Task-based fMRI predicts response and remission to exposure therapy in obsessive-compulsive disorder
Task-based fMRI predicts response and remission to exposure therapy in obsessive-compulsive disorder
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DOI：
10.1073/pnas.1909199116
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发表时间：
2019-10-08
影响因子：
11.1
通讯作者：
Marsh, Rachel
中科院分区：
文献类型：
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作者：
Pagliaccio, David;Middleton, Rachel;Marsh, Rachel
暴露和仪式预防（EX/RP）是一种有效的一线治疗强迫症（OCD），但只有一些患者在EX/RP后症状轻微。在这里，我们调查是否基于任务的神经活动可以预测谁对EX/RP的反应最好。未服药的成人强迫症患者（n = 36）和健康参与者（n = 33）在高分辨率，多频带功能MRI（fMRI）期间完成西蒙空间不相容性任务;然后为患者提供每周两次EX/RP（17次）。线性混合效应模型被用来确定大脑区域，其中冲突相关的活动缓和了耶鲁-布朗强迫症量表（Y-BOCS）评分的变化斜率。左侧苍白球和35个皮质包裹/区域的突触相关活动显著预测强迫症患者EX/RP的症状改善（错误发现率校正P < 0.05）。重要的包裹/区域包括扣带-鳃盖和默认模式网络区域，特别是前扣带、前扣带和后扣带。总结这些包裹/区域，更大的冲突相关活动预测更大的EX/RP反应，以及哪些患者以>80%的灵敏度和特异性实现缓解（Y-BOCS评分= 12; Cohen d = 1.68）。脑活动和治疗反应之间的相关性部分由患者EX/RP依从性介导（B = -2.99;总效应的43.61%; P = 0.02）。脑活动和依从性一起高度预测缓解。总之，这些研究结果表明，扣带-鳃盖和默认模式区域通常涉及任务控制和内省过程，分别可能是新的治疗目标，增强强迫症患者解决认知冲突的能力，从而促进遵守EX/RP，增加缓解的可能性。
Exposure and ritual prevention (EX/RP) is an effective first-line treatment for obsessive-compulsive disorder (OCD), but only some patients achieve minimal symptoms following EX/RP. Herein, we investigate whether task-based neural activity can predict who responds best to EX/RP. Unmedicated adult patients with OCD (n = 36) and healthy participants (n = 33) completed the Simon Spatial Incompatibility Task during high-resolution, multiband functional MRI (fMRI); patients were then offered twice-weekly EX/RP (17 sessions). Linear mixed-effects models were used to identify brain regions where conflict-related activity moderated the slope of change in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores across treatment. Conflict-related activity in the left pallidum and 35 cortical parcels/regions significantly predicted symptom improvement with EX/RP for patients with OCD (false discovery rate-corrected P < 0.05). Significant parcels/regions included cingulo-opercular and default mode network regions, specifically the anterior insula and anterior and posterior cingulate. Summarizing across these parcels/regions, greater conflict-related activity predicted greater EX/RP response and which patients achieved remission (Y-BOCS score = 12; Cohen's d = 1.68) with >80% sensitivity and specificity. The association between brain activity and treatment response was partially mediated by patient EX/RP adherence (b = -2.99; 43.61% of total effect; P = 0.02). Brain activity and adherence together were highly predictive of remission. Together, these findings suggest that cingulo-opercular and default mode regions typically implicated in task control and introspective processes, respectively, may be targets for novel treatments that augment the ability of persons with OCD to resolve cognitive conflict and thereby facilitate adherence to EX/RP, increasing the likelihood of remission.