Systematic changes in cerebral glucose metabolic rate after successful behavior modification treatment of obsessive-compulsive disorder.
Systematic changes in cerebral glucose metabolic rate after successful behavior modification treatment of obsessive-compulsive disorder.
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DOI：
10.1001/archpsyc.1996.01830020023004
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发表时间：
1996-02
影响因子：
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通讯作者：
Jeffrey M. Schwartz;P. Stoessel;L. Baxter;K. Martin;M. Phelps
中科院分区：
文献类型：
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作者：
Jeffrey M. Schwartz;P. Stoessel;L. Baxter;K. Martin;M. Phelps
背景：我们试图在一个新的患者样本中确定，在行为改变治疗的强迫症的症状改善是否伴随着尾状核葡萄糖代谢率的显著变化，这是用正电子发射断层扫描测量的，正如在之前的研究中看到的那样。其次，通过结合本研究和先前研究的样本，我们还检查了强迫症行为治疗前获得的眶皮质、尾状核和丘脑的大脑活动之间是否存在病理相关性，但随着症状的改善而显著降低。方法对9例强迫症患者进行结构化暴露和反应预防行为认知治疗前后10周的正电子发射断层扫描。研究人员对结果进行了单独分析，并将其与先前研究中9个类似对象的结果结合起来进行了分析。结果：行为治疗应答者的双侧尾状核糖代谢率显著降低（P < 0.05），高于治疗不良应答者。治疗前，眶回与尾状核头部、右侧眶回与丘脑的脑活动有显著相关性。这些相关性在有效治疗后显著降低。结论：这些结果重复并扩展了先前的研究结果，即强迫症行为治疗对尾状核功能的改变。前额皮质-纹状体-丘脑脑系统参与强迫症症状的调解。
BACKGROUND We sought to determine in a new patient sample whether symptomatic improvement in obsessive-compulsive disorder treated with behavior modification is accompanied by significant changes in glucose metabolic rates in the caudate nucleus, measured with positron emission tomography, as seen in a previous study. Second, by combining samples from this and the previous study, we also examined whether there were pathologic correlational relationships among brain activity in the orbital cortex, caudate nucleus, and thalamus that obtained before behavioral treatment of obsessive-compulsive disorder, but that decreased significantly with symptom improvement. METHODS Nine patients with obsessive-compulsive disorder were studied with positron emission tomography before and after 10 weeks of structured exposure and response prevention behavioral and cognitive treatment. Results were analyzed both alone and combined with those from nine similar subjects from the previous study. RESULTS Behavior therapy responders had significant (P < .05) bilateral decreases in caudate glucose metabolic rates that were greater than those seen in poor responders to treatment. Before treatment, there were significant correlations of brain activity between the orbital gyri and the head of the caudate nucleus and the orbital gyri and the thalamus on the right. These correlations decreased significantly after effective treatment. CONCLUSIONS These results replicate and extend previous findings of changes in caudate nucleus function with behavior therapy for obsessive-compulsive disorder. A prefrontal cortico-striato-thalamic brain system is implicated in mediation of symptoms of obsessive-compulsive disorder.