De Bascule, Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands.
J Am Acad Child Adolesc Psychiatry. 2010 Dec;49(12):1238-48, 1248.e1-5. doi: 10.1016/j.jaac.2010.08.007. Epub 2010 Nov 2.
Pediatric obsessive compulsive disorder (OCD) has been associated with cognitive abnormalities, in particular executive impairments, and dysfunction of frontal-striatal-thalamic circuitry. The aim of this study was to investigate if planning as an executive function is compromised in pediatric OCD and is associated with frontal-striatal-thalamic dysfunction, and if this dysfunction would normalize after successful treatment.
Twenty-five medication-free pediatric patients (mean ± SD 13.95 ± 2.52 years old, range 9 to 19 years) with OCD and 25 healthy controls, matched by age and gender, were scanned twice using a self-paced pseudo-randomized event-related functional magnetic resonance imaging version of the Tower of London. Patients were rescanned after 16 sessions of protocol-based cognitive behavioral therapy; healthy controls were rescanned after a similar interval.
Patients performed the task significantly slower but with similar accuracy compared with controls. Neuroimaging results showed less recruitment of frontal and parietal regions in patients with OCD compared with controls during the planning versus control task. With increasing task load patients compared with controls showed more recruitment of ventrolateral and medial prefrontal cortex and insula and anterior cingulate cortex. After treatment, these differences ceased to be significant, with time by group by task load interaction analyses showing a significant decrease in right posterior prefrontal activity in patients with OCD compared with healthy controls.
Pediatric patients with OCD showed subtle planning impairments and decreased dorsolateral prefrontal and parietal recruitment that normalized after cognitive behavioral treatment. Planning dysfunction is likely to be a state rather than a trait feature of pediatric OCD.
儿科强迫症（OCD）与认知异常有关，尤其是执行功能障碍和额纹状体丘脑回路功能障碍。本研究旨在探讨是否计划作为执行功能在儿科 OCD 中受到损害，并且与额纹状体丘脑功能障碍相关，以及这种功能障碍是否会在成功治疗后恢复正常。
使用自我调节的伪随机事件相关功能磁共振成像版的伦敦塔，对 25 名未接受药物治疗的儿科 OCD 患者（平均 ± SD 13.95 ± 2.52 岁，年龄 9 至 19 岁）和 25 名年龄和性别匹配的健康对照组进行了两次扫描。患者在接受 16 次基于方案的认知行为治疗后重新扫描；健康对照组在类似的间隔后重新扫描。
与对照组相比，患者的任务完成速度明显较慢，但准确性相似。神经影像学结果显示，与对照组相比，OCD 患者在计划与对照任务中，额部和顶叶区域的招募减少。随着任务负荷的增加，与对照组相比，患者表现出更多的前扣带皮层、腹外侧前额叶皮层、岛叶和内侧前额叶皮层的招募。治疗后，这些差异不再显著，时间与组与任务负荷的交互分析显示，与健康对照组相比，OCD 患者的右后前额叶活动显著减少。
儿科 OCD 患者表现出轻微的计划障碍和背外侧前额叶和顶叶募集减少，这些在认知行为治疗后恢复正常。计划功能障碍可能是儿科 OCD 的一种状态而不是特征性特征。
