Neurocognitive assessment in obsessive compulsive disorder patients: Adherence to behavioral decision models.

Reversal Learning as a Neuropsychological Indicator for the Neuropathology of Obsessive Compulsive Disorder? A Behavioral Study

The aim of this study is to determine whether the levels of zonulin and occludin, tight junctions (TJ) proteins in the intestinal epithelium, will differ between obsessive compulsive disorder (OCD) patients and healthy controls. We also intended to investigate whether these would vary in OCD patients with and without major depressive disorder (MDD) comorbidity and in comparison with healthy controls. Sixty patients diagnosed with OCD and 30 healthy controls were included in the study. The cases were administered the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Hamilton Depression Rating Scale (HDRS). The patients were divided into two subgroups based on their HDRS scores and presence of MDD comorbidity. Zonulin and occludin levels were measured using the ELISA method. The research was carried out between April 2021 and October 2021. Zonulin and occludin levels were significantly higher in the OCD patient group than in the control group (p<0.001). The levels of both were also significantly higher in the OCD patients with MDD comorbidity (OCD+MDD) compared to those without MDD (OCD-MDD) (p<0.001). Zonulin and occludin levels also rose significantly as disease severity increased in the OCD patient group (respectively; p<0.001, p=0.001). The levels of both increased in line with the severity of depression based on HDRS scores in the OCD+MDD group (p<0.001). A positive correlation was determined between the duration of OCD and zonulin and occludin levels. Evaluation of the entire OCD group revealed a moderate positive correlation between Y-BOCS and HDRS scores and zonulin and occludin. Zonulin and occludin levels in this research were significantly higher in the patients with OCD than in the healthy controls. That elevation was positively correlated with disease duration and severity, and the increase was significantly more pronounced in OCD with MDD comorbidity. These findings point to a possible disorder in the intestinal barrier and blood-brain barrier in OCD patients.

Objective To investigate the regulatory effect of cognitive behavioral therapy (CBT) on the functional connectivity of cognitive control network in untreated obsessive-compulsive disorder (OCD) patients, so as to provide evidence for understanding the neurobiological mechanism of CBT. Methods A total of 45 OCD patients and 45 matched normal controls were recruited at the outpatient clinic in Beijing Anding Hospital. Four therapists provided 14 times of CBT treatment for OCD patients. All subjects underwent clinical symptom assessment and magnetic resonance imaging at baseline and at the end of 12 weeks. The clinical symptoms were assessed by the psychiatrists using Y-BOCS, HAMD17 and HAMA. The clinical symptoms of OCD patients before and after CBT treatment were compared. The GRETNA software package was used to preprocess the resting-state fMRI data. The whole brain function network was constructed with the template of Power 264 functional brain area as the network node. The function connection intensity outside the cognitive control network was calculated, and the function connection of 2 groups of brain networks at two timepoints were compared by repeated measurement of variance analysis. Results A total of 41 patients completed CBT. The scores of obsessive-compulsive symptoms, anxiety symptoms and depressive symptoms decreased at the end of 12th week, of which 32 patients were improved (Y-BOCS reduction ≥35%). Single factor repeated analysis of variance and post hoc tests were performed between patients with improvement and normal controls. At baseline, the functional connection between the cingulo-opercular network and the salience network of OCD patients was lower than that of the normal control (0.172±0.060 vs. 0.215±0.076, t=1.731, P=0.040), it increased after treatment (0.186±0.171 vs. 0.172±0.060, t=2.480, P=0.010). At baseline, the functional connection of cingulo-opercular network and subcortical network in OCD patients was lower than that of normal control (0.119±0.081 vs. 0.129±0.070, t=1.640, P=0.040), and it increased after treatment (0.130±0.161 vs. 0.119±0.081, t=2.421, P=0.020). At baseline, the functional connection between the frontal-parietal network and subcortical network was lower than that of normal controls (-0.004±0.039 vs. 0.021±0.054, t=2.280, P=0.020), and it increased after treatment (0.020±0.042 vs.-0.004±0.039, t=-2.300 P=0.020). Conclusions CBT could effectively improve obsessive-compulsive symptoms accompanying with improvement of the external functional connectivity of cognitive control network in OCD patients. Key words: Obsessive-compulsive disorder; Cognitive therapy; Cognitive control network; Functional connectivity

