Department & Institute of Psychiatry, Hospital das Clínicas Medical School, Universidade de São Paulo, São Paulo, Brazil.
Braz J Psychiatry. 2012 Jun;34 Suppl 1:S81-91. doi: 10.1590/s1516-44462012000500007.
Anxiety is an important component of the psychopathology of the obsessive-compulsive disorder (OCD). So far, most interventions that have proven to be effective for treating OCD are similar to those developed for other anxiety disorders. However, neurobiological studies of OCD came to conclusions that are not always compatible with those previously associated with other anxiety disorders.
The aim of this study is to review the degree of overlap between OCD and other anxiety disorders phenomenology and pathophysiology to support the rationale that guides research in this field.
Clues about the neurocircuits involved in the manifestation of anxiety disorders have been obtained through the study of animal anxiety models, and structural and functional neuroimaging in humans. These investigations suggest that in OCD, in addition to dysfunction in cortico-striatal pathways, the functioning of an alternative neurocircuitry, which involves amygdalo-cortical interactions and participates in fear conditioning and extinction processes, may be impaired.
It is likely that anxiety is a relevant dimension of OCD that impacts on other features of this disorder. Therefore, future studies may benefit from the investigation of the expression of fear and anxiety by OCD patients according to their type of obsessions and compulsions, age of OCD onset, comorbidities, and patterns of treatment response.
焦虑是强迫症(OCD)精神病理学的一个重要组成部分。到目前为止,大多数已被证明对治疗 OCD 有效的干预措施与针对其他焦虑症开发的干预措施相似。然而,对 OCD 的神经生物学研究得出的结论并不总是与先前与其他焦虑症相关的结论一致。
本研究旨在回顾 OCD 与其他焦虑症的表现和发病机制之间的重叠程度,以支持指导该领域研究的基本原理。
通过对动物焦虑模型的研究以及对人类的结构和功能神经影像学研究,获得了有关涉及焦虑症表现的神经回路的线索。这些研究表明,在 OCD 中,除了皮质纹状体通路的功能障碍外,涉及杏仁核-皮质相互作用并参与恐惧条件反射和消退过程的替代神经回路的功能也可能受损。
焦虑可能是 OCD 的一个重要维度,影响着这种疾病的其他特征。因此,未来的研究可能会受益于根据 OCD 患者的强迫观念和强迫行为类型、OCD 发病年龄、合并症和治疗反应模式来研究恐惧和焦虑的表达。