A Psychological and Neuroanatomical Model of Obsessive-Compulsive Disorder

Huey, Edward D.; Zahn, Roland; Moll, J.; Kapogiannis, D.; Wassermann, Eric M.; Grafman, Jordan

doi:10.1176/appi.neuropsych.20.4.390

Cited by 57 publications

(53 citation statements)

References 27 publications

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“…The key role of the nucleus caudatus in OCD etiology has been described in numerous OCD neuroimaging studies (for reviews see Whiteside et al, 2004; Chamberlain et al, 2005; Deckersbach et al, 2006; Friedlander and Desrocher, 2006; Huey et al, 2008). This structure is at the core of the spatial/attentional loop of the orbitofronto-striatal network model (Menzies et al, 2008).…”

Section: Discussionmentioning

confidence: 97%

Neural response in obsessive-compulsive washers depends on individual fit of triggers

Baioui¹,

Pilgramm²,

Merz³

et al. 2013

Front. Hum. Neurosci.

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Background: Patients with obsessive-compulsive disorder (OCD) have highly idiosyncratic triggers. To fully understand which role this idiosyncrasy plays in the neurobiological mechanisms behind OCD, it is necessary to elucidate the impact of individualization regarding the applied investigation methods. This functional magnetic resonance imaging (fMRI) study explores the neural correlates of contamination/washing-related OCD with a highly individualized symptom provocation paradigm. Additionally, it is the first study to directly compare individualized and standardized symptom provocation.Methods: Nineteen patients with washing compulsions created individual OCD hierarchies, which later served as instructions to photograph their own individualized stimulus sets. The patients and 19 case-by-case matched healthy controls participated in a symptom provocation fMRI experiment with individualized and standardized stimulus sets created for each patient.Results: OCD patients compared to healthy controls displayed stronger activation in the basal ganglia (nucleus accumbens, nucleus caudatus, pallidum) for individualized symptom provocation. Using standardized symptom provocation, this group comparison led to stronger activation in the nucleus caudatus. The direct comparison of between-group effects for both symptom provocation approaches revealed stronger activation of the orbitofronto-striatal network for individualized symptom provocation.Conclusions: The present study provides insight into the differential impact of individualized and standardized symptom provocation on the orbitofronto-striatal network of OCD washers. Behavioral and neural responses imply a higher symptom-specificity of individualized symptom provocation.

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Section: Discussionmentioning

confidence: 97%

Neural response in obsessive-compulsive washers depends on individual fit of triggers

Baioui¹,

Pilgramm²,

Merz³

et al. 2013

Front. Hum. Neurosci.

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“…54,55 There have been reports of oxidative stress in populations with OCD, including increased lipid peroxidation; [56][57][58][59] decreased vitamin E, 58 catalase, GPx and selenium; 59 increased superoxide dismutase; 59 and changes in overall oxidative status. 60 Some of these alterations have been linked to symptom severity.…”

Section: Obsessive-compulsive Disordermentioning

confidence: 99%

N-acetylcysteine in psychiatry: current therapeutic evidence and potential mechanisms of action

Dean

Giorlando

Berk

2011

J Psychiatry Neurosci

421

314

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There is an expanding field of research investigating the benefits of alternatives to current pharmacological therapies in psychiatry. N-acetylcysteine (NAC) is emerging as a useful agent in the treatment of psychiatric disorders. Like many therapies, the clinical origins of NAC are far removed from its current use in psychiatry. Whereas the mechanisms of NAC are only beginning to be understood, it is likely that NAC is exerting benefits beyond being a precursor to the antioxidant, glutathione, modulating glutamatergic, neurotropic and inflammatory pathways. This review outlines the current literature regarding the use of NAC in disorders including addiction, compulsive and grooming disorders, schizophrenia and bipolar disorder. N-acetylcysteine has shown promising results in populations with these disorders, including those in whom treatment efficacy has previously been limited. The therapeutic potential of this acetylated amino acid is beginning to emerge in the field of psychiatric research.

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“…In terms of neurocircuitry, abnormally reduced activation of several cortical regions, including lateral OFC, was found on functional MRI during reversal learning in both OCD patients and clinically unaffected close relatives (Chamberlain et al, 2008). A recent proposal of how anatomical and psychological models of OCD might be integrated provides a heuristic for further work in this highly important area (Huey et al, 2008).…”

Section: Integrating Cognitive Findings With Anatomical Modelsmentioning

confidence: 99%

Invasive Circuitry-Based Neurotherapeutics: Stereotactic Ablation and Deep Brain Stimulation for OCD

Greenberg

Rauch

Haber

2009

Neuropsychopharmacol

327

229

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Psychiatric neurosurgery, specifically stereotactic ablation, has continued since the 1940s, mainly at a few centers in Europe and the US. Since the late 1990s, the resurgence of interest in this field has been remarkable; reports of both lesion procedures and the newer technique of deep brain stimulation (DBS) have increased rapidly. In early 2009, the US FDA granted limited humanitarian approval for DBS for otherwise intractable obsessive-compulsive disorder (OCD), the first such approval for a psychiatric illness. Several factors explain the emergence of DBS and continued small-scale use of refined lesion procedures. DBS and stereotactic ablation have been successful and widely used for movement disorders. There remains an unmet clinical need: current drug and behavioral treatments offer limited benefit to some seriously ill people. Understandings of the neurocircuitry underlying psychopathology and the response to treatment, while still works in progress, are much enhanced. Here, we review modern lesion procedures and DBS for OCD in the context of neurocircuitry. A key issue is that clinical benefit can be obtained after surgeries targeting different brain structures. This fits well with anatomical models, in which circuits connecting orbitofrontal cortex (OFC), medial prefrontal cortex (mPFC), basal ganglia, and thalamus are central to OCD pathophysiology and treatment response. As in movement disorders, dedicated interdisciplinary teams, here led by psychiatrists, are required to implement these procedures and maintain care for patients so treated. Available data, although limited, support the promise of stereotactic ablation or DBS in carefully selected patients. Benefit in such cases appears not to be confined to obsessions and compulsions, but includes changes in affective state. Caution is imperative, and key issues in long-term management of psychiatric neurosurgery patients deserve focused attention. DBS and contemporary ablation also present different patterns of potential benefits and burdens. Translational research to elucidate how targeting specific nodes in putative OCD circuitry might lead to therapeutic gains is accelerating in tandem with clinical use.

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A Psychological and Neuroanatomical Model of Obsessive-Compulsive Disorder

Cited by 57 publications

References 27 publications

Neural response in obsessive-compulsive washers depends on individual fit of triggers

Neural response in obsessive-compulsive washers depends on individual fit of triggers

N-acetylcysteine in psychiatry: current therapeutic evidence and potential mechanisms of action

Invasive Circuitry-Based Neurotherapeutics: Stereotactic Ablation and Deep Brain Stimulation for OCD

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