxel-based analysis was performed using tract-based spatial statistics (TBSS). Using SPSS, we compared the integrity in three bilateral regions of interest (ROI), the sagittal stratum, posterior thalamic radiation and cingulum, in 32 OCD patients and 30 matched healthy controls at baseline. Patients received a four-day concentrated ERP format. We investigated longitudinal changes in 26 OCD patients and 22 healthy controls at 3months follow-up using repeated-measures ANOVA. Exploratory t-tests were conducted for AD and MD. Secondary hypothesis used linear regression to investigate if baseline FA predict treatment outcome 3 months later, and if patients with illness onset before 18 years of age would show lower FA in sagittal stratum. Finally, we performed sensitivity analysis on medication and comorbidity influences on FA. Results: Three months after treatment, 77% of the patients were in remission. Contrary to our hypotheses, we did not find any significant differences in FA, RD, AD or MD between the groups before treatment, nor significant group by time effects in any of the ROI. None of the baseline FA measures significantly predicted treatment outcome. Illness onset before 18 years of age did not significantly predict FA in the sagittal stratum. Adjusting for medication or comorbid anxiety or mood disorder did not influence the results. Conclusions: Although concentrated ERP in OCD lead to high remission, we did not find significant long-term changes by DTI. Future studies will benefit from using larger sample sizes and multi-shell diffusion-weighted imaging when investigating white matter microstructure in OCD and underlying neurobiological mechanisms of treatment.
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Affiliation(s)
- Vilde Brecke
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
| | - Anders Lillevik Thorsen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Centre for Crisis Psychology, University of Bergen, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Olga Therese Ousdal
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Chris Vriend
- Department of Psychiatry, Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Dag Alnæs
- Bjørknes College, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristen Hagen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Psychiatric Department, Hospital of Molde, Molde, Norway
| | - Bjarne Hansen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Centre for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Gerd Kvale
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Odile A van den Heuvel
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Department of Psychiatry, Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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8
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Lillevik Thorsen A, de Wit SJ, Hagland P, Ousdal OT, Hansen B, Hagen K, Kvale G, van den Heuvel OA. Stable inhibition-related inferior frontal hypoactivation and fronto-limbic hyperconnectivity in obsessive-compulsive disorder after concentrated exposure therapy. Neuroimage Clin 2020; 28:102460. [PMID: 33395956 PMCID: PMC7606869 DOI: 10.1016/j.nicl.2020.102460] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/09/2020] [Accepted: 10/02/2020] [Indexed: 01/03/2023]
Abstract
Less IFG activation and more fronto-limbic connectivity was found in OCD. IFG hypoactivation and fronto-limbic hyperconnectivity persisted after exposure therapy. Activation and connectivity before treatment did not predict treatment outcome.
Response inhibition has previously been suggested as an endophenotype for obsessive–compulsive disorder (OCD), evidenced by studies showing worse task performance, and altered task-related activation and connectivity. However, it’s unclear if these measures change following treatment. In this study, 31 OCD patients and 28 healthy controls performed a stop signal task during 3 T functional magnetic resonance imaging before treatment, while 24 OCD patients and 17 healthy controls were rescanned one week and three months after concentrated exposure and response prevention over four consecutive days using Bergen 4-Day Format. To study changes over time we performed a longitudinal analysis on stop signal reaction time and task-related activation and amygdala connectivity during successful and failed inhibition. Results showed that there was no group difference in task performance. Before treatment, OCD patients compared to controls showed less inhibition-related activation in the right inferior frontal gyrus, and increased functional connectivity between the right amygdala and the right inferior frontal gyrus and pre-supplementary motor area. During error-processing, OCD patients versus controls showed less activation in the pre-SMA before treatment. These group differences did not change after treatment. Pre-treatment task performance, brain activation, and connectivity were unrelated to the degree of symptom improvement after treatment. In conclusion, inferior frontal gyrus hypoactivation and increased fronto-limbic connectivity are likely trait markers of OCD that remain after effective exposure therapy.
