Subjective uncertainty and limbic hyperactivation in obsessive-compulsive disorder.
Subjective uncertainty and limbic hyperactivation in obsessive-compulsive disorder.
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DOI：
10.1002/hbm.22038
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发表时间：
2013-08
影响因子：
4.8
通讯作者：
Taylor SF
中科院分区：
文献类型：
--
作者：
Stern ER;Welsh RC;Gonzalez R;Fitzgerald KD;Abelson JL;Taylor SF
强迫症（OCD）通常与病理性的不确定性有关，不确定性是关于一个行为是否被正确地执行，还是一个坏的结果是否会发生，导致旨在减少不确定性的强迫性“证据收集”行为。目前的研究使用事件相关功能磁共振成像来调查强迫症患者和对照组的神经功能，因为主观确定性被评定为对决定的连续证据的响应。不确定性是实验操纵，使一些决定与没有“客观”的不确定性（所有观察到的证据指向一个正确的选择），而其他决定包含可计算的，但不同程度的客观不确定性的基础上显示的概率。结果表明，强迫症患者与控制不包含客观不确定性的决定不同，患者认为自己更不确定。患者还表现出更大的激活，在网络的大脑区域以前与内部集中的思想和评价，包括腹内侧前额叶皮层，海马体旁，中颞叶皮层，以及杏仁核和眶额皮层/腹前额叶。在患者组中，在这些大脑区域中发现了显着更多的正向受试者间相关性，这表明该网络在患者中更加相互关联。强迫症患者没有不同的控制任务参数导致不确定性的决定。这些结果表明，强迫症是与超激活的边缘/边缘脑区网络时，作出决定，这可能有助于更大的主观经验的怀疑，障碍的特点。
Obsessive-compulsive disorder (OCD) is often associated with pathological uncertainty regarding whether an action has been performed correctly or whether a bad outcome will occur, leading to compulsive “evidence gathering” behaviors aimed at reducing uncertainty. The current study used event-related functional magnetic resonance imaging to investigate neural functioning in OCD patients and controls as subjective certainty was rated in response to sequential pieces of evidence for a decision. Uncertainty was experimentally manipulated so that some decisions were associated with no “objective” uncertainty (all observed evidence pointed to one correct choice), whereas other decisions contained calculable but varying levels of objective uncertainty based on displayed probabilities. Results indicated that OCD patients differed from controls on decisions that contained no objective uncertainty, such that patients rated themselves as more uncertain. Patients also showed greater activation in a network of brain regions previously associated with internally-focused thought and valuation including ventromedial prefrontal cortex, parahippocampus, middle temporal cortex, as well as amygdala and orbitofrontal cortex/ventral anterior insula. In the patient group, a significantly greater number of positive intersubject correlations were found among several of these brain regions, suggesting that this network is more interconnected in patients. OCD patients did not differ from controls on decisions where task parameters led to uncertainty. These results indicate that OCD is associated with hyperactivation in a network of limbic/paralimbic brain regions when making decisions, which may contribute to the greater subjective experience of doubt that characterizes the disorder.