Brain connectivity and prediction of relapse after cognitive-behavioral therapy in obsessive-compulsive disorder.
Brain connectivity and prediction of relapse after cognitive-behavioral therapy in obsessive-compulsive disorder.
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DOI：
10.3389/fpsyt.2015.00074
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发表时间：
2015
影响因子：
4.7
通讯作者：
O'Neill J
中科院分区：
文献类型：
--
作者：
Feusner JD;Moody T;Lai TM;Sheen C;Khalsa S;Brown J;Levitt J;Alger J;O'Neill J
强化认知行为疗法（CBT）可以有效减轻强迫症（OCD）的症状。然而，许多人在治疗后复发。很少有研究调查预测随访临床状态的生物学标志物。目的是确定强化CBT前的脑网络连接模式是否预测随访期间临床症状的恶化。我们获得了17名强迫症成年人在4周强化CBT之前和之后的静息状态功能磁共振成像数据。分析功能连通性数据以产生图论度量。我们在治疗前后和12个月的随访期间检查了治疗前连接体特性与强迫症临床症状之间的关系。治疗前后强迫症症状平均减轻40.4±16.4%（64.7%缓解，58.8%缓解），但35.3%在随访期间出现临床显著恶化。从处理前到处理后，小世界度和聚类系数显著增加。模块化的减少与强迫症症状的减少相关。治疗前较高的小世界连通性与随访期间强迫症症状的恶化显著相关。治疗前后的心理测量和神经认知测量并不是显著的预测因子。这是首个关于CBT治疗强迫症效果的图论连通性研究，也是首个测试其与后续临床状态关联的研究。结果显示，功能性网络效率是强迫症患者CBT反应和复发的生物标志物。CBT可以提高网络效率，因为它缓解了大多数患者的症状，但那些进入治疗时网络效率已经很高的患者复发的风险更大。结果对治疗方案的选择具有潜在的临床意义。
Intensive cognitive-behavioral therapy (CBT) can effectively reduce symptoms in obsessive–compulsive disorder (OCD). However, many relapse after treatment. Few studies have investigated biological markers predictive of follow-up clinical status. The objective was to determine if brain network connectivity patterns prior to intensive CBT predict worsening of clinical symptoms during follow-up. We acquired resting-state functional magnetic resonance imaging data from 17 adults with OCD prior to and following 4 weeks of intensive CBT. Functional connectivity data were analyzed to yield graph-theory metrics. We examined the relationship between pre-treatment connectome properties and OCD clinical symptoms before and after treatment and during a 12-month follow-up period. Mean OCD symptom decrease was 40.4 ± 16.4% pre- to post-treatment (64.7% responded; 58.8% remitted), but 35.3% experienced clinically significant worsening during follow-up. From pre- to post-treatment, small-worldness and clustering coefficient significantly increased. Decreases in modularity correlated with decreases in OCD symptoms. Higher pre-treatment small-world connectivity was significantly associated with worsening of OCD symptoms during the follow-up period. Psychometric and neurocognitive measures pre- and post-treatment were not significant predictors. This is the first graph-theory connectivity study of the effects of CBT in OCD, and the first to test associations with follow-up clinical status. Results show functional network efficiency as a biomarker of CBT response and relapse in OCD. CBT increases network efficiency as it alleviates symptoms in most patients, but those entering therapy with already high network efficiency are at greater risk of relapse. Results have potential clinical implications for treatment selection.