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Affiliation(s)
- Anders Lillevik Thorsen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Bergen, Norway.
| | - Stella J de Wit
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Pernille Hagland
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Olga Therese Ousdal
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Department of Radiology, Haukeland University Hospital, Bergen, Norway; Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Bjarne Hansen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Kristen Hagen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Psychiatric Department, Hospital of Molde, Molde, Norway
| | - Gerd Kvale
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Odile A van den Heuvel
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam, Netherlands
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9
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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10
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Thorsen AL, Hagland P, Radua J, Mataix-Cols D, Kvale G, Hansen B, van den Heuvel OA. Emotional Processing in Obsessive-Compulsive Disorder: A Systematic Review and Meta-analysis of 25 Functional Neuroimaging Studies. Biol Psychiatry Cogn Neurosci Neuroimaging 2018; 3:563-571. [PMID: 29550459 DOI: 10.1016/j.bpsc.2018.01.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 01/11/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Patients with obsessive-compulsive disorder (OCD) experience aversive emotions in response to obsessions, motivating avoidance and compulsive behaviors. However, there is considerable ambiguity regarding the brain circuitry involved in emotional processing in OCD, especially whether activation is altered in the amygdala. METHODS We conducted a systematic literature review and performed a meta-analysis-seed-based d mapping-of 25 whole-brain neuroimaging studies (including 571 patients and 564 healthy control subjects) using functional magnetic resonance imaging or positron emission tomography, comparing brain activation of patients with OCD and healthy control subjects during presentation of emotionally valenced versus neutral stimuli. Meta-regressions were employed to investigate possible moderators. RESULTS Patients with OCD, compared with healthy control subjects, showed increased activation in the bilateral amygdala, right putamen, orbitofrontal cortex extending into the anterior cingulate and ventromedial prefrontal cortex, and middle temporal and left inferior occipital cortices during emotional processing. Right amygdala hyperactivation was most pronounced in unmedicated patients. Symptom severity was related to increased activation in the orbitofrontal and anterior cingulate cortices and precuneus. Greater comorbidity with mood and anxiety disorders was associated with higher activation in the right amygdala, putamen, and insula as well as with lower activation in the left amygdala and right ventromedial prefrontal cortex. CONCLUSIONS Patients with OCD show increased emotional processing-related activation in limbic, frontal, and temporal regions. Previous mixed evidence regarding the role of the amygdala in OCD has likely been influenced by patient characteristics (such as medication status) and low statistical power.
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Affiliation(s)
- Anders Lillevik Thorsen
- Obsessive-Compulsive Disorder (OCD) team, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Bergen, Norway.
| | - Pernille Hagland
- Obsessive-Compulsive Disorder (OCD) team, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Joaquim Radua
- FIDMAG Germanes Hospitalàries, Centre for Biomedical Research in Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden; Department of Psychosis Studies, Institute of Psychology, Psychiatry, and Neuroscience, King's College London, London, United Kingdom
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Gerd Kvale
- Obsessive-Compulsive Disorder (OCD) team, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Bjarne Hansen
- Obsessive-Compulsive Disorder (OCD) team, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Odile A van den Heuvel
- Obsessive-Compulsive Disorder (OCD) team, Haukeland University Hospital, Bergen, Norway; Department of Anatomy & Neurosciences, VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; Amsterdam Neuroscience, Amsterdam, The Netherlands
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11
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Eilertsen T, Thorsen AL, Holm SEH, Bøe T, Sørensen L, Lundervold AJ. Parental socioeconomic status and child intellectual functioning in a Norwegian sample. Scand J Psychol 2017; 57:399-405. [PMID: 27589048 DOI: 10.1111/sjop.12324] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 06/28/2016] [Indexed: 11/29/2022]
Abstract
Socioeconomic status (SES) in childhood has been linked to cognitive function and future academic and occupational success in studies from several countries. However, previous Nordic studies have shown inconsistent results regarding the strength of this link. We therefore investigated the association between SES and cognitive functioning in a sample of 255 Norwegian children, including 151 typically developing children and 104 children with a psychiatric diagnosis. The third edition of the Wechsler Intelligence Scale for Children (WISC-III) to assess cognitive function was used. SES was defined from maternal and paternal education and family income of typically developing children and of a subsample of children with a psychiatric diagnosis. Multiple adjusted regression analyses were used to investigate the relation between SES and cognitive functioning. The analyses showed that SES explained a significant part of the variance of the full-scale WISC-III score and two WISC-III indices (Verbal Comprehension and Freedom from Distractibility). Overall, the strength of the relations was weaker than expected from reports from other non-Nordic countries. Parental education was the only significant individual predictor, suggesting that income was of minor importance as a predictor of cognitive functioning. Further studies should investigate how diverse political and socioeconomic contexts influence the relation between SES and cognitive functioning.
