Gilbert Andrew R, Akkal Dalila, Almeida Jorge R C, Mataix-Cols David, Kalas Catherine, Devlin Bernie, Birmaher Boris, Phillips Mary L
Drs. Gilbert, Akkal, Almeida, Devlin, Birmaher, and Phillips and Ms. Kalas are with the University of Pittsburgh School of Medicine. Dr. Mataix-Cols is with King's College London, Institute of Psychiatry.
Drs. Gilbert, Akkal, Almeida, Devlin, Birmaher, and Phillips and Ms. Kalas are with the University of Pittsburgh School of Medicine. Dr. Mataix-Cols is with King's College London, Institute of Psychiatry.
J Am Acad Child Adolesc Psychiatry. 2009 Sep;48(9):936-944. doi: 10.1097/CHI.0b013e3181b2163c.
Neuroimaging studies have identified distinct neural correlates of obsessive-compulsive disorder (OCD) symptom dimensions in adult subjects and may be related to functional abnormalities in different cortico-striatal-thalamic neural systems underlying cognition and affective processing. Similar symptom dimensions are apparent in childhood and adolescence, but their functional neural correlates remain to be elucidated.
Pediatric subjects with OCD (n = 18) and matched controls (n = 18), ages 10 to 17 years, were recruited for two functional magnetic resonance imaging experiments. They were scanned while viewing alternating blocks of symptom provocation (contamination-related or symmetry-related) and neutral pictures and imagining scenarios related to the content of each picture type.
The subjects with OCD demonstrated reduced activity in the right insula, putamen, thalamus, dorsolateral prefrontal cortex, and left orbitofrontal cortex (contamination experiment) and in the right thalamus and right insula (symmetry experiment). Higher scores on OCD symptom-related measures (contamination and total severity) were significantly predictive of reduced neural activity in the right dorsolateral prefrontal cortex during the contamination experiment.
Our findings indicate reduced activity in neural regions underlying emotional processing, cognitive processing, and motor performance in pediatric subjects with OCD compared with the controls. These between-group differences are present during both contamination and symmetry provocation experiments and during symptom provocation as well as viewing neutral pictures. The direction of activity is in contrast to adult findings in the insula and in components of cortico-striatal-thalamic neural systems. Our findings suggest developmental effects on neural systems underlying symptom dimensions in pediatric OCD.
神经影像学研究已确定成年强迫症（OCD）患者症状维度的不同神经关联，这可能与认知和情感加工背后不同的皮质-纹状体-丘脑神经系统的功能异常有关。相似的症状维度在儿童期和青少年期也很明显，但其功能神经关联仍有待阐明。
招募10至17岁患有强迫症的儿科患者（n = 18）和匹配的对照组（n = 18），进行两项功能磁共振成像实验。在他们观看交替出现的症状激发（与污染相关或与对称相关）和中性图片，并想象与每种图片类型内容相关的场景时进行扫描。
患有强迫症的受试者在右侧岛叶、壳核、丘脑、背外侧前额叶皮质以及左侧眶额叶皮质（污染实验）和右侧丘脑及右侧岛叶（对称实验）中的活动减少。在污染实验期间，强迫症症状相关测量指标（污染和总体严重程度）得分较高显著预测右侧背外侧前额叶皮质神经活动减少。
我们的研究结果表明，与对照组相比，患有强迫症的儿科患者在情绪加工、认知加工和运动表现背后的神经区域活动减少。这些组间差异在污染和对称激发实验期间、症状激发以及观看中性图片时均存在。活动方向与成人在岛叶以及皮质-纹状体-丘脑神经系统组成部分中的研究结果相反。我们的研究结果提示了发育对儿科强迫症症状维度背后神经系统的影响。
