An S K, Mataix-Cols D, Lawrence N S, Wooderson S, Giampietro V, Speckens A, Brammer M J, Phillips M L
Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK.
Mol Psychiatry. 2009 Mar;14(3):318-31. doi: 10.1038/sj.mp.4002129. Epub 2008 Jan 8.
Preliminary neuroimaging studies suggest that patients with the 'compulsive hoarding syndrome' may be a neurobiologically distinct variant of obsessive-compulsive disorder (OCD) but further research is needed. A total of 29 OCD patients (13 with and 16 without prominent hoarding symptoms) and 21 healthy controls of both sexes participated in two functional magnetic resonance imaging experiments consisting of the provocation of hoarding-related and symptom-unrelated (aversive control) anxiety. In response to the hoarding-related (but not symptom-unrelated) anxiety provocation, OCD patients with prominent hoarding symptoms showed greater activation in bilateral anterior ventromedial prefrontal cortex (VMPFC) than patients without hoarding symptoms and healthy controls. In the entire patient group (n=29), provoked anxiety was positively correlated with activation in a frontolimbic network that included the anterior VMPFC, medial temporal structures, thalamus and sensorimotor cortex. Negative correlations were observed in the left dorsal anterior cingulate gyrus, bilateral temporal cortex, bilateral dorsolateral/medial prefrontal regions, basal ganglia and parieto-occipital regions. These results were independent from the effects of age, sex, level of education, state anxiety, depression, comorbidity and use of medication. The findings are consistent with the animal and lesion literature and several landmark clinical features of compulsive hoarding, particularly decision-making difficulties. Whether the results are generalizable to hoarders who do not meet criteria for OCD remains to be investigated.
初步的神经影像学研究表明，患有“强迫性囤积综合征”的患者可能是强迫症（OCD）在神经生物学上的一种独特变体，但仍需进一步研究。共有29名强迫症患者（13名有明显囤积症状，16名无明显囤积症状）和21名男女健康对照者参与了两项功能磁共振成像实验，实验内容包括引发与囤积相关和与症状无关（厌恶对照）的焦虑。在应对与囤积相关（而非与症状无关）的焦虑激发时，有明显囤积症状的强迫症患者双侧前内侧前额叶皮质（VMPFC）的激活程度高于无囤积症状的患者和健康对照者。在整个患者组（n = 29）中，激发的焦虑与一个额叶边缘网络的激活呈正相关，该网络包括前VMPFC、内侧颞叶结构、丘脑和感觉运动皮层。在左侧背侧前扣带回、双侧颞叶皮质、双侧背外侧/内侧前额叶区域、基底神经节和顶枕区域观察到负相关。这些结果不受年龄、性别、教育程度、状态焦虑、抑郁、共病情况和药物使用的影响。这些发现与动物和损伤方面的文献以及强迫性囤积的几个标志性临床特征一致，特别是决策困难。这些结果是否适用于不符合强迫症标准的囤积者仍有待研究。
