Dysfunctional Reward Circuitry in Obsessive-Compulsive Disorder
Dysfunctional Reward Circuitry in Obsessive-Compulsive Disorder
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DOI：
10.1016/j.biopsych.2010.12.003
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发表时间：
2011-05-01
影响因子：
10.6
通讯作者：
Denys, Damiaan
中科院分区：
文献类型：
--
作者：
Figee, Martijn;Vink, Matthijs;Denys, Damiaan
背景：强迫症（OCD）最初被认为是一种焦虑症，但具有类似成瘾行为的特征。强迫症患者可能会产生依赖性的强迫行为，因为奖励效应后，减少强迫引起的焦虑。奖励处理严重依赖于腹侧纹状体-眶额回路，强迫症患者的脑成像研究一直显示该回路异常激活。这是第一个功能成像研究明确的奖励电路在OCD.Methods：奖励预期和接收过程中的大脑活动进行了比较，18名强迫症患者和19名健康对照组，使用金钱奖励延迟任务和功能磁共振成像。奖励处理之间的强迫症患者与污染的恐惧为主，主要是高风险assessment.Results：强迫症患者表现出衰减的奖励预期活动的脑桥核与健康对照组相比。减少活动的神经核更明显的强迫症患者污染的恐惧比患者的高风险评估。在接受奖励时，患者和对照组的大脑活动相似。一个提示对更多的功能障碍的奖励处理被发现在治疗抵抗性强迫症患者谁随后成功地治疗了脑深部电刺激的nucleus verbens.Conclusions：强迫症患者可能不太能够作出有益的选择，因为改变了nucleus verbens激活时，预期的奖励。这一发现支持强迫症作为奖励加工和行为成瘾障碍的概念。
Background: Obsessive-compulsive disorder (OCD) is primarily conceived as an anxiety disorder but has features resembling addictive behavior. Patients with OCD may develop dependency upon compulsive behaviors because of the rewarding effects following reduction of obsession-induced anxiety. Reward processing is critically dependent on ventral striatal-orbitofrontal circuitry and brain imaging studies in OCD have consistently shown abnormal activation within this circuitry. This is the first functional imaging study to investigate explicitly reward circuitry in OCD.Methods: Brain activity during reward anticipation and receipt was compared between 18 OCD patients and 19 healthy control subjects, using a monetary incentive delay task and functional magnetic resonance imaging. Reward processing was compared between OCD patients with predominantly contamination fear and patients with predominantly high-risk assessment.Results: Obsessive-compulsive disorder patients showed attenuated reward anticipation activity in the nucleus accumbens compared with healthy control subjects. Reduced activity of the nucleus accumbens was more pronounced in OCD patients with contamination fear than in patients with high-risk assessment. Brain activity during reward receipt was similar between patients and control subjects. A hint toward more dysfunctional reward processing was found in treatment-resistant OCD patients who subsequently were successfully treated with deep brain stimulation of the nucleus accumbens.Conclusions: Obsessive-compulsive disorder patients may be less able to make beneficial choices because of altered nucleus accumbens activation when anticipating rewards. This finding supports the conceptualization of OCD as a disorder of reward processing and behavioral addiction.