Tolin D F, Kiehl K A, Worhunsky P, Book G A, Maltby N
The Institute of Living/Hartford Hospital, Hartford, CT 06106, USA.
Psychol Med. 2009 Feb;39(2):325-36. doi: 10.1017/S0033291708003371. Epub 2008 May 19.
Prior studies have suggested unique patterns of neural activity associated with compulsive hoarding. However, to date no studies have examined the process of making actual decisions about whether to keep or discard possessions in patients with hoarding symptoms. An increasing body of clinical data and experimental psychopathology research suggests that hoarding is associated with impaired decision making; therefore, it is important to understand the neural underpinnings of decision-making abnormalities in hoarding patients.
Twelve adult patients diagnosed with compulsive hoarding, 17% of whom also met criteria for obsessive-compulsive disorder (OCD), and 12 matched healthy controls underwent functional magnetic resonance imaging (fMRI) while making decisions about whether or not to discard personal paper items (e.g. junk mail) brought to the laboratory as well as control items that did not belong to them. Items were either saved or destroyed following each decision.
When deciding about whether to keep or discard personal possessions, compulsive hoarding participants displayed excessive hemodynamic activity in lateral orbitofrontal cortex and parahippocampal gyrus. Among hoarding participants, decisions to keep personal possessions were associated with greater activity in superior temporal gyrus, middle temporal gyrus, medial frontal gyrus, anterior cingulate cortex, precentral gyrus, and cerebellum than were decisions to discard personal possessions.
These results provide partial support for an emerging model of compulsive hoarding based on complications of the decision-making process. They also suggest that compulsive hoarding may be characterized by focal deficits in the processing of reward and changes in reward contingencies, particularly when these are perceived to be punishing.
先前的研究表明与强迫性囤积相关的独特神经活动模式。然而，迄今为止，尚无研究考察囤积症状患者在实际决定是否保留或丢弃物品的过程。越来越多的临床数据和实验性精神病理学研究表明，囤积与决策受损有关；因此，了解囤积患者决策异常的神经基础很重要。
12名被诊断为强迫性囤积的成年患者，其中17%也符合强迫症（OCD）的标准，以及12名匹配的健康对照者在对是否丢弃带到实验室的个人纸质物品（如垃圾邮件）以及不属于他们的对照物品做出决定时接受功能磁共振成像（fMRI）检查。每次决定后，物品要么被保留要么被销毁。
在决定是否保留或丢弃个人物品时，强迫性囤积参与者在外侧眶额皮质和海马旁回表现出过度的血流动力学活动。在囤积参与者中，决定保留个人物品时，颞上回、颞中回、内侧额回、前扣带回皮质、中央前回和小脑的活动比决定丢弃个人物品时更强。
这些结果为基于决策过程并发症的强迫性囤积新模型提供了部分支持。它们还表明，强迫性囤积可能的特征是在奖励处理和奖励意外情况变化方面存在局部缺陷，特别是当这些被视为惩罚时。
