Nabeyama Maiko, Nakagawa Akiko, Yoshiura Takashi, Nakao Tomohiro, Nakatani Eriko, Togao Osamu, Yoshizato Chika, Yoshioka Kazuko, Tomita Mayumi, Kanba Shigenobu
Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Psychiatry Res. 2008 Aug 30;163(3):236-47. doi: 10.1016/j.pscychresns.2007.11.001. Epub 2008 Jul 29.
Dysfunction of the frontal-subcortical circuits has been the most common finding in the pathophysiology of obsessive-compulsive disorder (OCD), and recent neuropsychological studies have shown cognitive impairments in OCD. To clarify the pathophysiology of OCD without the confounding effects of medication, we investigated the alterations of brain function in OCD patients and changes after clinical improvement due solely to behavior therapy. The participants were 11 outpatients with OCD and 19 normal controls. The patients received 12 weeks of behavior therapy. We investigated the differences in the behavioral performance and functional magnetic resonance imaging results during the Stroop test in the patients and normal controls, and their changes after treatment in the patients. The patients showed less activation in the anterior cingulate gyrus and cerebellum than control subjects. Following significant improvement in OC symptoms, the cerebellum and parietal lobe showed increased activation, and the orbitofrontal cortex, middle frontal gyrus, and temporal regions showed decreased activation during the Stroop task, and performance of the task itself improved. Our findings suggest that dysfunction of the posterior brain regions, especially the cerebellum, is involved in the pathogenesis of OCD, and that normalization in function can occur with improvement of OC symptoms.
额叶 - 皮质下回路功能障碍是强迫症（OCD）病理生理学中最常见的发现，最近的神经心理学研究表明强迫症患者存在认知障碍。为了在不受到药物混淆效应影响的情况下阐明强迫症的病理生理学，我们研究了强迫症患者的脑功能改变以及仅因行为疗法导致临床改善后的变化。参与者包括11名强迫症门诊患者和19名正常对照者。患者接受了为期12周的行为疗法。我们研究了患者和正常对照者在斯特鲁普测试期间的行为表现和功能磁共振成像结果的差异，以及患者治疗后的变化。与对照受试者相比，患者在前扣带回和小脑中的激活较少。强迫症症状显著改善后，在斯特鲁普任务期间，小脑和顶叶的激活增加，眶额皮质、额中回和颞区的激活减少，并且任务本身的表现有所改善。我们的研究结果表明，后脑区域，尤其是小脑的功能障碍与强迫症的发病机制有关，并且随着强迫症症状的改善，功能可以恢复正常。