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Affiliation(s)
- Thomas Eilertsen
- Department of Biological and Medical Psychology, University of Bergen, Norway
| | | | | | - Tormod Bøe
- The Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
| | - Lin Sørensen
- Department of Biological and Medical Psychology, University of Bergen, Norway.,K. G. Jebsen Center for Research on Neuropsychiatric Disorders, Bergen, Norway
| | - Astri J Lundervold
- Department of Biological and Medical Psychology, University of Bergen, Norway.,The Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway.,K. G. Jebsen Center for Research on Neuropsychiatric Disorders, Bergen, Norway
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12
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Thorsen AL, van den Heuvel OA, Hansen B, Kvale G. Neuroimaging of psychotherapy for obsessive-compulsive disorder: A systematic review. Psychiatry Res 2015; 233:306-13. [PMID: 26228566 DOI: 10.1016/j.pscychresns.2015.05.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 10/20/2014] [Accepted: 05/11/2015] [Indexed: 10/23/2022]
Abstract
The symptoms of obsessive-compulsive disorder (OCD) include intrusive thoughts, compulsive behavior, anxiety, and cognitive inflexibility, which are associated with dysfunction in dorsal and ventral corticostriato-thalamocortical (CSTC) circuits. Psychotherapy involving exposure and response prevention has been established as an effective treatment for the affective symptoms, but the impact on the underlying neural circuits is not clear. This systematic review used the Medline, Embase, and PsychINFO databases to investigate how successful therapy may affect neural substrates of OCD. Sixteen studies measuring neural changes after therapy were included in the review. The studies indicate that dysfunctions in neural function and structure are partly reversible and state-dependent for affective symptoms, which may also apply to cognitive symptoms. This is supported by post-treatment decreases of symptoms and activity in the ventral circuits during symptom provocation, as well as mainly increased activity in dorsal circuits during cognitive processing. These effects appear to be common to both psychotherapy and medication approaches. Although neural findings were not consistent across all studies, these findings indicate that people with OCD may experience functional, symptomatic, and neural recovery after successful treatment.
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Affiliation(s)
- Anders Lillevik Thorsen
- OCD-team, Haukeland University Hospital, Bergen, Norway; Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.
| | - Odile A van den Heuvel
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Bjarne Hansen
- OCD-team, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Gerd Kvale
- OCD-team, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Bergen, Norway
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13
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Thorsen AL, Johansson K, Løberg EM. Neurobiology of cognitive remediation therapy for schizophrenia: a systematic review. Front Psychiatry 2014; 5:103. [PMID: 25177300 PMCID: PMC4133649 DOI: 10.3389/fpsyt.2014.00103] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/01/2014] [Indexed: 12/13/2022] Open
Abstract
Cognitive impairment is an important aspect of schizophrenia, where cognitive remediation therapy (CRT) is a promising treatment for improving cognitive functioning. While neurobiological dysfunction in schizophrenia has been the target of much research, the neural substrate of cognitive remediation and recovery has not been thoroughly examined. The aim of the present article is to systematically review the evidence for neural changes after CRT for schizophrenia. The reviewed studies indicate that CRT affects several brain regions and circuits, including prefrontal, parietal, and limbic areas, both in terms of activity and structure. Changes in prefrontal areas are the most reported finding, fitting to previous evidence of dysfunction in this region. Two limitations of the current research are the few studies and the lack of knowledge on the mechanisms underlying neural and cognitive changes after treatment. Despite these limitations, the current evidence suggests that CRT is associated with both neurobiological and cognitive improvement. The evidence from these findings may shed light on both the neural substrate of cognitive impairment in schizophrenia, and how better treatment can be developed and applied.
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Affiliation(s)
| | - Kyrre Johansson
- Department of Psychosocial Science, University of Bergen , Bergen , Norway
| | - Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital , Bergen , Norway ; Department of Biological and Medical Psychology, University of Bergen , Bergen , Norway
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