Distinct neural correlates of washing, checking, and hoarding symptom dimensions in obsessive-compulsive disorder
Distinct neural correlates of washing, checking, and hoarding symptom dimensions in obsessive-compulsive disorder
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DOI：
10.1001/archpsyc.61.6.564
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发表时间：
2004-06-01
影响因子：
--
通讯作者：
Phillips, ML
中科院分区：
文献类型：
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作者：
Mataix-Cols, D;Wooderson, S;Phillips, ML
背景：强迫症（OCD）在临床上具有异质性，但以往大多数功能性神经影像学研究将具有混合症状的患者归为一组，因此可能降低了研究的效力并使研究结果模糊不清。
目的：研究强迫症中洗涤、检查和囤积症状维度的神经相关性。
设计：症状激发范式、功能性磁共振成像、组块设计和非参数脑映射分析。
地点：大学医院。
参与者：16名具有混合症状的强迫症患者（11名住院患者，5名门诊患者）和17名男女健康志愿者。
干预：所有受试者参与4次功能性磁共振成像实验。他们在观看交替出现的情绪性（与洗涤相关、与检查相关、与囤积相关或厌恶的、与症状无关）和中性图片块时接受扫描，并想象与每种图片类型内容相关的情景。
主要观察指标：血氧水平依赖反应。
结果：患者和对照组在症状激发过程中主观焦虑都有所增加（患者增加更为显著），并且激活了先前与强迫症相关的神经区域。协方差分析在控制抑郁因素后，显示出与每个症状维度相关的独特激活模式。患者在双侧腹内侧前额叶区域和右侧尾状核（洗涤）、壳核/苍白球、丘脑和背侧皮质区域（检查）、左侧中央前回和右侧眶额叶皮质（囤积）以及左侧枕颞区域（厌恶的、与症状无关）的激活程度显著高于对照组。患者内部的相关性分析进一步支持了这些结果，该分析显示在每个实验中主观焦虑、问卷评分和神经反应之间具有高度特异性的正相关。伴有（n = 9）和不伴有（n = 7）共病诊断的患者之间没有持续显著的差异。
结论：研究结果表明，不同的强迫症状维度是由涉及认知和情绪处理的额 - 纹状体 - 丘脑回路中相对不同的成分所介导的。强迫症可能最好被概念化为多种可能重叠的综合征谱系，而非一个单一的疾病分类实体。
Context: Obsessive-compulsive disorder (OCD) is clinically heterogeneous, yet most previous functional neuroimaging studies grouped together patients with mixed symptoms, thus potentially reducing the power and obscuring the findings of such studies.Objective: To investigate the neural correlates of washing, checking, and hoarding symptom dimensions in OCD.Design: Symptom provocation paradigm, functional magnetic resonance imaging, block design, and nonparametric brain mapping analyses.Setting: University hospital.Participants: Sixteen patients with OCD (11 inpatients, 5 outpatients) with mixed symptoms and 17 healthy volunteers of both sexes.Intervention: All subjects participated in 4 functional magnetic resonance imaging experiments. They were scanned while viewing alternating blocks of emotional (washing-related, checking-related, hoarding-related, or aversive, symptom-unrelated) and neutral pictures, and imagining scenarios related to the content of each picture type.Main Outcome Measure: Blood oxygenation level-dependent response.Results: Both patients and control subjects experienced increased subjective anxiety during symptom provocation (patients significantly more so) and activated neural regions previously linked to OCD. Analyses of covariance, controlling for depression, showed a distinct pattern of activation associated with each symptom dimension. Patients demonstrated significantly greater activation than controls in bilateral ventromedial prefrontal regions and right caudate nucleus (washing); putamen/globus pallidus, thalamus, and dorsal cortical areas (checking); left precentral gyrus and right orbitofrontal cortex (hoarding); and left occipitotemporal regions (aversive, symptom-unrelated). These results were further supported by correlation analyses within patients, which showed highly specific positive associations between subjective anxiety, questionnaire scores, and neural response in each experiment. There were no consistently significant differences between patients with (n = 9) and without (n = 7) comorbid diagnoses.Conclusions: The findings suggest that different obsessive-compulsive symptom dimensions are mediated by relatively distinct components of frontostriatothalamic circuits implicated in cognitive and emotion processing. Obsessive-compulsive disorder may be best conceptualized as a spectrum of multiple, potentially overlapping syndromes rather than a unitary nosologic entity.