Obsessive-compulsive disorder (OCD) is a common psychiatric illness characterised by recurrent, intrusive thoughts and repetitive, stereotyped behaviours. There is converging evidence that OCD is associated with a specific cognitive deficit related to organising and manipulating information in working memory. There is also evidence that OCD is associated with certain pre-morbid personality traits. However, further research is needed to elucidate whether these cognitive deficits and personality traits are specific to OCD or are present in other anxiety disorders and/or individuals with sub-clinical levels of obsessive-compulsive (OC) symptoms. In this thesis, 20 OCD patients were compared to 20 patients with panic disorder, 20 subjects with sub-clinical OC symptoms and 20 healthy control subjects on tests of working memory and the Five-Factor Model of personality. To measure different aspects of working memory, participants completed three delayed matching-to-sample (DMS) tasks and two continuous performance working memory tasks (n-back tasks). The DMS tasks assessed the ability to actively maintain different types of information in working memory (irregular objects; geometric objects; spatial locations). The n-back tasks assessed the ability to update and temporally order verbal and spatial stimuli in working memory. The OCD patients were less accurate than the healthy control subjects on the memory trials of the spatial DMS task, the 3- back trials of the spatial n-back task, and the 2-back and 3-back trials of the verbal n-back task. The OCD patients were also less accurate than patients with panic disorder and sub-clinical OC subjects on the verbal 3-back task. The results indicated that OCD patients were impaired on cognitive tasks requiring the maintenance of spatial stimuli and the updating and temporal ordering of verbal and spatial stimuli in working memory. The OCD patients were not impaired on tasks requiring the maintenance of object information in working memory. To measure normal personality traits, subjects completed the Revised NEO Personality Inventory (NEO PIR). Compared to healthy controls, OCD patients reported being highly emotional and introverted, less open to new experiences, and lacking confidence in their own abilities. The OCD patients were similar to the panic disorder patients on most of the domains and facets of the NEO PI-R, however, they were distinguished by their lower openness to experiencing new activities, and being less diligent and purposeful. Compared to the sub-clinical OC subjects, OCD patients reported being more prone to feelings of depression, more vulnerable to stress, less likely to experience positive emotions, more humble and sincere and less able to carry tasks through to completion. Overall, the thesis provided further evidence that OCD patients are impaired on cognitive tasks requiring the organisation and manipulation of information in working memory. However, it is still unclear whether this deficit arises due to capacity constraints being exceeded in working memory systems, or some other executive dysfunction such as excessive error monitoring. Future research, combining neuropsychological testing with neuroimaging techniques, is required to better understand the neural mechanisms underlying the impaired performance of OCD patients on tests of working memory. The present thesis also found that normal personality traits - as measured by the NEO PI-R - were able to distinguish OCD patients from healthy controls, patients with panic disorder and individuals with sub-clinical levels of OC symptoms. The results have implications for sub-clinical OC research and the clinical management of OCD.

Background and AimsRecent studies have challenged the anxiety-avoidance model of obsessive–compulsive disorder (OCD), linking OCD to impulsivity, risky-decision-making and reward-system dysfunction, which can also be found in addiction and might support the conceptualization of OCD as a behavioral addiction. Here, we conducted an exploratory investigation of the behavioral addiction model of OCD by assessing whether OCD patients are more impulsive, have impaired decision-making, and biased probabilistic reasoning, three core dimensions of addiction, in a sample of OCD patients and healthy controls.MethodsWe assessed these dimensions on 38 OCD patients and 39 healthy controls with the Barratt Impulsiveness Scale (BIS-11), the Iowa Gambling Task (IGT) and the Beads Task.ResultsOCD patients had significantly higher BIS-11 scores than controls, in particular on the cognitive subscales. They performed significantly worse than controls on the IGT preferring immediate reward despite negative future consequences, and did not learn from losses. Finally, OCD patients demonstrated biased probabilistic reasoning as reflected by significantly fewer draws to decision than controls on the Beads Task.ConclusionsOCD patients are more impulsive than controls and demonstrate risky decision-making and biased probabilistic reasoning. These results might suggest that other conceptualizations of OCD, such as the behavioral addiction model, may be more suitable than the anxiety-avoidance one. However, further studies directly comparing OCD and behavioral addiction patients are needed in order to scrutinize this model.

Background: A large amount of resting-state functional magnetic resonance imaging (rs-fMRI) studies have revealed abnormalities of regional homogeneity (ReHo, an index of localized intraregional connectivity) in the obsessive-compulsive disorder (OCD) in the past few decades, However, the findings of these ReHo studies have remained inconsistent. Hence, we performed a meta-analysis to investigate the concurrence across ReHo studies for clarifying the most consistent localized connectivity underpinning this disorder.Methods: A systematic review of online databases was conducted for whole-brain rs-fMRI studies comparing ReHo between OCD patients and healthy control subjects (HCS). Anisotropic effect size version of the seed-based d mapping, a voxel-wise meta-analytic approach, was adopted to explore regions of abnormal ReHo alterations in OCD patients relative to HCS. Additionally, meta-regression analyses were conducted to explore the potential effects of clinical features on the reported ReHo abnormalities.Results: Ten datasets comprising 359 OCD patients and 361 HCS were included. Compared with HCS, patients with OCD showed higher ReHo in the bilateral inferior frontal gyri and orbitofrontal cortex (OFC). Meanwhile, lower ReHo was identified in the supplementary motor area (SMA) and bilateral cerebellum in OCD patients. Meta-regression analysis demonstrated that the ReHo in the OFC was negatively correlated with illness duration in OCD patients.Conclusions: Our meta-analysis gave a quantitative overview of ReHo findings in OCD and demonstrated that the most consistent localized connectivity abnormalities in individuals with OCD are in the prefrontal cortex. Meanwhile, our findings provided evidence that the hypo-activation of SMA and cerebellum might be associated with the pathophysiology of OCD.

