Modulation of the OCD neural network by conventional treatment

项目摘要/摘要 麦克莱恩医院项目4 拟议项目“强迫症神经网络的常规调制”的主要目标是 治疗“是研究如何对严重强迫症密集暴露和反应进行常规干预 预防(ERP)治疗和护理标准用药管理--影响假定的强迫症网络进一步 我们对强迫症常见有效治疗方法如何影响神经回路的理解 回避和令人厌恶的不确定性。为了实现这一目标，P4将识别VLPFC、rACC、 脑岛、dACC、OFC和嘴侧纹状体与PAAT表现和临床症状报告的关系 强迫症患者接受强化治疗并随着时间的推移疾病负担发生变化。 该项目将跟踪95名强迫症患者，对大脑和行为进行密集的纵向评估 在典型的~8wk疗程中。P4将以我们组的运营经验为基础，表演连续剧 强迫症的MRI(功能和结构)和详细的系列临床评估，以及我们的强化治疗工具包 纵向评估，目前部署在NIMH资助的其他数据收集工作中，并与 核心C的成员，以确定OCDnet的变化，持续回避(根据PAAT和 基于设备的探索性措施)和强迫症的临床变化。三次综合性考察访问 (治疗前、治疗中和治疗后)进行核磁共振和临床评估将提供疾病轨迹信息 为了探测在粗略时间尺度上变化的构造之间的关系，并辅之以低负担， 数字表型以捕捉中等和精细时间尺度上的变异。阐明了人类的行为方式 与临床和治疗参数变化相关的假定强迫症净变化将为以下目标提供目标 强迫症的新干预措施，并帮助了解目前如何以及哪些人可以获得治疗 实现其最佳的治疗效果。

PROJECT SUMMARY/ABSTRACT McLean Hospital Project 4 The main goal of the proposed project, entitled “Modulation of the OCD neural network by conventional treatment,” is to study how conventional interventions for severe OCD – intensive exposure and response prevention (ERP) therapy and standard of care medication management – affect the putative OCDnet to further our understanding of how commonly available, efficacious treatments for OCD impact neural circuits involved in avoidance and aversive uncertainty. To achieve this goal, P4 will identify abnormalities in the vlPFC, rACC, insula, dACC, OFC and rostral striatum that track with performance on the PAAT and clinical symptom reports in individuals with OCD as they receive intensive treatment and undergo changes in illness burden over time. The project will follow 95 individuals with OCD using intensive longitudinal assessment of brain and behavior over the typical ~8wk treatment course. P4 will build on our group’s operational experience performing serial MRI (functional and structural) and detailed serial clinical assessments in OCD, and our toolkit for intensive longitudinal assessment, currently deployed in other NIMH-funded data collection efforts and developed with members of Core C, to identify changes in the OCDnet, persistent avoidance (as measured on PAAT and with exploratory device-based measures), and clinical changes in OCD. Three sets of comprehensive study visits (before, during, and after treatment) with MRI and clinical assessments will provide illness trajectory information for probing relationships between changing constructs at a coarse timescale, complemented by low-burden, digital phenotyping to capture variation at intermediate and finer time scales. Elucidating the ways in which the putative OCDnet changes in relation to changes in clinical and therapeutic parameters will provide targets for new interventions for OCD and help understand how and in which individuals currently available treatments achieve their optimal therapeutic benefit.