The effects of cognitive behavioral therapy on the whole brain structural connectome in unmedicated patients with obsessive-compulsive disorder
The effects of cognitive behavioral therapy on the whole brain structural connectome in unmedicated patients with obsessive-compulsive disorder
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DOI：
10.1016/j.pnpbp.2020.110037
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发表时间：
2021-01-10
影响因子：
5.6
通讯作者：
Li, Zhanjiang
中科院分区：
文献类型：
--
作者：
Cao, Ruixiang;Yang, Xiangyun;Li, Zhanjiang
认知行为疗法（Cognitive Behavioral Therapy，CBT）被认为是治疗强迫症（Obsessive Disorder，OCD）的一线疗法，与药物治疗相比，具有对痛苦的耐受性强、脱落率和复发率低、无生理"副作用"等优点。先前的研究已经报道了CBT相关的局灶性脑区域和连接的改变。然而，CBT对全脑结构网络的影响尚未阐明。在这里，我们收集了34名未经药物治疗的强迫症患者在12周CBT前后的弥散MRI数据。50名健康对照（HC）也以匹配的间隔扫描两次。我们构建了个体脑白色物质连接体，并进行了图论网络分析，以研究CBT对全脑结构拓扑结构的影响。我们观察到显着的组与时间的相互作用的全局网络聚类系数和节点集群的左舌回，左颞中回，左楔前叶，左梭状回的26 CBT响应者在强迫症患者。进一步分析显示，这些CBT应答者在基线时显示出明显高于HC的整体和淋巴结聚集，并在CBT后降至正常水平。在8名CBT无应答者中也发现了左舌回淋巴结聚集的显著变化。在CBT应答患者中，左舌回和左梭状回的节点簇的前后减少与强迫症状的改善呈正相关。这些结果表明，强迫症患者全脑白色网络的网络分离度异常增高，CBT后可能恢复正常，这为了解强迫症患者CBT反应的机制和临床实践提供了潜在的影像学生物标志物。
Cognitive behavioral therapy (CBT) is considered a first-line treatment for patients with obsessive-compulsive disorder (OCD), and it possesses advantages over pharmacological treatments in stronger tolerance to distress, lower rates of drop out and relapse, and no physical "side-effects". Previous studies have reported CBT-related alterations in focal brain regions and connections. However, the effects of CBT on whole-brain structural networks have not yet been elucidated. Here, we collected diffusion MRI data from 34 unmedicated OCD patients before and after 12 weeks of CBT. Fifty healthy controls (HCs) were also scanned twice at matched intervals. We constructed individual brain white matter connectome and performed a graph-theoretical network analysis to investigate the effects of CBT on whole-brain structural topology. We observed significant group-by-time interactions on the global network clustering coefficient and the nodal clustering of the left lingual gyrus, the left middle temporal gyrus, the left precuneus, and the left fusiform gyrus of 26 CBT responders in OCD patients. Further analysis revealed that these CBT responders showed prominently higher global and nodal clustering compared to HCs at baseline and reduced to normal levels after CBT. Such significant changes in the nodal clustering of the left lingual gyrus were also found in 8 CBT non-responders. The pre-to-post decreases in nodal clustering of the left lingual gyrus and the left fusiform gyrus positively correlated with the improvements in obsessive-compulsive symptoms in the CBT-responding patients. These findings indicated that the network segregation of the whole-brain white matter network in OCD patients was abnormally higher and might recover to normal after CBT, which provides mechanistic insights into the CBT response in OCD and potential imaging biomarkers for clinical practice.