Panic disorder and obsessive compulsive disorder in a hyperventilation challenge test

Chronic tics and Tourette syndrome in patients with obsessive–compulsive disorder

Lateralized readiness potentials and sensorimotor activity in adults with obsessive-compulsive disorder

Electrophysiological sleep features and inhibitory control functions in patients with obsessive-compulsive disorder.

Computed tomography and neurological soft signs in obsessive-compulsive disorder

Obsessive compulsive disorder (OCD) is a serious mental disease highly associated with the dysfunctional dynamics of brain networks. The default mode network (DMN) is an essential brain network responding to various cognitive functions, which has been reported the abnormality in OCD patients. However, the underlying evolutions of temporal-spatial neurodynamics in fast-changing DMN activity of OCD remains largely unclear. In the present work, we tried to address this issue by tracking the neurodynamic structure of electrophysiological DMN activity in OCD patients during the resting state. To achieve this purpose, we reconstructed the DMN source activity from the scalp EEG signal with the exact low-resolution brain electromagnetic tomography (LORETA) algorithm, and applied coactive micropattern (CAMP) analysis developed by our previous studies to characterize DMN dynamics. We observed three CAMPs with distinct spatial structures in DMN dynamics for the normal subjects, while there were four different CAMPs in OCD patients. More interestingly, the temporal features of CAMPs which displayed similar spatial structures in two groups were also significantly altered in OCD patients compared with those in normal subjects, implying an abnormal DMN dynamic structure for OCD. Moreover, stronger DMN source connectivity in different CAMP networks emerged in OCD patients, where the posterior cingulate cortex and frontal cortex might be two hub regions with more increased connectivity. Overall, our results showed pathological alterations in the dynamic configuration of the DMN in OCD patients and revealed the neural brain network mechanism for OCD. All these findings could deepen our understanding of the neural pathology of OCD and might provide potential electrophysiological markers for diagnosing OCD patients clinically.

Serotonin uptake and imipramine binding in the blood platelets of obsessive-compulsive disorder patients

Obsessive-compulsive disorder (OCD) patients show hyperactive performance monitoring when monitoring their own actions. Hyperactive performance monitoring is related to OCD symptomatology, like the unflexibility of compulsive behaviors, and was suggested as a potential endophenotype for the disorder. However, thus far the functioning of the performance monitoring system in OCD remains unclear in processes where performance is not monitored in one's own actions internally, but through external feedback during learning. The present study investigated whether electrocortical indicators of feedback processing are hyperactive, and whether feedback-guided learning is compromised in OCD. A modified deterministic four-choice object reversal learning task was used that required recurrent feedback-based behavioral adjustment in response to changing reward contingencies. Electrophysiological correlates of feedback processing (i.e. feedback-related negativity [FRN] and P300) were measured in 25 OCD patients and 25 matched healthy comparison subjects. Deficits in behavioral adjustment were found in terms of higher error rates of OCD patients in response to negative feedback. Whereas the FRN was unchanged for reversal negative feedback, it was reduced for negative feedback that indicated that a newly selected stimulus was still incorrect. The observed FRN reduction suggests attenuated monitoring of feedback during the learning process in OCD potentially contributing to a deficit in adaptive behavior reflected in obsessive thoughts and actions. The reduction of FRN amplitudes contrasts with overactive performance monitoring of self-generated errors. Nevertheless, the findings contribute to the theoretical framework of performance monitoring, suggesting a dissociation of processing systems for actions and feedback with specific alterations of these two systems in OCD.

Background:Propensity to sexual excitation and inhibition is one of the key dimensions of sexuality. Clinicians working with Obsessive-Compulsive Disorder (OCD) patients rarely assess this and other aspects of sexuality, since treatment targets generally symptom reduction. Literature on sexual functioning in OCD patients is scarce and no study has focused on symptom subtypes, nor investigated the psychological processes related to sexual response.Objective:In the present short report, we describe an exploratory study investigating the association between symptom subtypes and propensity towards sexual excitation/inhibition in OCD patients, controlling for gender, age and antidepressant treatment.Methods:Seventy-two OCD patients (mean age = 34.50 years, 37.50% women) completed the Obsessive-Compulsive Inventory-Revised and the Sexual Inhibition/Sexual Excitation Scales.Results:Patients with more severe compulsive washing habit had a lower propensity towards excitation and a higher one towards inhibition due to threat of performance consequences (i.e., contamination with sexually transmitted diseases/having an unwanted pregnancy). Patients with more severe symptoms of checking showed a higher propensity towards inhibition due to the threat of performance consequences. Gender, age and antidepressant treatment were not related to sexual functioning.Conclusion:Specific OCD symptom subtypes may be associated with some psychological processes involved in sexual response. Sexual well-being should be carefully evaluated by practitioners and should be regarded as a treatment target. Future studies should investigate more comprehensively the processes involved in sexuality.