Department of Psychiatry, Medical School, University of Michigan, Ann Arbor, Michigan 48109, USA.
Biol Psychiatry. 2010 Dec 1;68(11):1039-47. doi: 10.1016/j.biopsych.2010.08.018. Epub 2010 Oct 14.
Exaggerated concern for correct performance has been linked to hyperactivity of the medial frontal cortex (MFC) in adult obsessive-compulsive disorder (OCD), but the role of the MFC during the early course of illness remains poorly understood. We tested whether hyperactive MFC-based performance monitoring function relates to altered MFC connectivity within task control and default mode networks in pediatric patients.
Eighteen pairs of OCD and matched healthy youth underwent functional magnetic resonance imaging during performance monitoring and at rest. Task-related hyperactivations in the posterior and ventral MFC were used as seeds for connectivity analyses during task and resting state.
In posterior MFC, patients showed greater activation of dorsal anterior cingulate cortex (dACC) than control subjects, with greater activation predicting worse performance. In ventral MFC, control subjects exhibited deactivation, whereas patients activated this region. Compared with control subjects, patients showed increased dACC-ventral MFC connectivity during task and decreased dACC-right anterior operculum and ventral MFC-posterior cingulate connectivity during rest.
Excessive activation and increased interactions of posterior and ventral MFC during performance monitoring may combine with reduced resting state connectivity of these regions within networks for task control and default mode to reflect early markers of OCD. Alteration of reciprocal interactions between these networks could potentiate the intrusion of ventral MFC-based affectively laden, self-referential thoughts, while disrupting posterior MFC-based performance-monitoring function in young patients.
过度关注正确的表现与成年强迫症（OCD）患者内侧前额叶皮层（MFC）的过度活跃有关，但 MFC 在疾病早期的作用仍知之甚少。我们测试了基于过度活跃的 MFC 的表现监测功能是否与儿科患者的任务控制和默认模式网络内的 MFC 连接改变有关。
18 对 OCD 患者和匹配的健康青少年在执行表现监测和休息时接受功能磁共振成像。将后 MFC 和腹侧 MFC 的任务相关激活用作任务和静息状态连接分析的种子。
在后 MFC 中，患者的背侧前扣带皮层（dACC）比对照组表现出更大的激活，更大的激活预示着更差的表现。在腹侧 MFC 中，对照组表现出去激活，而患者则激活了该区域。与对照组相比，患者在任务期间显示出 dACC-腹侧 MFC 连接增加，在休息期间显示出 dACC-右前脑回和腹侧 MFC-后扣带回连接减少。
在表现监测期间，后 MFC 和腹侧 MFC 的过度激活和相互作用增加，可能与这些区域在任务控制和默认模式网络中的静息状态连接减少相结合，反映 OCD 的早期标志物。这些网络之间的相互作用的改变可能会增强基于腹侧 MFC 的情感丰富、自我参照的想法的入侵，同时破坏年轻患者基于后 MFC 的表现监测功能。
